Do Doctors Get Paid For Giving Referrals?

[easysurfer]

Asking just out of curiosity. Answer may be well known, but not to me .

If I see my family doc and the doc refers me to see a specialist, does the family doc get paid for giving out the referral?

Or is the referral just a courtesy thing along with meeting a requirement for some patients' health insurance?

 

[HadEnuff]

They don't get paid. If they are part of a large medical group they are encouraged to refer within the medical group, but as a patient you can ask for a referral outside the group, and you should get it.

 

[Bamaman]

My internal medicine doctor doesn't get paid for referrals. Medicare barely pays him for seeing me to decide a referral is warranted.

I guess that's why he's still working at age 68--and ER is not in his vocabulary. He complains about the incredible paperwork workload to do business in the modern medical world--one with a 50% expense ratio.

 

[EastWest Gal]

Payment for referrals is a federal crime under the Anti-Kickback Statute [42 U.S.C § 1320a-7b(b)]. So no, physician’s don’t get paid for referrals!

 

[Aerides]

Payment for referrals is a federal crime under the Anti-Kickback Statute [42 U.S.C § 1320a-7b(b)]. So no, physician’s don’t get paid for referrals!

Thanks, glad to hear it. In seeing the OP question I thought for a second.. If docs did get paid it would be something everyone bitched about with good reason. It would undermine trust in the whole idea that you'd ever need to see a specialist.

 

[zinger1457]

They should have similar laws/rules concerning prescription drugs.

 

[Rustic23]

Bamaman I think for basic Medicare no referral is necessary. If I'm wrong, I sure one of the experts here will chime in.

 

[Bamaman]

Bamaman I think for basic Medicare no referral is necessary. If I'm wrong, I sure one of the experts here will chime in.

The specialists most often will refuse to see patients that are not referred. When I go to my primary physician, it's a shame how little he's paid very little for office visits and in office testing.

My diabetic doctor and most specialists get paid much more. There are some specialists like nephrologists that get paid handsomely for their time--big $.

 

[swakyaby]

Primary care docs don’t get kickbacks for making referrals to specialists. But most specialists require a patient be referred by the primary care doctor because the specialist wants someone to send the report to and to coordinate the patient’s overall care.

 

[RetMD21]

Primary care docs don’t get kickbacks for making referrals to specialists. But most specialists require a patient be referred by the primary care doctor because the specialist wants someone to send the report to and to coordinate the patient’s overall care.

And they don't want to see people who don't need their services but have been doing their own "research" on Google

 

[Jerry1]

Payment for referrals is a federal crime under the Anti-Kickback Statute [42 U.S.C § 1320a-7b(b)]. So no, physician’s don’t get paid for referrals!

So instead, they have ownership connections. For example, they own the radiology center they send you to for an MRI. Or, their group is owned by a hospital and they refer to the hospital. So, not a kickback, but there is profit being made downstream from the referral in many instances.

 

[EastWest Gal]

So instead, they have ownership connections. For example, they own the radiology center they send you to for an MRI. Or, their group is owned by a hospital and they refer to the hospital. So, not a kickback, but there is profit being made downstream from the referral in many instances.

This also isn’t legal, per the Stark law, a series of legislative provisions that started taking effect in the early 90s. Pete Stark, Congressman representing Oakland and other East Bay Area cities from 1973-2013. introduced this legislation starting in 1988. He was my in-laws Congressman.

Every physician on any medical staff is required to complete “compliance training” every two years to remain on medical staff. The training is web-based and reviews kickbacks, Stark provisions, fraud, and HIPAA regulations.

Many radiology centers are owned by hospitals. Most hospitals aren’t owned by physicians. Physicians get nothing for recommending a preferred place for services. In California, physicians cannot be directly employed by a hospital. This keeps the hospital from “owning” the physician. Not so in PA.

Most labs are hospital owned or owned by megacorps. Quest Diagnostics, is international and publicly traded.

 

[Jerry1]

I’m not sure of the ways it’s done, but I am certain that physicians have ownership in radiology centers and surgical centers. Maybe the keep ownership under a certain percentage? Also, while hospitals in California may not employ doctors, they certainly do elsewhere. Even if they don’t employ them, they set them up with office accommodations on site and they also associate with them through networks. In those circumstances, I doubt you’ll find a doctor that refers out of network except in very limited cases. Doctors are the life blood of facilities. There are certainly financial benefits being provided in some form.

 

[audreyh1]

We have a doctor owned hospital. When you see any doctor here they disclose part ownership.

 

[RetMD21]

I’m not sure of the ways it’s done, but I am certain that physicians have ownership in radiology centers and surgical centers. Maybe the keep ownership under a certain percentage? Also, while hospitals in California may not employ doctors, they certainly do elsewhere. Even if they don’t employ them, they set them up with office accommodations on site and they also associate with them through networks. In those circumstances, I doubt you’ll find a doctor that refers out of network except in very limited cases. Doctors are the life blood of facilities. There are certainly financial benefits being provided in some form.

It's illegal to base compensation on the value of referrals. Referrals in network can be required but not if the patient expresses another preference, the insurer requires something else, or if it is in the best interest of the patient.

Jerry1 you seem to be pretty sure that things aren't on the up and up. If you have actual knowledge of specific event maybe you should report it.

 

[aja8888]

We have a doctor owned hospital. When you see any doctor here they disclose part ownership.

Same here, my cardiologist and his partners own the practice, the test equipment and the building(s). Lab work is leased space in their building and run by one of the biggies.

 

[Jerry1]

Jerry1 you seem to be pretty sure that things aren't on the up and up. If you have actual knowledge of specific event maybe you should report it.

No, not at all. All I’m saying is that there are business arrangements out there that flow benefits, if not money directly, to physicians. I liken it to taking gray areas in the tax code, or similar to how people on this forum discuss how they manage their income in order to qualify for ACA subsidies. This is completely on the up and up. I’m just pointing out that it would be naive to believe that physicians and facility administrators haven’t figured out how to work around their situations. I’m also sure there are some people who are doing things they shouldn’t. That’s just life. I don’t condone that, but I don’t kid myself to think it’s not happening.

 

[RetMD21]

No, not at all. All I’m saying is that there are business arrangements out there that flow benefits, if not money directly, to physicians. I liken it to taking gray areas in the tax code, or similar to how people on this forum discuss how they manage their income in order to qualify for ACA subsidies. This is completely on the up and up. I’m just pointing out that it would be naive to believe that physicians and facility administrators haven’t figured out how to work around their situations. I’m also sure there are some people who are doing things they shouldn’t. That’s just life. I don’t condone that, but I don’t kid myself to think it’s not happening.

Sure, despite laws intended to prevent it there must be some of this going on. Some of the conflicts are more obvious. Unless on salary, a surgeon gets paid to operate. That fee is likely to be much more than any incremental earnings from investment in a surgery center. One would hope that a recommendation for a procedure would be based on patient benefit mostly but there have to be debatable cases. I think second opinions for major elective procedures are a good idea. Of course if you are actively bleeding this isn't possible but the need for surgery is probably clear As the medical system becomes more integrated it may become harder to guess at the incentives. Just knowing that an employer is monitoring referral patterns would likely have an impact.