Patient self-referral

[danchiao]

Long story short, is it ethically / lawfully legal to refer patients to yourselves?
For example, you are double board certified for internal medicine and GI. Let say you work in a primary care clinic affiliated with hospital from M-Th, and then Friday u work as a GI in your own private clinic. And so you refer all those pts >50 yo to yourself on Friday for colonoscopy. Of course this is just an example, and can be applied to any other specialties, for example IM and surgery. what about if this is for same hospital, not hospital -> private practice.

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[gutonc]

Meet you new worst friend, the Stark Law.

The short and simple answer is that you can't see a patient in (for example) a hospital employed PC office on Monday (or take care of them and discharge them as a hospitalist) and then do their outpatient treadmill test or colonoscopy the following Thursday in your private practice (or other separate employed group). So your first example is a hard no.

There are exceptions, primarily for a group practice, or in AMCs.

 

[IMGASMD]

Long story short, is it ethically / lawfully legal to refer patients to yourselves?
For example, you are double board certified for internal medicine and GI. Let say you work in a primary care clinic affiliated with hospital from M-Th, and then Friday u work as a GI in your own private clinic. And so you refer all those pts >50 yo to yourself on Friday for colonoscopy. Of course this is just an example, and can be applied to any other specialties, for example IM and surgery. what about if this is for same hospital, not hospital -> private practice.

If you still need to hustle as IM as a gastroenterologist and only scoping one day. You’re doing something wrong.

Financially it wouldn’t make sense, at some point you’d start to realize that you can only work so much. You’d want to maximize your time and income.

That being said, family doctors around me, still admin their own patients. They also do colonoscopy on their patients.

Surgeons who did lower bowel resection, sometimes also will do EGD on some of their patients…. And follow them indefinitely.

One of my IM attending was a volunteer teaching faculty, but he was also renal trained. So if the patient ended up needing renal consult, he’d consult himself. That being said, usually there’s an on-call schedule for who the referrals should go to first. Don’t get into fights with other colleagues. Renal is not lucrative, but I am sure if it was cardiac or GI, you will be asking for trouble.

 

[DrMetal]

Long story short, is it ethically / lawfully legal to refer patients to yourselves?

depends on their BMI. If >35, always refer to a pretentious colleague instead.

 

[Elixir6]

depends on their BMI. If >35, always refer to a pretentious colleague instead.

?

This is stupid because obese patients are generally easier to scope than very thin if that's what you are implying

 

[DrMetal]

?

This is stupid because obese patients are generally easier to scope than very thin if that's what you are implying

Really? I had no idea. Doesn't your table have weight limits? I wasn't thinking of scoping . . .was thinking more about scanning. Most CT/MRI scanners have a 500-600 lbs weight limit, which some of my patients exceed. The local zoo is an enticing option.

 

[Elixir6]

Really? I had no idea. Doesn't your table have weight limits? I wasn't thinking of scoping . . .was thinking more about scanning. Most CT/MRI scanners have a 500-600 lbs weight limit, which some of my patients exceed. The local zoo is an enticing option.

In thin patients the colon is more tortuous because it's fit into a smaller space, and moves around more easily. If there is more omentum and pericolic fat, the colon is more straight and doesn't loop as much when pushing a scope around bends. If the patient is larger, we use a hospital bed. Extreme obesity will make colonoscopy unfeasible, mostly from a sedation risk-benefit issue.

The reason I was being a little harsh here is trying to avoid making a patients BMI a moral/judgement issue to send them to a colleague you don't like.

 

[DrMetal]

The reason I was being a little harsh here is trying to avoid making a patients BMI a moral/judgement issue to send them to a colleague you don't like.

Ahh, see, that's the problem, having morals. I dumped all of mine recently, I find it easier that way to practice medicine in 2022.