Ethical Physician Self-Referral

  1. There is a situation at my hospital that is bothersome and I'd like to get some feedack.

    In my community, we have an infectious disease doctor who has started his own IV infusion center at his office. Since opening this business, this doctor no longer uses home health for IV infusions. He does not give patients a choice and tells them they have to come to his office so that he can monitor their lab values and adjust their dosage. (something that can be done through home health/lab draws) If the patient insists on home health, he "fires" them as his patient. He has the patients come to his office three times a week. Some patients come in on stretchers, some with elderly caregivers exhausting themselves (and the patient) trying to get to the office. Patients with draining MRSA infected wounds are forced to take the city bus to his office. Although the patient is only receiving the infusion 3xW, he sends them home hooked up and after the infusion they remain hooked up at a TKO rate until their next appointment. Home health could teach the infusion to the caregiver and they would have much more freedom and comfort between infusions. If they have IV complications after hours, home health may not trouble shoot the IV, the patient is instructed to go to the ER. He refers most of these patients to home health, but only for wound care. So he gives them their IV and then they go home and wait for home health to come change their dressing. Apparently, the patient is still technically considered homebound if they are going to a "doctors appointment", so it is not medicare fraud. The sad thing is that it is very difficult for most of these patients and caregivers to go to his office. This doctor is willing, however to let the medical patient's have their IV's done by home health...just not the Medicare and private insurance patients. Discharge planners have commented on the large increase in patient's going home on IV antibiotics since he opened his business. Many complaints have been made to Administration, including the hospital attorney and Chief medical officer. The answer is always, "We will talk to him".

    Sorry this is so long and I hope it's in the right forum. What do you guys make of this situation?
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    About nservice

    Joined: Dec '06; Posts: 121; Likes: 83
    Specialty: 10 year(s) of experience in Tele, Renal, ICU, CIU, ER, Home Health.


  3. by   Laught3r
    In my humble opinion, I think it is time to contact your local health department and send an anonymous tip about this doctor.
  4. by   canoehead
    Why can't you advise the patients that you provide IV service in the home. Then they can request a referral. If the doc refuses to give a referral they can be advised about second opinions. You can't say anything negative about the doc, but information will get around the community without you saying a word.
  5. by   NRSKarenRN
    There is nothing illegal nor unethical about this practice. Physician is providing a service to clients as extension of office practice. Patients SHOULD be educated about their options for care, especially when hospitalized or receiving wound care. Medicare has strict regs that it's PATIENTS choice of provider. Nurses should be able to give patients staff directory with listing of infectious disease doctors in the area if patients express qualm/problems getting to this particular provider.

    Nothing wrong either with telling patient which infectious disease doctors have homecare provide IV admin "in the comfort of your own home" if they mention issue first.

    An education article or advertisement in your local paper about IV services homecare provides seems prudent too as keeping your services in public mind.
  6. by   fultzymom
    I think the patients have the right to know all of their options. They should be told that they can get these same services with home health and the local lab. I don't think that he should refuse to take care of them either if the patient chooses not to use his services. I am sure he is just trying to boost up his clinic that he has going. Not sure that is the right thing to do. Sounds like he is abusing his position to me.
  7. by   Weeping Willow
    So who else can you report him to? the TKO part really bothers me and the having to drag to an ER for problems. Ooh, and there's the answer! Insurance complanies probably don't like having to pay for ER visits when the problem is something a home health IV nurse can readily take care of - or even a family member who has been properly trained by that nurse. Hint, hint - drop a word to the insurance company and see how fast this doctor changes his tune. This sounds like maybe one good use of insurance companies - to lower the boom on what does sound unethical to me.

    Also, it sounds like he is using probably only 1 or 2 antibiotics, if they can be given only 3x/wk. What infections exactly is he treating and what is he using? Does he provide any after hours call service at all?

    Do any of the patients not really need the antibiotics?

    Do any of the patients or caregivers complain about having to drag into his office 3x/wk?
  8. by   oramar
    The guy must be making money doing this or he wouldn't be doing it. I don't think he is breaking any laws but if I were his patient I would change doctors.
  9. by   nservice
    Thanks for your feedback. Unfortunately, this is the only infectious disease doc in our area, so he has a monopoly going on. Yes, a couple of patients have complained and he quickly "fired" them as his patient. These patients asked for homehealth to do the IV's because they had received home IV infusions in the past. As for patient's not needing the antibioitics (IV) I'm not sure. I just know the rate has increased drastically since his clinic opened. I'd hate to think that this doc is feeding superbugs in order to make a buck. I know that there is a Medicare Law against physician self-referral, but It is only for a limited number of services. I'm not sure what these limitations are. I'm mainly concerned about the patients who are experiencing hardships when they really are homebound, but being forced to visit the clinic so often. I also don't like that the patient's are given no choice. The doctor says they have to come into the clinic, so they take it as the gospel. Discharge planners are not "allowed" to offer any other options to the patient and the doctor won't approve any other referrals.

    On a side note, I no longer work in home health, just still in the loop when it comes to information. So, It's really none of my business, except as a patient advocate feeling like something is rotten in Denmark.
  10. by   birdgardner
    Who sees the fired patients if he's the only infectious disease specialist in the area?