July 1995 Bulletin

Dr. Strickland reviews problems of Stark II

Cites consequences of rule on X-rays

Academy president James W. Strickland, MD, told the House Ways and Means Subcommittee on Health on May 3 that while the Academy supports the intent of the so-called Stark II law to insure that Medicare patients are protected from fraud and abuse, there are some unintended consequences which neither protect patients nor encourage efficient and effective health care.

Dr. Strickland cited the impact on Medicare patients of orthopaedic surgeons, who although not in a group practice, nevertheless share the costs of a common facility for X-rays, physical therapy and other services. Their Medicare patients cannot be X-rayed in the shared facilities, but must be sent elsewhere and then return to the orthopaedist for diagnosis and treatment. Dr. Strickland presented a letter written to Rep. Fortney Stark (R-Calif.) chairman of the committee, from a patient who experienced that situation.

George H. Morello, San Mateo, Calif., wrote that he visited an orthopaedic surgeon because of "excessive pain and my inability to walk more than a few hundred feet. After a thorough examination, my doctor advised that X-rays would be required and I fully expected to walk down the hall (for the X-rays).

X-rays barred

"I was told, however, that this is no longer possible due to legislation either authorized or sponsored by you, forbidding X-rays to be taken on the same premises."

He told the Senator that he arrived at his doctor's office for an 11 a.m. appointment and parked in the garage of the building. At the end of the examination he was advised that he had to go to another location two blocks away for the X-rays. He decided to drive, but when he arrived, he found the garage in that building was full and there was no street parking available. He drove back to the orthopaedist's office and walked two blocks in the rain to get the X-ray, and walked back two blocks in the rain to his car.

"I had to wait for the X-rays, have them sent to the doctor, return to his office, then have his staff try to fit me into a packed appointment schedule and create more hardships for his staff and the other patients who were waiting," Morello said. "You have not helped anyone, but rather have created a nightmare."

Urges modification

Dr. Strickland urged that the law be modified to avoid this problem.

He also pointed out that the definition of durable medical equipment under the law prohibits orthopaedic surgeons from supplying prosthetic devices, artificial limbs, crutches, casts, splints and canes to patients as part of the treatment. Patients must be referred to another location not financially-connected with the physician providing the initial treatment, in order to receive the devices. Although Medicare carriers are refusing to reimburse for these items, orthopaedic surgeons are supplying the devices as an integral part of the patient's treatment.

Dr. Strickland told the legislators that the unintended consequence of the "isolated transaction rule" on the sale of a service such as a physical therapy service is that sales require a lump sum payment. Payment for the service on an installment basis is prohibited because although the title has passed to the new owner, physicians appear to have a financial interest until the final installment payment is made.

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