IMRT referral triples after urology group purchases IMRT machine

| March 19, 2012

This post is courtesy of The Pathology Blawg, formerly The Pathology Malpractice Blog.  In addition to discussing medicolegal issues in the world of pathology, The Pathology Blawg also provides material about physician self referral, markups, client billing, pod labs and other unscrupulous maneuvers that negatively impact patient care, contribute to overutilization and damage the profession of pathology, with the hope that greater awareness will bring an end to these practices.

IMRT machine aka ATM machine

This is an article from the Baltimore Sun about Chesapeake Urology Associates' (CUA) use of Intensity Modulated Radiation Therapy (IMRT) for prostate cancer.  Before 2007, they referred 12% of their Medicare patients for IMRT, but amazingly, starting in 2007, their referral rate more than tripled to 43%.  Why the difference?  They bought an IMRT machine in 2007, and now they can bill for the treatments.  Our good friend Dr. Jean Mitchell is interviewed for the piece, and she states the obvious:  This is a way for urology groups to simply make a ton of money off of their patients.  Interestingly, Dr. Mitchell states that CUA's doctors are "some of the less egregious", as many urology groups send around 70% of their patients to IMRT machines they own.

CUA would only speak through their attorney (which is never a good sign), who said,

CUA's doctors are well-respected physicians of the highest integrity," said Howard R. Rubin, the attorney. "They reject any insinuation by you or Prof. Mitchell that any recommendations relating to a patient's care are motivated by anything other than the best interests of the patient.

Which leads me to my question.  If this level of referral (43%) for IMRT is the referral rate the group has decided is in the best interests of their patients, then why did so many patients not get referred for IMRT prior to the group's purchase of the machine?  Why did they not take more of their patient's best interests into account before they owned the machine?

It's all smoke and mirrors.  Keep in mind that urology offices also routinely own their own CT scanners and pathology labs.  They have perfected vertical integration of the diagnosis and treatment of prostate cancer and the commoditization of prostate cancer patients.

Maryland, as the article states, is starting to crack down heavily on self referral, and has already forced orthopedists to sell their in office MRIs.  Raise your hand if you think CUA's IMRT referral rate will drop if Maryland gets around to banning self referral for IMRT.  My hand is up. 


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Category: Pathology News

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