Keith,
At the risk of getting head of learned counsel, typically the IDTF is set up to take in patients NOT referred by the Group - in other words, patients not of the practice - the community at large whether Medicare, Medicaid or other insurances. In my experience Groups seek to do this in order to gain increased utilization of the equipment to offset the fixed costs of the in-office equipment.
I did not intend to insinuate that the Group would "cherry pick" who they send to which port of entry since the self referral rules would apply to the IDTF and since the IDTF would not be able to fall under the protection of the In-Office Ancillary Services Exception
The general principle is that the business of the IDTF is to take in patients not "of the practice". By definition, the Group cannot refer patients to an entity in which they have an ownership. Therefore, by definition, the Group is not falling into the trap of discrimination.
I may have inadvertently misstated the description in the scenario I described. The bigger issue they face is how they construct the entity to provide the IDTF with access to the medical imaging equipment and personnel housed in the Practice. That takes a carefully constructed business arrangement.
Make sense? Again, I defer to the lawyers expert in such transactions to weigh in on this matter.
I would suppose the original question posed is one seeking the possibility of stopping the Group from becoming even more of a competitor in their territory. I would not bet on that horse.
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Douglas Smith FRBMA
President & CEO
Phase 4 Radiology Business Strategies, LLC
Canton GA
770-213-4605
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Original Message:
Sent: 02-15-2019 13:42
From: Keith Chew
Subject: IDTF Question
Doug – I do have a question based upon your response. If the ortho group refers their non-MCare and MCaid patients to the center and their MCare and MCaid patients elsewhere would that not violate the equal treatment doctrine – stating that they cannot treat MCare and MCaid patients any differently than they do the other patients of the practice?
Keith E. Chew, MHA, CMPE, FRBMA
C | 217-971-5293
18 Hawks Nest | Chatham, Illinois 62629
Original Message------
Keith and David are correct in their statements, but keep in mind an "office" (like the one mentioned) entity can set up a separate entrance to the facility and enroll it as an IDTF serving non-Medicare and Medicaid patients - with some limitations as to the percentage of the total, in-office business and IDTF business, the IDTF can perform - with some additional detailed regulatory compliance hurdles to overcome with respect to a number of really important matters in order to make the proposed structure work - including compliance with Self Referral Prohibitions and other matters about which learned counsel can opine with specificity. Bottom line: can they do it - yes - but will require some fancy footwork by attorneys expert in these matters.
I have seen such structures put in place - especially by Ortho Groups - some have made economic sense while others simply could not drive enough volume to reach profitability.
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Douglas Smith FRBMA
President & CEO
Phase 4 Radiology Business Strategies, LLC
Canton GA
770-213-4605
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