Aromatic Bill in Annapolis

April 04, 1992

There's more than a whiff of chicanery surrounding a controversial bill on financial self-dealing by physicians that is edging its way quickly toward passage in the General Assembly. The aroma emanating from this bill is hardly pleasant. Legislators, beware.

On the surface, the measure seems a consumer-oriented, right-thinking kind of ethics bill. It would stop physicians from referring patients to diagnostic and therapeutic centers in which they hold financial interests. That's a sensible step. Physician self-referrals are a cause of bloated health-care costs.

But this bill, which has already passed the House, doesn't impose a sweeping ban on physician self-referrals. It bars only certain health-care providers while creating loopholes for others. In the case of radiation therapists, the loophole is flagrant -- and apparently intentional.

Those lobbying hardest for this bill are -- you guessed it -- the radiation oncologists who would be exempt from its provisions. They'd still be able to engage in self-referrals that could lead to abuse. But the bill would directly bar one publicly owned company, Radiation Care Inc., which has a site in College Park and another planned for Rockville. One competitive threat would be eliminated.

Radiation Care claims the state's radiologists want to keep their monopoly on radiation therapy. Company representatives note that radiologists are among the best-paid physicians (one Florida study showed incomes of $800,000 or more) and that their stranglehold on the Maryland market allows them to overcharge. The average fee per procedure at Radiation Care is far lower than nearby radiation units, the company claims.

Supporters of this bill say there is anecdotal evidence of self-referral abuse at radiation centers. But there is no empirical evidence. The long list of exemptions from the ban on physician referrals hints strongly that this is little more than a special-interest bill to preserve the status quo.

If the state medical society is serious about barring a physician from making patient referrals to treatment centers partly owned by that physician, it ought to support amendments to make the ban comprehensive, not exclusionary. Unless that happens, state senators should give this bill a prompt burial. It reeks of favoritism and protectionism -- for the physicians, not the consumers.

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