Self-Referral: Arizona Style

I have written about the self-referral issue a number of times in this blog. Ironically, the issue came up again late this summer, this time from my home town of Phoenix.

A local newspaper article cited a radiation clinic owned by local urologists. The radiation oncologist at the center collected $2.6 million from Medicare, more than any other radiation oncologist in the state. In fact, the sum represents 5 percent of all Medicare payments to Arizona radiation oncologists in 2012.

The urologists who own the center insisted that their ownership does not influence their treatment recommendations.

The article then goes on to cite multiple studies underscoring the increased utilization of medical imaging and therapies when referring physicians have a financial interest. The reporter also discusses a number of patients who were directed by their physicians to travel longer distances and in some cases drive pass similar centers to get treated at the self referral site.

There is another center in Tucson with the same business model.

Not surprisingly, the conclusion of the article is that there is a conflict of interest when physicians have ownership in a center where they send patients.

Self-referral is a black eye for all of medicine. When looked upon by objective eyes, it becomes evident that the practice is wrong. The misaligned incentives, compounded by lower reimbursements, make it inevitable that patients will be redirected for medical care because of money. Costs to the health care system have been presented by several agencies. The administration has recommended self-referral limitations in each budget submitted since President Obama has been in office.

As physicians, we have held a high level of public trust. Our patients rely on the patient-physician relationship for their health. They place their faith in us that we will be stewards of medical care for them and their families. Conflict of interest issues such as self-referral undermine the public trust in physicians. The ultimate result is that everyone in medicine is affected.

Slowly, more and more stakeholders are recognizing the problem. ACR will continue to support efforts to address self-referral.

Howard B. Fleishon, MD, MMM, FACR

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