The Excuses for Self-Referral

Those who practice imaging self-referral always have an excuse for their actions. Here are some of the most common, along with some possible rebuttals.

1. Having imaging in the office is sooooooo convenient for my patients. Just ask them and they will tell you how much they appreciate it. They don't mind that I own the equipment.

The vast majority of self-referring clinicians schedule imaging at different time than the patient's clinical appointment. Thus, the patient has to make two trips anyway. How is that more convenient? Those places that do schedule the imaging on top of a clinical appointment run in a "just in time" fashion that puts undue stress on whoever is reading the study to get the interpretation out fast, which can lead to mistakes. Does this "convenience" outweigh the danger? And what if your patient has to go to the hospital? The potentially life-saving comparison images might be locked up in your office PACS, unavailable to those trying to take care of your patient for you.

2. Clinicians have lost income over the years and deserve to get it back any way they can.

If I lose money in the stock market, am I allowed to rob a bank? How did this entitlement mentality arise?

3. Advanced imaging helps me make decisions, and so it should be considered an ancillary service just like a chest x-ray.

But why does that warrent having a $2 Million scanner in your office?

4. Yes, my December volume is really high. The patients ask me to get their scans done before the end of the year since they have already met their deductables. I'm just helping them out.

And it's so much easier to collect from the insurance companies instead of the patients themselves, isn't it?

5. How dare you accuse me of ordering extra scans! Each scan I order is justified!

Perhaps, but then why do self-referring clinicians order from 2 to 8 times as many scans as those who don't self-refer? Are the latter group of doctors not taking proper care of their patients?

6. How can you call my equipment inferior? The radiologists that read my studies don't complain!

Maybe they should complain. Sounds like they are too timid to offend their revenue source.

7. What do you mean I might be causing cancers by ordering extra scans! The radiologists didn't warn me about that! Everyone says CT is safe!

Again, maybe they should be raising some warnings. All it's going to take is one good lawyer seeing a goldmine in this issue, and a lot of heads will roll.

9. I'm not hurting anyone. I only scan people with insurance.

And you send those without insurance to the hospital, having skimmed the cream for yourself.

9. If I'm doing such a bad thing, why are there lots of radiologists and equipment companies standing in line to help me do it?

Because there are always people out there willing to exploit a loophole in the law if they see a dollar at the end of it.

10. But the law allows me to do it!

You mean the loopholes in Stark I and II. Stark never intended for you to have anything beyond an x-ray and an ultrasound machine in your office.

11. So what are you going to do about it?

That's the big question, isn't it?