[NPInfo] Interesting......from PA Forum

[Margienp at aol.com]

Hello,
He needs to be reported ,he is not practicing the acceptable standard of  
care. There are guidelines for breast MRI's, If you do not want to report   him 
to the board, he needs to be reported to the cred. in the hospital.
This is also insurance fraud. 
Does he have any ownership in the hospital or the MRI machine? He may be  
getting a kick back, violation of stark law.
 
Let us know the outcome.
In a message dated 4/28/2008 2:30:15 P.M. Eastern Daylight Time,  
dmittman at comcast.net writes:


Hello folks,

I practice in a small New Mexico town. There is  only 1 radiologist at  
our little local hospital. Of late, he's been  reading mammograms for  
my patients and if they have some "dense"  breast tissue, he puts on  
the report "abnormal report; breast MRI  suggested for further  
evaluation." His new little toy at the  hospital is that breast MRI  
machine. He talked admin into getting  it...and now (I think) is  
feeling pressured to prove to admin that  it's a money-maker...and  
needs to generate revenue to pay it  off.

Here's the dealie: a majority of my patients have medicaid,  medicare  
or zero insurance...either patients don't have the funding  to get a  
MRI or insurance won't pay for MRI because it is not viewed  currently  
as the standard of care. My patients who are uninsured get  their  
women's exams and mammo for free under a NM program...and  this  
program will not pay for a breast MRI. I am obligated to inform  the  
patient of the "abnormal mammo". ALL of our providers had a  meeting  
with him 1 month ago to tell him why we are frustrated with  his  
suggestions for breast MRI...we asked him to rephrase on the  report.  
Still hasn't. In fact, he says it's a liability for HIM if  he doesn't  
put that on the report. So, now, it's a liability for  ME....and me  
telling the patient that he recommends an MRI   freaks them out--even  
though I try to phrase this information to the  patient carefully. I  
even had one lady say to her husband, "well,  maybe we could sell  
junior's car?" (to get money to pay for a  possibly un-necessary MRI).

Today, I got a phone call from a patient  who was totally flipping out  
on the phone, thinking she's got breast  cancer..."oh my God,...how  
come you didn't tell me!!!!!" Oh boy, I  told her to back up...and  
asked her where on earth is she getting  this. SHe states she received  
a letter from the radiologist stating  her mammo was abnormal and she  
needs breast MRI for further  evaluation. The letter goes on to invite  
her to call the radiology  department to set up a time to come in for  
the MRI. Sincerely,  so-and-so....The patient did what the letter told  
her to do. But,  the scheduler said that her PCP (me!) needs to have  
this  pre-authorized and I've gotta be the one to give them a written   
order for this. So, the patient calls me and I get an earful. I   
hadn't even gotten the mammo report back!

This is heinous. I am  very fired up about this radiologist's attempts  
to scare the  patients by intimidation into getting the MRI asap...I  
called the  radiologist and told him that I am 'this close' to simply  
not  referring patients there anymore. Instead, they would have to  
drive  65 miles to Silver City to get their mammos. He apologized   
profusely...and said he can re-phrase the letter. I told him I flat-  
out don't want the letter being mailed to the patient. And, if it is   
it should say something like "talk to your provider". I additionally   
am mad about this as I feel he's going around my back.

We, as a  team, are getting close to simply boycotting him. THis is a  
very,  very, very small town. The majority of his referrals come from  
our  group. He will certainly feel the pinch if we cut him off.

Do any of  you have suggestions? Are any of you having the same  
problem? Am I  getting too worked up about this? Would any of you  
report him to the  state medical board? I am feeling that this  
practice is unethical  and  wrong.
pp

_______________________________________________
NPInfo  mailing  list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************





Be kinder  than necessary, everyone you meet is fighting some kind of  battle.



**************Wondering what's for Dinner Tonight? Get new twists on family 
favorites at AOL Food.      
(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)