Tuesday, May 03, 2005

CT / MRI Physician Self Referrals

One of the Cancer Centers I lead has an Imaging Center within it. It is an added convenience for all of our cancer patients to be able to have any of their diagnostic scans without leaving the building. This has worked great until the Medical Oncology group in our center decided to build their own Imaging Center twenty minutes away.

Of course, we hear the "We're not going to send any patients from here there." Uhhhh, yea. If you build it, they will come (especially if you own a significant stake). We first noticed a drop in CT scans then we heard from a mutual patient that they had a scan at this new facility. We didn't even know it existed. While the state I'm in is a Certificate of Need state, it doesn't cover CT scanners under a certain price range if I'm correct. Needless to say we were a little surprised.

Upon further investigation you would expect that we would find that they had purchased a new 32 or 64 multi-slice CT scanner. Only the best for their patients, right? Not a chance. What did they purchase and install? A refurbished Siemens unit. Let's say that it is not exactly top of the line.

Soon, we start having patients ask our receptionist why they have to travel 20 minutes to have a CT scan when they can have one right here without leaving the building. Hmmmmm....... We have a very astute receptionist who questioned what reason the Medical Oncologist gave for sending them away. They stated that he said "we like the techs better down there." Yea, right. While the patient is thinking technologists we all know they were thinking "technical charges!" This was a patient that lives a half a mile away from our facility. This has been repeated several times. We even had a patient that lives in another state that presented for treatment and they sent them 20 minutes away to the new center. These are cancer patients for pete's sake. They would like to be home resting and not driving all over town.

In the May 2 Wall Street Journal, Donald Ryan of CareCore National Inc. a firm that analyzes imaging claims to help control costs for insurers, states that "Utilization goes through the roof" when physicians have a financial investment in a center that provides diagnostic imaging scans. Talk about a major conflict of interest. And not to mention the ethical issues this presents. But, it appears this is the wave of the future. I can go to my PCP and he'll attempt to send me to his group's Imaging Center 25 minutes away when we have the equipment downstairs.

Guess what's next? A PET/CT Scanner. Rad Onc will be next to follow. Physicians are continually siphoning off the profitable business from hospitals and leaving the non-profitable non-insured patients for the hospital to provide care. To boot, they're doing it on inferior equipment and its usually non-PACS meaning it can't be visualized on multiple PC's. Hospital's better get a better lobby or there are going to be quite a few of them heading for closure.


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