Paying for referrals

[bigradquestions]

Hi SDN'ers,

It's relatively well-established that paying for a referral from external groups such as those in medical oncology, surgical oncology, or urology is both unethical and illegal.

But what about internal referrals? In many hub-and spoke (usually academic) centers with satellites, there is a disincentive for the "mother ship" attending physician to refer to the satellite due to per-patient RVU-based productivity bonuses.

Ethics aside, does anyone know if it is *legal* for the "hub" physician to receive a monetary referral incentive in order to refer to the satellite?

Thanks for your help!

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[medgator]

I know that in many large multi site systems, the ethical issues with said scenarios are the reason why they are all salaried based on experience/years in practice with an equivalent bonus for everyone in the practice based on the global performance of whole dept above some metric.

Basically a split pot model like in many professional groups with everyone sharing productivity bonuses

 

[Gfunk6]

Times they are a changin'

http://www.medscape.com/viewarticle/852247?src=wnl_edit_newsal&uac=141473EY&impID=852575&faf=1

Interesting quote:

What should patients do? Ask their doctor who he or she works for, Reilly added. If the doctor is employed by the hospital and recommends surgery or some other expensive treatment, he said, "research the indications for the procedure" and "consider a second opinion" from an independent practitioner.

 

[deleted480308]

It's not unethical at all, but the rest of the medical community seems to think it is so you have to deal with the reality you are in...

 

[thesauce]

Times they are a changin'

http://www.medscape.com/viewarticle/852247?src=wnl_edit_newsal&uac=141473EY&impID=852575&faf=1

Interesting quote:

It bothers me that the implication is we're referring in-house for UNECESSARY procedures. This is just a matter of offering all of the patient's NECESSARY care under one network. I do think it keep things simpler in terms of billing and medical records.

 

[Mad Jack]

It's not unethical at all, but the rest of the medical community seems to think it is so you have to deal with the reality you are in...

Note to everyone: when discussing payment ethics, never, ever listen to a libertarian if you value not going to prison.

 

[deleted480308]

Note to everyone: when discussing payment ethics, never, ever listen to a libertarian if you value not going to prison.

This libertarian isn't saying to break the law. It's illegal. I'm just saying it's not actually unethical. Lots of things aren't ethically wrong that I wouldn't suggest doing...going to jail isn't worth proving every point

 

[medgator]

Times they are a changin'

http://www.medscape.com/viewarticle/852247?src=wnl_edit_newsal&uac=141473EY&impID=852575&faf=1

Interesting quote:

Still doesn't touch the amount extracted last year from another Hospital system in FL.... $85 Million

http://beneschhealthlaw.com/2014/06...en-hospitals-and-physicians-must-be-reviewed/

Or the largest I've come across recently, Adventist health system involving multiple states

http://www.bizjournals.com/tampabay...leblower-lawsuit-leads-to-record-setting.html

"The complaint says Adventist hospitals paid for:

• The leases of a BMW and a Mustang for a surgeon.
• A $366,000 base salary for a family practitioner that more than doubled the salary of similar practitioners in that area, due to the extraordinarily high level of his facility fee referrals to Adventist for X-ray and CBC tests.
• A bonus of nearly $368,000 plus salary for total annual pay of $710,000 for a dermatologist who worked just three days a week. He also received payments to cover his costs for staff, equipment, supplies and medical malpractice insurance for the remainder of his time spent on his private practice."