Specialists should shoulder some of the grunt work: “Shouldn’t specialists pay some (or all) of the administrative cost of doing those referrals since it is our referrals that make it possible for them to earn that higher income?”
Related posts:
- Bribes for referrals
- Are hospitalists doing their job too well?
- When specialists provide primary care, and why patients aren’t complaining
- Physician salaries: Would the French model work here?
- A referral to a specialist turns patients into currency
- The problem with the Relative Value Scale Update Committee
- Hospitalists and referrals
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Point well taken. I always impress on my referring doctors to just give the patient our contact information and my staff will take care of everything, including getting their records. By extending the courtesy of making the referring MD’s jobs so much easier, they show appreciation by sending me patients. Perhaps if one specialist that you refer to doesn’t lift a finger to make your job easier, then you would be more inclined to send the patients to ANOTHER specialist who does. Free market forces successfully at work again. It works.
Why don’t you have the specialist pay a referral fee?
Because that would be a kickback and that would be illegal. The feds don’t like when you pay for referals. That is bad and unless you like orange jumpsuits and walks around the yard that idea goes nowhere.
Is that only a kickback if the feds are paying for it?
If you have a relationship with a specialist, you are comfortable with their competency, and you continue to be part of the patient’s care, where is the harm in being paid a referral fee?
There is a difference between asking what is the harm vs what is the law? There are many things for which the good outweighs the bad, but yet the government regulatory agencies choose to make it illegal. I am not saying that referral fees are necessarily always a good thing, but there are a lot of laws that apply to doctors that don’t apply to other professions. For example, lawyers can freely get kickbacks when referring to others and it’s not regulated as being illegal.
The harm is the appearence of referal for money. It also has the appearence of sending you rpatients where you get the most money, not where you think they would be the best off. The nominal fee that you might, MIGHT get (we all overestimate our own importance) would be offset by the liability. So doctor you are referring to Doctor X because he pays you a referal fee? Why not Doctor Y because he doesn’t pay your protection money? And when your patients found out, and they will. They will come after both parties in a bad outcome. What’s the harm with that. This is a complete and total ethical slimebath.
Forget the appearance of pay for referrals. I know generalists that have told me they refer in a certain direction because of sports tickets, etc… The more complicated issue is specialists that practice (1/2 day per week) in a generalists office as an associate. The specialist and generalist can split the fee quite legally.
” I am not saying that referral fees are necessarily always a good thing, but there are a lot of laws that apply to doctors that don’t apply to other professions. “
Are they laws that apply generally or are they laws that apply as a result of a contract you sign with the government? That’s what I’m wondering.
There is nothing unethical about a referral fee if you are in fact continuing to serve the patient during the referral.
Paying for referrals as concerns federally-insured patients, Medicare, Tricare and the like is forbidden by anti-kickback statutes. Those have teeth, sharp ones.
Federal laws aside, it is a practice generally thought unethical, introducing a conflict of interest into the decision where to refer, Does it exist anyway? Sure.
“Dear Dr (your name here):
Please accept this grant of (you fill in the number) from our 503c charitable organization to further your continuing education. You have been nominated by your professional peers to receive this award because of your outstanding committment to quality care in this community.
Signed
(not the doctor, but maybe his spouse)
Chair, selection committee (and you know what it takes to be “selected”)”
Or perhaps that same beneficient organization can “lend” an expensive piece of durable medical equipment to a “worthy” clinician in the community, something that can be used for billable services. And everyone knows what it takes to be “worthy.”
They aren’t really kickbacks, not exactly a quid pro quo, but the end result is the same.
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