In an age of declining reimbursements for traditional physician services—eyeball to eyeball with our patients or standing at the operating table—many physicians are looking for replacement sources of income to keep their small businesses healthy. This has been difficult or even impossible in the past because of government regulation or legislation (self-referral and anti-kickback statutes) concerning physician ownership of businesses ancillary to the provision of direct patient care.The authors interviewed a urologist named Pat Hezmall, M.D. from Urology Associates of North Texas, a 48-man group that seems to be big into "ancillary income." Dr. Hezmall's justification for what follows is:
Dr. Hezmall then goes on to list all the low-hanging fruit just ripe for urologists to pluck: lithotripsy, imaging, clinical laboratory services, anatomic laboratory services, ambulatory surgery centers, specialty hospitals, and finally IMRT. Krom, the AuntMinnie poster, mentions this about radiation therapy under the jurisdiction of urologists:
Physicians are liable for 100% of clinical outcomes, direct 85% of health care spending, but are recipients of only 15% of the health care revenues. Ownership of ancillary services provides physicians with an opportunity to directly improve clinical outcomes by controlling the operation and quality of the service, provide efficient and effective care, and offer therapeutic options within the practice. Improved outcomes result in increased patient satisfaction, increased physician satisfaction, increased payer satisfaction, and decreased liability.
"Additional income from ancillary services provides capital for investment in new technology, continuing the virtuous cycle of physician ownership and control of the entire decision-making process for our patients," Dr. Hezmall explained.
Ownership of ancillary services is not a new concept for urologists. As of 2003, 58% of U.S. urologists owned shares in lithotripsy partnerships. Urologists have long depended on in-office imaging equipment to practice their craft. Recent declines in reimbursement, especially for LHRH drugs, have generated an interest in expanding sources of ancillary income.
. . . we have radiation oncology in our practice...if you think self referral is bad with imaging, a group of urologists in our area just put in an IMRT machine in their office and are radiating away! everyone gets RT whether it's indicated or not. an mri is one thing, putting someone thru a round of RT who may not of needed it is another. when our rad onc confronted one of them, they whine about declining reimbursements. this from a guy who has 2 houses and drives a car worth over 100g. again, their big argument...convenience! it's sad. but there are radonc-ho's who work for these places. the urologists can offer big big salaries and still get a huge windfall. win win except for the patient of course. when are the govt and insurance companies going to wake up? i assume theyll just do a DRA like deal and 1/2 the reibursement for IMRT. i wonder how theyll make up for the lost revenue then?...gee let me see...AuntMinnie user "Fugue" came up with the name "Uro-Trash", obviously a pun on "Euro-trash", and I have blatantly stolen for my title.
The authors of the Urology Times article conclude:
Gee, finally an honest answer. It is completely and totally about the money. At least they admit it.
We believe that the days of physicians wrestling with the professional perception that it is not proper to make money from the delivery of care in outpatient business ventures are over. Many physicians also fear that such business ventures carry significant legal risk because of government regulation.
However, with good advice and with physicians making good decisions about which ancillary services to add to their practices, this concept can be very enjoyable and profitable, and provide an added dimension to the private practice of medicine.