1. R.A. Nylen , “Research Provides Golden Opportunity for Physicians: An Overview of Clinical Trials and How to Conduct Them,”Physician Executive28, no. 1 ( 2002 ): 32 –37; and
2. The End of an Era: What Became of the "Managed Care Revolution" in 2001?
3. Understanding the Recent Growth in Medicare Physician Expenditures
4. Federal law places limits on physicians’ “self-referring” Medicare and Medicaid patients to facilities in which they have a financial interest. When physicians have an ownership interest in a specialty facility, they capture a portion of the facility fee along with their professional fee. “Medicare and Medicaid Programs; Physicians’ Referrals to Health Care Entities with Which They Have Financial Relationships,” Final Rule, 42 CFR Parts 411 and 424,Federal Register66, no. 3 (2001). The law was intended to limit potentially adverse effects on patients of physicians’ financial conflicts of interest. But it included exemptions physicians could capitalize on, including the whole hospital and office-based ancillary services exemptions. The whole hospital exemption allows physicians to refer patients to hospitals where they practice if their ownership stake in the hospital is not limited to a specific department. The office-based ancillary services exemption allows self-referral for services performed in the physician’s office or by supervised employees, in a facility used solely by the physician’s practice. While not covered under self-referral laws, physicians’ investment in ASCs is allowed as a “safe harbor” under the federal criminal antikickback statute. Physicians could invest in ASCs if the facility functioned as an extension of their office practice. “Medicare and State Health Programs: Fraud and Abuse; Clarification of the Initial OIG Safe Harbor Provisions and Establishment of Additional Safe Harbor Provisions under the Anti-Kickback Statute,” Final Rule, 42 CFR, Part 1001,Federal Register64, no. 223 ( 1999 ).
5. L.P. Casalino et al. “Focused Factories? Physician-Owned Specialty Hospitals and Ambulatory Surgical Centers,”Health Affairs(Nov/Dec 2003 ): 56 –67; and