[dogmatism]

>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

[bonsai_spool]

> 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]

> 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...

[bonsai_spool]

> It looks like owning a chunk of the place you refer to is fine

The article you link to says that anyone can be liable even if she didn't realize her referral violates the law.

I cannot imagine any reasonable physician risking this after the decades of training required to get a doctor. I would not, for sure.

From the article you sent:

Some of the most widely used regulatory exceptions are longstanding and foundational across healthcare organizations. These include:

    In-office ancillary services exception: Allows physicians in the same practice to refer patients internally for DHS such as lab work or therapy, as long as certain supervision, location, and billing criteria are met.

    Rental of office space exception: Permits lease agreements between a physician and an entity, but only if the space is used exclusively for legitimate business purposes, rent is fair market value, and the agreement is in writing for at least one year.

    Employment exception: Protects compensation arrangements between hospitals and employed physicians, as long as compensation is consistent with fair market value and is not based on referral volume.

    Personal service arrangements exception: Covers contracts where a physician provides services (like medical directorships) to a DHS entity. The agreement must outline duties, last at least one year, and pay a fixed, fair-market-value fee unrelated to referrals.

Each of these exceptions includes detailed requirements, and missing even one element, like failing to document the arrangement in writing, can render the exception invalid. This is especially important when physicians have investment interests in joint ventures or ancillary service providers.

[lostlogin]

It’s exactly those points that allow referral to entities in which physicians have a financial interest. That’s why I provided the link.

Otherwise they’d be breaking the law with investment funds that hold stocks in large healthcare companies etc.

[bonsai_spool]

I remind you that we began this with the idea that doctors are prescribing treatments for their own financial benefit: https://news.ycombinator.com/item?id=48621445

At the diffuse 401k ownership level, individual actions are not relevant - the Stark law is clearly dealing with the first case and that was how this whole discussion began.