Follow-up clinic

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EM STUD 3000

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Could a EP run his own clinic for follow ups? Could he/she selectively refer patients with certain problems? Might this be profitable/feasable? Just a thought I had.

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I had wondered the same thing myself. I have heard of a couple of group practices with their own follow-up facility/doc-in-the-box type set ups where basic follow ups for wound care, suture removal, medication refills, etc take care in addition to level III/IV medical care. I have always wondered how economically feasible these setups are though...
 
Possible... but perhaps not ethical.

In fact, there was a law passed by the Fed a year or so ago saying that any physician referring solely to their own clinic/lab/therapists etc could be punished via fines. Cant' remember the name of the law though...

One of our attendings at my residency owns a urgent care clinic with his wife. I will ask him if he knows anything about that.

Q, DO
 
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It seems that for something like suture removal, which requires little time/thought/money to perform, any amount you charged would make for a good profit margin.
 
Interesting idea. Here are a couple of thoughts that come to mind...

First, I assume you would only "self refer" those that are well-insured and should have relatively simple follow-up. The problem with that is that people that meet these criteria would undoubtably have a private physician. You would essentially be stealing pts from the very people you depend upon to take the "self-pay" headaches from you come admission time. Word would quickly get out and not only would you alienate yourself from all the private physicians in town, you might also run afoul of administration since you would be pissing off all the consultants who make money for the hospital.

Another aspect would be that you would have to be careful that you don't bite off more than you can chew. When you see the pt in a follow-up role, you are in essence accepting responsiblity for the further care of the pt should any expected and/or unexpected problems or complications crop up. Not only would you not have the time, inclination, priviledges, and quite honestly, training to admit and mangage these people, you will have also black-balled yourself when it comes to referring these people to the other docs in the community that could and should follow them up.

The last thought I have is that I doubt it would really be financially feasable to do this. Considering clinic space and over-head, I doubt you would come any where close to making the same profit doing this as you would by spending this time working in the ED.

So in the end I would think this would be a bad idea. Just my two cents.
 
The law you would be violating is the STARK Laws:

The Stark I Amendment is a federal law that prohibits physicians from referring a Medicare patient to an entity for the furnishing of laboratory services if the physician or an immediate family member of the physician has a direct or indirect financial interest in the entity providing such services. The Stark II Amendment extends this prohibition by prohibiting physicians from referring Medicare and Medicaid patients for certain types of services known as "designated health services." A financial interest includes an ownership interest or a compensation arrangement (the latter includes both the giving and receiving of compensation).
There are also reporting requirements under the Stark Amendments. In particular, entities furnishing items or services for which payment may be made under the Medicare or Medicaid programs must submit information to the Health Care Financing Agency concerning their financial relationships.
 
Anyway, what would be the point of it? Urgent care/clinic work doesn't pay nearly as well as emergency work. The docs in those boxes are generally making a good deal less than we are for much more mind-numbingly boring work.
 
that and you know in the end no patient is as simple as a suture removal. they'll have through the roof blood pressure and poorly managed diabetes and then you'll be obliged to take care of that and really, that's why we all didn't go into medicine.
 
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