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What you should know about how financial interests sometimes influence physician medical decisions and recommendations

Savvy patients ask questions and may get a second opinion

Earlier this year, The Atlantic featured an article about hundreds of Michigan patients who accused a Michigan neurologist of intentionally misdiagnosing them with epilepsy. This led to harmful treatment with medications that caused patients to experience severe headaches, general exhaustion, and malaise.

At one trial, evidence showed that this physician had a contract with a hospital that increased his pay for every electroencephalogram (EEG) that he ordered. A patient’s attorneys argued that he had a financial conflict of interest that led him to perform as many EEGs as possible. In the closing argument, the plaintiff’s lawyer argued that the doctor had “turned that EEG machine into an ATM.” Some physicians from the community came forward and testified in court that they agreed with the plaintiffs’ accusations.

As a Houston, Texas medical malpractice attorney, I know that when Painter Law Firm investigates a case, we look carefully at the financial interests between the doctors and any facilities where tests or procedures are performed.

Here are some of the ways that behind-the-scenes financial considerations may influence or cloud a doctor’s medical decision making and recommendations:

Surgery centers. Over the last decade or so, many surgeons have realized that the big money to be earned in surgical care is in the facility fee. It used to be that this was the exclusive province of hospitals. Many surgeons, though, have invested in ambulatory surgery centers to keep the lucrative facility fee profits. Surgeons perform a variety of procedures in ambulatory surgery centers, including bariatric/weight-loss surgery, plastic surgery, and even some orthopedic back procedures.

In my experience, surgeons who own ambulatory surgery centers often make recommendations to a patient for surgery at their facilities, without offering an alternative option for doing the procedure in a hospital operating room. In many cases it may be “six of one, half a dozen of another,” but one thing’s for sure—if there’s a serious complication, it’s always safer for the patient to be at the hospital.

Before going forward with a surgeon’s recommendation for surgery at an ambulatory surgery center, keep the financial interest in mind. Make sure that you’re satisfied that the surgery is medically necessary and that the surgeon has fully explained the risks and benefits of surgery versus other options. Ask about the possibility of proceeding with the procedure in a hospital operating room and gauge the surgeon’s response. For all of these reasons and more, I’m convinced that it’s a good idea to get a second opinion before any non-emergency or elective surgery.

Imaging or procedure centers. Just like some surgeons own their own operating rooms in ambulatory surgery centers, some physicians own imaging or procedure centers. That way they get to keep the profit from tests that they order.

Imaging centers perform diagnostic radiology scans like MRIs and CTs. Cardiologists may own their own separate or office-based procedure centers, like a cardiac catheterization lab.

Remember, you have an option to have these tests or procedures done in hospital settings rather than in independent imaging or procedure centers.

Urgent care or freestanding emergency rooms. These small facilities have popped up in neighborhoods all over Texas, like blue bonnets in the spring.

As an initial observation, these facilities aren’t set up to treat life-threatening emergencies. At best, they’ll diagnose you and send you on your way to a full-fledged acute care hospital. If you’re facing a real life-or-death situation, your odds of survival will be a lot better if you go straight to a hospital emergency room.

Urgent care and freestanding ERs can be quick and helpful in some situations. However, critics have found that they’re often notorious for running up expenses for any test that they can run in-house.

Practice groups. The way medicine is rapidly changing, I think it will be hard to find a truly independent doctor or practice group a decade from now. Large hospital systems are gobbling up individual physician office practices and small practice groups, merging them into larger hospital-controlled groups.

Where do you think these doctors will refer their patients who need hospital services or consultations with medical specialists? Will it be based on safety and quality or the hospital system that writes their paychecks? Many hospital-controlled physician groups require doctors to refer patients to other specialists in the same practice group and affiliated hospitals.

To be clear, financial interests don’t always influence medical decision making. On the other hand, it would be foolish to think that it never does. That’s why we always recommend that patients consider getting a second opinion before taking medical advice that would lead to costly surgeries, procedures, or long-term medical care. And if you’re getting a second opinion, make sure to select a doctor who’s not affiliated with the same practice group or possibly even the same hospital system.

If you’ve been seriously injured by poor or questionable medical or hospital care, then contact a top-rated Houston, Texas medical malpractice attorney for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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