Thursday, March 04, 2010

Just Say No

Should a physician be allowed to prescribe a test or treatment, provide it, and then collect for it?

That question first came up with drugs and the answer was, and remains, a clear no. The idea is that when making decisions about prescribing medications, the doctor should not be tempted to make money by prescribing inappropriately.

But over the years the issue has gotten fuzzed up, perhaps starting with the country doctor who bought a large house and turned it into a hospital. The doctor then charged for the hospital’s services but founding a needed hospital was seen as a public service and there was little worry that the doctor would admit patients unnecessarily in order to generate personal income.

As time has gone on, more and more diagnostic and therapeutic services have come to be provided and charged for by the physicians who prescribe them, even to the extent of a resurgent trend in physician-owned hospitals.

The issue has reached the federal level. Congressman Stark of California has made something of a reputation for himself by sponsoring legislation to prohibit, or at least restrain, what has come to be known as self-referrals.

The issue came up in a February 26 New York Times story about the Melbourne Internal Medicine Associates, a group practice in Florida. MIMA operates a radiation therapy service and is under investigation for billing for the services of physicians who were out of the country when the service was rendered and for prescribing more expensive radiation treatments when less expensive treatments would be adequate.

The MIMA case may be mostly about fraudulent billing, but underlying it all is the self-referral question.

In politics, nothing is simple, but to me the question is not complicated. If it were mine to decide, I’d just say no.

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