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Feb 19, 2009

Delayed Medical Tests

Emergency Primary Care (Not)
02/18/09 - DocsOnTheWeb by 911Doc

The Stark law (below) "stops" waste, fraud, and abuse by eliminating effective services. The government favors one-stop, no-other-choice shopping when the government provides medical services, but they require private doctors to fragment and delay their services.

[edited] Doctor's clinics are no longer allowed to provide on-site lab and Xray. The "Stark" law comes to mind. I witnessed a combination of poor primary care skills and the heavy hand of government.

An old man went in to his physician's office yesterday for a checkup. He 'wasn't feeling well' and the doc took him off one of his anti-hypertensive meds. Today he feels worse and WOW! the labs drawn at his checkup were resulted today and showed kidney failure and high potassium.

When the patient got to us in the emergency department, he was 'almost dead' with a pulse of 30. We brought him back from the precipice. I asked his primary doctor why the labs took so long to be resulted. He said, "We have to send out all labs".

This adds another pressure point to ER medicine. People know that their primary physician will not get answers that day. In this case it was almost a day late and a dollar short. Thanks Uncle Sam, you have prevented primary care physicians from committing fraud by over-ordering tests. Good job. Bunch of freaking putzes.

Physician self-referral

The Stark law governs physician self-referral for Medicare and Medicaid patients.

Self Referral is a physician referring a patient to a medical facility in which he has a financial interest, be it ownership, investment, or a structured compensation arrangement.

Critics of self-referral allege an inherent conflict of interest, because the physician can benefit from the referral. They suggest that such arrangements may encourage over-utilization of services, in turn driving up health care costs. They believe that it would create a captive referral system, limiting competition by other providers.

Others say that some problems may exist, but are not widespread. Physicians are responding to a need which would otherwise not be met, particularly in a medically underserved area.

Most laws are not written with a delicate hand. Instead of auditing abuse, our government eliminates efficient services, including standard lab tests, for all of the patients and doctors who are not defrauding the system. Broad-brush laws have real consequences.

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