Tuesday, August 26, 2008

A "Clear Vue" to Self-Referral



The self-referral mills in St. Louis were not alone in their approach to skirting the Stark Laws. According to ArkansasBusiness.com, there is another such operation in Lowell, Arkansas. In similar fashion, Fayetteville MRI, running a strip mall operation called Clearvue Medical Imaging, also depends on self-referral of its investors, and keeps it legal by avoiding Medicare and Medicaid patients.

Arkansas Business got hold of a confidential memo, which

. . . indicates that Fayetteville MRI – led by four northwest Arkansas doctors – is seeking 50 physicians to invest a total of $5,000. It anticipates annual profits that would quickly exceed $2 million from a controversial business plan that relies on self-referral.

State and federal laws forbid self-referral to imaging centers that accept Medicare and Medicaid patients, so Fayetteville MRI will not accept patients insured by those government programs, the memo said.


The article goes on to name the names of the owners and shareholders of the operation. They are actually leasing an outpatient clinic from a radiologist!
Their attorney is none too happy about being "outed":

Tim Ezell, an attorney with Friday Eldredge & Clark LLP of Little Rock and who is representing Fayetteville MRI, wasn't happy that Arkansas Business obtained a copy of the private offering memorandum. It was mailed to the newspaper by an anonymous tipster identified only as "A Concerned Doctor."

"It's really troubling to me that the contents of this offering memo are out there for public consumption because it really is supposed to be confidential," he said.


And he was very quick to point out that his little project is just within the limits of legality:

Ezell also said the business model isn't violating kickback laws.

"Those kickback laws are applicable to situations where there are ... government health care beneficiaries involved, like Medicare and Medicaid," he said. "There are no government beneficiaries involved in the Fayetteville MRI transaction."

Yup. When cornered, one of the physician-investors excused his actions:

Brown, one of the investors in Fayetteville MRI, said what's driving up the health care costs are attorneys who file malpractice claims against doctors.

"We have to cover our butt on everything," Brown said. "We know we could be sued and they always are looking in retrospect what tests I do that are not needed for my clinical care."

So if he orders tests, it's to protect himself from plaintiffs' attorneys in the event of a lawsuit, he said.

"It's all to cover myself from lawyers," Brown said. "It has nothing to do with padding my pocketbook."

Oh, puhleeeese. I'll go back to an argument I made earlier. All doctors face this same pressure. We know for certain that the self-referrers order from two to eight times the number of scans of those who don't own their own equipment. So, I guess that not only are the less-well-endowed committing malpractice, but they must be more immune to lawsuits as well. Wow.

Three of the four St. Louis shops closed after receiving negative publicity. We'll see if the light of truth has the same effect in Arkansas.

Thursday, August 21, 2008

If I Had A Scanner.....


With apologies to Peter, Paul, and Mary

If I had a scanner,
I’d scan her in the morning,
I’d scan her in the evening,
As long as I can.

I’d check her for tumors,
I’d check her for infection,
I’d scan her for the cash I’d get
From Medicare and Aetna
As long as I can.

If I had a PET/CT,
I’d scan her in the morning,
I’d scan her in the evening,
As long as I can.

I’d check her for tumors,
I’d check her for infection,
I’d scan her for the cash I’d get
From Medicare and Aetna
As long as I can.

If I had an MRI,
I’d scan her in the morning,
I’d scan her in the evening,
As long as I can.

I’d check her for tumors,
I’d check her for infection,
I’d scan her for the cash I’d get
From Medicare and Aetna,
As long as I can.

I don’t have a scanner,
I don’t have a PET/CT,
I don’t have an MRI, so much for my plan.

Cause the hammer of CMS
Rang the bell of warning,
And they cut off the cash I’d get
From Medicare and Aetna.
It’s all over, man.

Cause the hammer of CMS
Rang the bell of warning,
And they cut off the cash I’d get
From Medicare and Aetna.
It’s all over, man.

Tuesday, August 19, 2008

Changin' Times

We haven't seen a total reversal of self-referral yet, but there have been some victories here and there. The Times, They Are a Changin'. Slowly but surely.

Remember the blatant self-referral clinics in St. Louis? There were four imaging centers that skirted the Stark Laws by not accepting federally-paid patients (Medicare, Medicaid, etc.) According to a follow-up article by Mary Jo Feldstein of the St. Louis Post-Dispatch, three of the four have closed down. No one knows why this happened at this point, but maybe patients got wise to what was happening to them, or just maybe someone developed a conscience. More likely, they were about to get into trouble over insurance money:
Insurers are looking into whether the clinics violated a policy that requires physicians and facilities that care for some of their members to care for all of their members.
To care for "all of their members", the self-referrers would have had to take Medicare patients, too, which would disrupt their little operation. No doubt clinic #4, Cedar Plaza Imaging in south St. Louis County, is not long for this world, either.

CMS may have given us another early Christmas present. According to Diagnostic Imaging,


Following its charge to reduce costly imaging overutilization, the Centers for Medicare and Medicaid Services has announced more stringent prohibitions against self-referral practices. Final Stark rules for the Hospital Inpatient Prospective Payment System for 2009 could force providers to restructure numerous space and equipment arrangements. . .

The new provisions broaden the definition of Designated Health Services (DHS) "entities" and prohibit under-arrangements and "per-click" arrangements for space and equipment leases. . .

The final IPPS rules will become effective Oct. 1, 2009. They will be published in the Aug. 19 issue of the Federal Register.
The implications for radiologists are positive. The new rules will take further incentive away from self-referral and will make lease arrangements with imaging centers less attractive, said attorney Thomas W. Greeson, a partner in the law firm of Reed Smith LLP in Falls Church, VA,

"It will also mean that many of the arrangements where hospitals have been able to establish relationships with referring physicians based on ownership or leasing of services on a per-click basis will be less attractive and give radiologists the opportunity to be part of the technical component services that otherwise were provided under these various arrangements," Greeson told Diagnostic Imaging.

This is a pretty big step. It doesn't cure the problem, but it's a start. Sadly, the self-referrers will no doubt find ways around any new rules and regulations that CMS can deliver, but at least it's getting harder and harder to do so.