Wednesday, July 16, 2008

Cheat Me In St. Louis

Just when I think imaging self-referral can't get worse, I find something like this. As reported in the Saint Louis Post-Dispatch, a lawyer named Kirk Bowman is managing four imaging mills in the St. Louis area. The business model is very simple:

Here's how Bowman's clinics work: After being evaluated by a board of directors, physicians who want to join make an investment that varies by location, Bowman said. He declined to provide details.

To remain investors, physicians must earn 75 "participation units" throughout the quarter. An MRI counts as three participation units. A CT scan counts as two. Then, the profits are split equally among the investors, he said. Physicians can miss the target for one quarter before being asked to relinquish their ownerships.

Bowman said the referral requirements ensured everyone's contributing to the center's being a success. . .

The referral requirements are so low, 25 to 50 patients a quarter, that physicians do not feel pressured to prescribe tests unnecessarily, Bowman and Schwarze said. And, profits earned are too small to tempt physicians to risk their livelihoods for a bump in income, they said.

You might think this little Ponzi scheme violates the Stark laws, and you would be correct, except for one minor detail:

The Stark law was named after its sponsor, U.S. Rep. Pete Stark, D-Calif., and was designed to protect patients and limit health care spending. It bars a physician from referring patients to a diagnostic center in which the doctor has a financial interest when the patient's care is paid for by the federal government through such programs as Medicare.

At least two dozen states have extended similar laws to cover all patients, but Missouri has not. Because the clinic Schwarze invested in declines to care for patients in federal programs, it is not covered by the Stark law.

Bowman isn't worried about the appearances:
"We assume people are honest. I don't know another way to do it," Bowman said. "I don't think a doctor is going to risk his whole career to manufacture an MRI."
Honest. Riiiiiiight. Just ask Dr. Jean Mitchell from Georgetown, who has written extensively about self-referral:

"There's no other business where you can control demand and supply," Mitchell said. "This is guaranteed success. It's a cash cow."

She sees Bowman's clinics as even more questionable because they require physicians to refer a certain number of patients to maintain their investment.

"I've never seen anything so blatant as this," said Mitchell, a health economist.

Neither have I.

If you happen to be in St. Louis, and your doctor sends you to Reliable Imaging of St. Louis in West County, Lynn Haven Imaging in Hazelwood, Cedar Plaza Imaging in South County or Boone's Crossing Imaging in the Chesterfield Valley for imaging, look him or her in the eye and ask how much he or she will be making from the referral. Then consider finding another doctor.


Ron said...

Great title Dr. Howard.

Now how can I get some extra pizza money?

When I was in training, my teaching institution probably did not do much more than 70 MRI's a month. You practically had to get a letter from the Pope to get an MRI. You mean to tell me the conspirators in this scheme come up with 70 patients a month to get MRI's? That seems criminal.

If these guys are willing to sell their soles and disregard everything they learned about ethics for "pizza money", I'm worried what else they would do for "mortgage money" and "car payment money" and "kid's tuition money". If they can manufacture this many MRI's a month, I wonder how many arthroscopes and unnecessary surgeries they are doing a month to make the "real money"?

It is bad enough that Dr. Schwarz looks his patients in they eye and tells them they need unnecessary exams so he can have a little "pizza money." However, I wonder how Dr. Schwarz sleeps at night if he also can look a patient in the eye and tell them they need unnecessary surgery (hypothetical) for his financial gain?

Anonymous said...

This same Mr. Bowman recently filed bankruptcy for his latest startup in the St. Louis area. It looks like everyone involved has jumped ship away from Kirk Bowman, who may have never intended to pay what's cited as over $600,000 in debt? I am purely speculating...

Anonymous said...

It seems Kirk Bowman is not to be trusted and I would highly recommend people who are thinking about doing business with him need to do intensive background check on him. I would also encourage them to talk to folks who had broken relationship with him and ask them as many questions as possible before engaging in any type of business with Bowman. My advice to you (as many have advised me but I didn't listen and paid the price of my life) is to stay away from Kirk Bowman as far as you can and help spread the word about this individual so others will not be hurt by him. He is a complete fraud and will NEVER change!

Anonymous said...

Kirk Bowman of St. Louis has the personalities that match what this article is describing: