> Doctors are incentivized to prescribe treatments, because that's how they make money for themselves and their practice.

This is literally illegal! Physicians cannot refer patients to entities they own or have an interest in.

What is perverse is that, while we have the Stark Law to constrain physician behavior, we've decided that it's okay if a diffuse group like a non-physician-owned hospital chain enforces rules to this effect.

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lostlogin 11 hours ago | parent | next [-]

> This is literally illegal! Physicians cannot refer patients to entities they own or have an interest in.

There has to be a done of exceptions to this.

You see a cardiologist and they recommend a stent. They aren’t going to recommend a different cardiologist does it.

You see a doctor, and they refer you for a test. They have a share portfolio that contains shares in the facility they referred to.

Medicine is riddled with potential conflicts of interest. Managing them is what professionals are supposed to do and what regulators are supposed to enforce.

I don’t live in the US, I’m a n Mew Zealand. Sadly, I am aware of behaviour that looks like corruption in our system.

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bonsai_spool 11 hours ago | parent [-]

> You see a cardiologist and they recommend a stent. They aren’t going to recommend a different cardiologist does it.

Things must be different in NZ.

First, it's true that you're going to want to go to who your doctor knows/recommends. The law in the US is just that they can't refer you to a group they own/their spouse owns, or for which they get a financial benefit.

Next, you're speaking about the doctor doing a consult visit before doing a procedure. That is not the same thing as ordering a treatment for you to go get the treatment elsewhere—which describes what happens you go to the pharmacist to get drugs.

Finally, the cardiologist you see in the office is almost certainly not doing stents for you as those are very distinct skillsets (in the US).

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dogmatism 6 hours ago | parent [-]

>Finally, the cardiologist you see in the office is almost certainly not doing stents for you as those are very distinct skillsets (in the US).

Umm, what? No. It's exceedingly rare for an interventional cardiologist in the US not to do office work. The average number of PCI/yr is like 50 or something. Plus if one spent all one's time in the cath lab, they'd have a spinal fusion, knee replacement, thyroid cancer, and cataracts.

But what you are trying to get at is that there is law about self-referral ("Stark law") but in reality there are exceptions that render it fairly useless

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bonsai_spool 5 hours ago | parent [-]

> But what you are trying to get at is that there is law about self-referral ("Stark law") but in reality there are exceptions that render it fairly useless

What are the exceptions that render it useless? I have never heard of them in my 10+ years of hearing about it.

I did not know that I-cards do office work, not my area of medicine.

IR is in the angio lab daily without cataracts, thyroid cancer, etc., so that part of your statement is clearly not true.

I also don't understand what you mean about knee replacements... humans are generally capable of standing without requiring surgical intervention.

	▲	lostlogin 2 hours ago \| parent [-]
		> What are the exceptions that render it useless? I have never heard of them in my 10+ years of hearing about it. It sounds so unlikely that there is a blanket rule that you can’t refer to something you have a shareholding in. If you own a shareholding in a hospital you work at, you can’t refer internally for a test? I just don’t believe that. Edit: I did some hunting. ‘Per click’ payments or bonus payments based on volume are illegal. Rents must be fair market etc. It looks like owning a chunk of the place you refer to is fine. https://www.healthcarecompliancepros.com/stark-law-explained...

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FireBeyond 11 hours ago | parent | prev [-]

Diagnostic imaging companies - each of the big ones (Siemens, GE, Philips) all offer in-house financing on very favorable terms for MRI, CT, etc., that they specifically advertise to physicians. They also all offer specialist consulting help to facilitate you getting a CoN (Certificate of Need) for your facility. Hell, they also will help you find other physicians in your area who'd like to go in with you on setting up a DI facility, and they will assist with spinning up the practice.

We then find that physicians who own a DI practice (or a share in one) refer their patients to diagnostic imaging at rates several standard deviations above other physicians and at rates that are "statistically improbable" when correlated to underlying ICD-10 diagnostic codes.

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bonsai_spool 11 hours ago | parent [-]

Everything above is fair, if true. I don't see a reference in your answer so I can't assess the quality of evidence.

The point is that they cannot refer you to one of their companies. Of course, there may not be a meaningfully-competitive local market, so patients may end up needing to go to the physician-owned imaging facility. I do not thing this is a large issue for most of the US population though it's probably an issue on a spatial basis.

	▲	FireBeyond 8 hours ago \| parent [-]
		> Of course, there may not be a meaningfully-competitive local market, so patients may end up needing to go to the physician-owned imaging facility. Certificates of Need. A legal requirement in most states for creating a new healthcare facility. Ostensibly to make sure that the population in that area has adequate healthcare options. But lobbied for by healthcare facility and hospital owners, it actually surveys other providers (your competitors) in the area and asks if their revenue would be adversely affected by you opening up. Too much of this, and no CoN for you.