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Koop blasts physicians' self-referral

Former U.S. Surgeon General C. Everett Koop has stepped into the fray over legislation that would stop doctors from referring their patients to clinics in which they hold a financial interest.

In a videotaped message that will be released today, Koop calls on the state's doctors and legislators to end greed and return the practice of medicine to the days when patients could trust their doctors.

Koop said the practice is estimated to cost Florida patients an extra $500-million a year.

"Doctors referring their patients to clinics in which they have an interest is incompatible with all that professionalism in medicine stands for," Koop said. "It is reminiscent of kickbacks and split fees which were the hallmarks of unethical medicine when I began to practice 50 years ago."

Koop noted that the American Medical Association, unlike the Florida Medical Association (FMA), has taken a firm stand against doctors owning an interest in clinics where they send patients.

"To legislators I say, the country is watching, and you will influence American medicine for good or ill," Koop said. "To physicians I say, if we do not reform health care now, you will either get nationalized medicine, exorbitantly expensive and insensitive to patient needs, or you will have private medicine run amok, and there are those who will say that you are partly responsible."

Koop's message comes at a time when the FMA is attempting to gut bills that would stop doctors from referring patients to any laboratory or clinic in which they have an ownership interest.

Identical bills pending in the House and Senate forbid referrals to jointly owned clinics that offer diagnostic imaging, laboratory services, radiation therapy and physical therapy. The bill exempts radiation therapy clinics operated by Cancer Treatment Holdings Inc., owner of clinics in Tampa, West Palm Beach and Coral Springs, but establishes a rate review system that would force any clinic overcharging its patients to comply with state-set rates.

The FMA has opposed the bill, but has now drafted an amendment that would "grandfather" all existing clinics and treatment centers but prevent future joint ventures from opening.

Other amendments making the rounds at the Capitol where dozens of lobbyists have joined the fray, would exempt other jointly owned clinics from the bill, including a diagnostic imaging clinic owned by Tampa's St. Joseph's Hospital and doctors who practice there.

Another radiation therapy company seeking exemption from the law is Radiation Care Inc., a company that plans to open a clinic in Orlando later this year.

Legislators say they are unwilling to grant an exemption to Radiation Care because it has no facilities operating in Florida and has questionable operations in other states. Lobbyists for the company say some reports on their operations have been exaggerated and have urged legislators to allow them to compete in Florida's health care market.

Millions of health care dollars are at stake in the fight. Independent radiation therapy clinics, hospitals and doctors often are competing for the same business in markets where some health care experts say too many expensive health care facilities are underused and drive up the overall cost of health care.

The action taken by Florida's Legislature is certain to spark similar moves in other states. Texas officials already have called on Florida legislators for copies of the bill and President Bush cited a Florida Hospital Cost Containment study of the problem in his own call for health care reforms earlier this month.

"A recent study done by the state of Florida has focused attention on the abusive practice of physician "self-referrals,'

" Bush said. "The Florida study showed that physicians who self-refer utilize services at a far higher rate than physicians who do not have these financial interests. The result is a significant increase in public and private sector health care costs."

State Rep. Charlie Roberts, D-Titusville, sponsor of the House bill that started the uproar between doctors who support and oppose the bill, said Tuesday he is not likely to accept attempts to amend the bill if it would damage the state's ability to cut health care costs.

The bill has won widespread support from the state's business lobby as it looks for a way to cut down on health care and workers compensation costs.

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