Urology-Radiation Oncology centers

[khanquest]

Hi everyone,

I am a third year Urology resident, I'll be joining my uncle's Urology practice after residency. They are strongly considering opening a Radiation facility and he asked me to do some research about it.

Based on my research, Urologist owned radiation centers appear illegal based on Stark Law (Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services if the physician has a financial relationship with that entity) yet I've heard and seen these centers everywhere.

How do so many urologists own Radiation Oncology facilities? Yet when I google search, there are several examples of Urologists getting charged with Stark law violations when opening these centers.. am I missing something?

Any good resources?

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[DoctwoB]

There is an exemption to stark laws if you offer services in your office. PCPs can draw labs in their office. Pulmonologist get PFTs and CXRs in their office. Dermatologists gave pathology services in office. And urologists often have XRT in office.

In-office ancillary services exception

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This was a very popular arrangement in the 2000s since IMRT prostate reimbursement was insanely high. It has since come down to earth and while not peanuts, has to justify a large capital investment and hiring a rad onc. Additionally the standard of care for radiation in prostate cancer is quickly moving to hypofractionation which = less money, and Medicare payments are moving towards a bundled payment system for XRT which may additionally lower reimbursement. In this environment I’d be quite hesitant to make the big capital investment.

I admittedly haven’t run the numbers myself

 

[armybound]

A resident from my program went in to a group that had this. They basically would brachytherapy everyone instead of RALP. Must faster, and I think reimburses better.

 

[IgM]

lol similar interests here! I’m actually a rad onc graduating in a couple years and looking for contacts in urology graduating around the Same time interested in living out west in a small town! If you meet anyone who fits the bill let me know!