Why does Dr care where I get test?

[AnnieG]

The specialist I saw yesterday wants me to have an MRI. He gave me a brochure from the facility that he "uses" and said that the office would contact them. I said that I would check with my insurance.

Got home and called insurance company. Turns out that the company is in network, but not that particular facility. Insurance company rep even put me on hold and called them to verify. Definitely out of network. So rep gave me 2 other nearby in network facilities.

I called the Dr's office with this info. Got a call a few hours later that the Dr had personally called the out of network facility and they "agreed to take the in network payment for me". I insisted on the in network facility and now have an appointment there.

So, why does he care so much? Isn't one MRI the same as the next? Does he get a kick back from that facility? Is he going to have a grudge against me?

[Smallsteps]

I doubt any Dr would hold a grudge for not using their chosen facility. I often think that there is business partnerships between some providers and specialists and or diagnostic facilities. that can be anything from belonging to a similar parent company or association to you refer to me and I will refer to you system. I had a DR recommend a former classmate as a specialist. I did my independent research before making the appointment.
Of course there can be other reasons for example a bad experience with other groups but in general YOU are in charge and the work for you.

[disneysteve]

Isn't one MRI the same as the next? Does he get a kick back from that facility?

To answer the 2nd question first, no, he definitely does not get a "kick back" from the facility as that would violate Federal law.

As for the 1st question, no, one MRI is not the same as the next. As with any other technology, there are better ones and lesser ones. The resolution can vary and depending on what they're looking for, the doctor make have experienced an older/lower quality MRI missing something.

[Gailete]

I used to work with a doctor that all her patients reported constipation. Of course this was due to the fact that they had all had a joint replaces and were on narcotic pain relievers for the pain. All they needed was some stool softeners. But no, this doctor sent a consult to her GI Doctor that was her finance. Then of course there were the rounds of tests and whatnot, when at least 99% of them needed on a decrease in the pain meds or Metamucil or stool softener/laxative. This was happening in the early 90s before the big health care changes that have been happening. I don't know if they could get away with that any more. I hope not.

As to the MRI, unless the doctor got a signed notice stating that they would bill you as in network and also that info was reported through proper channels to your insurance company, I wouldn't chance it. You could be looking at $100s+ in co-payments. It is too easy after the fact to 'forget' that there had been a verbal agreement.

[SeanH]

When I order an MRI I have a few things in mind:

(1) I would really like it to be somewhere within my EMR so I have immediate access to it - as opposed to the patient bringing in a disk that inevitably has some sort of weird operating software that makes it difficult to navigate. If its in my system - I overread it when it becomes available a day or two before, make sure the findings match the impression and then can pull it up in the room to show it to you and talk it through. When its on a disk, you'll be waiting in my office while I try to read it during a clinic day. I'm probably less likely to show you the MRI because I'd have to move the disk around.

(2) I'd prefer a higher quality MRI - I'm still personally unsure how this happens, but many of the MRIs that patients bring in are of very low quality.

(3) I'd like for it to be somewhere where the radiologist and technicians will show initiative and add additional viewing as necessary - ie. we captured an issue, but its at the edge of the field and further imaging will better delineate the problem.

(4) Some radiologists are assuredly better than others - perhaps he trusts the people who read at that facility.

On the flip side - I personally found some of the situations health law lawyers were able to describe in school concerning Stark law situations very complicated (to phrase it another way - I was sure certain situations would be illegal and they weren't). The doctor can't receive a "kickback", but the doctor can potentially own "shares" or some stake of ownership in an MRI that can be lucrative for them. They can additionally own shares in surgery centers which "pay" or whatever legal word is appropriate.

I'm personally very skeptical about the use of MRI, BUT this is not a medical advice forum so I wish you all the best in resolving your issues. Above are a few thoughts that you can assign value to as you please. Thanks.

[Gailete]

I'd like for it to be somewhere where the radiologist and technicians will show initiative and add additional viewing as necessary - ie. we captured an issue, but its at the edge of the field and further imaging will better delineate the problem.

Sean - Amen on that one. If there is even the slightest misinterpretation of the area to be look at, whether, x-ray, CT or MRI and the tech doesn't bother moving the 'camera' a bit to where the patient is telling him he is having problems, they can miss everything. I thought it was weird when I got ordered an ultrasound for pain on my left side. Only when I was walking into the place did I read the actual order that they were supposed to look at the right side. The girl doing the test said that the doctor apparently figured that it was because the pain was probably 'referred' pain from the right. BUT, what if the pain cause WAS really on the left side of my body??? I'm only a nurse, but I'm pretty sure that a tumor (or any other problem) on the left side can causes pain on the left.

[disneysteve]

I would really like it to be somewhere within my EMR so I have immediate access to it

Access to the report is a big factor. Some facilities we refer to are great at getting us reports and also have online portals where we can easily log in and view the films if we wish. Other sites are very difficult to communicate with, rarely send us reports in a timely manner if at all, and waste a bunch of my staff's time having to call and track down reports every time a patient goes there.

So yes, we have preferred sites to send our patients to.

[AnnieG]

Thanks for all the replies.

I get very frustrated that many doctors don't seriously consider the cost to the patient. I'll be $350 into this one issue before any action is taken (2 visits, 1 MRI). And that's with the crazy good insurance we have for 2017 (merger got us a great plan this year, but I expect it to be gone by next year). Plus he has already hinted strongly at surgery, even though every medical site online has that as the last option.

I've been trying to follow up on all my PCP's referrals, but it is a lot of time and money. Living with pain is easier!

[Gailete]

Living with pain is easier!

Tonight, I can't agree with you as I have been in agony all day!

[disneysteve]

I'll be $350 into this one issue before any action is taken (2 visits, 1 MRI).

Sorry, what part of 2 visits and 1 MRI constitute "no action" being taken? I'm sure those visits included taking a history and doing a physical exam as well as reviewing any test results and ordering that MRI. Just because you aren't cured yet doesn't mean your doctor hasn't done anything.

[Gailete]

Thanks for all the replies.

I get very frustrated that many doctors don't seriously consider the cost to the patient. I'll be $350 into this one issue before any action is taken (2 visits, 1 MRI). And that's with the crazy good insurance we have for 2017 (merger got us a great plan this year, but I expect it to be gone by next year). Plus he has already hinted strongly at surgery, even though every medical site online has that as the last option.

I've been trying to follow up on all my PCP's referrals, but it is a lot of time and money. Living with pain is easier!

Even if the doctor has hinted about possible surgery, that doesn't mean that Dr. Online is wrong. Even if it is a last resort, they will still bring it up as a possibility. Dr. Steve is correct, in that your doctor/s are doing something.

Currently I'm going through something similar, and found out last week that neither one of my docs got the x-ray reports from the hospital ER after a big fall in March - and I had specifically asked them to send them to both docs. Frustrating, yes. What is worse is that a month ago I had been taken off one of meds for break-through pain, and this weekend my pain patch didn't want to stick on. By the time I took it off for my normal change at least 30-40% had gotten unstuck to my skin which meant I had only been getting a partial dose of meds and as my pain got worse and worse, the patch was lifting more and more. One horrible painful weekend for sure! By about 12 hours after having a new patch put on the pain was finally decreasing. Thank God, and I mean that literately. I can't live like that! I had left a message for the doctors on Friday and just got a call back with a new appointment with a different doc to see what is going on. That is doing something in my book for sure!

I'm sorry that you are in pain, but in our current era with health care, we no longer get admitted to the hospital to get problems diagnosed like they used to do. Now it is almost always outpatient diagnosing, which stretches the pain and discomfort out for the patient. I have found that the less time I spend in a hospital the better. It also helps to prevent MRSA, a nasty thing to get while a patient. Better to take your time than get something like that. I hope that the docs get your problem figured out soon!

[TexasHusker]

The specialist I saw yesterday wants me to have an MRI. He gave me a brochure from the facility that he "uses" and said that the office would contact them. I said that I would check with my insurance.

Got home and called insurance company. Turns out that the company is in network, but not that particular facility. Insurance company rep even put me on hold and called them to verify. Definitely out of network. So rep gave me 2 other nearby in network facilities.

I called the Dr's office with this info. Got a call a few hours later that the Dr had personally called the out of network facility and they "agreed to take the in network payment for me". I insisted on the in network facility and now have an appointment there.

So, why does he care so much? Isn't one MRI the same as the next? Does he get a kick back from that facility? Is he going to have a grudge against me?

The doctor likely won't hold a grudge, but he's probably a shareholder in the imaging facility. Furthermore, if his "preferred" facility is waiving out-of-network penalties and accepting the in-network allowable, it is actually breaking the law.

[TexasHusker]

To answer the 2nd question first, no, he definitely does not get a "kick back" from the facility as that would violate Federal law.

As for the 1st question, no, one MRI is not the same as the next. As with any other technology, there are better ones and lesser ones. The resolution can vary and depending on what they're looking for, the doctor make have experienced an older/lower quality MRI missing something.

There is NO LAW that a physician cannot own shares in a healthcare facility. I know numerous physician that own labs, imaging centers, hospitals, PT/OT, and all sorts of other related stuff, and they refer their patients to them like flies on stink.

You likely own shares in a healthcare facility yourself, if you own mutual funds of any kind.

[disneysteve]

The doctor likely won't hold a grudge, but he's probably a shareholder in the imaging facility.

That's a really broad accusation.

I absolutely have a preferred imaging facility where I refer my patients. I don't have any business connection with them at all. They are just convenient, are very good about scheduling patients promptly, get us reports rapidly, and have a good online provider portal.

There is NO LAW that a physician cannot own shares in a healthcare facility.

I didn't say there was. What I said was that a doctor can't get a kick back from the facility he refers to.

"In general, federal law prohibits physicians from referring Medicare or Medicaid beneficiaries to entities for “designated health services” if the physicians or their immediate family members have ownership or investment interests in the entities or have compensation arrangements with the entities" - from the NIH website.

[TexasHusker]

That's a really broad accusation.

I absolutely have a preferred imaging facility where I refer my patients. I don't have any business connection with them at all. They are just convenient, are very good about scheduling patients promptly, get us reports rapidly, and have a good online provider portal.


I didn't say there was. What I said was that a doctor can't get a kick back from the facility he refers to.

"In general, federal law prohibits physicians from referring Medicare or Medicaid beneficiaries to entities for “designated health services” if the physicians or their immediate family members have ownership or investment interests in the entities or have compensation arrangements with the entities" - from the NIH website.

I'd bet a dollar he's a shareholder.