The American College of Surgeons has received a number of
inquiries regarding the ethics of certain fee arrangements for
patients being treated by extracorporeal shock wave lithotripsy
(ESWL). In many instances, a corporation, or other entity, has
been established to purchase and operate the ESWL equipment.
A variety of arrangements have been developed to handle the billing
of fees associated with the procedure.
In some situations, the corporation or entity which owns or
operates the ESWL equipment, and seeks patient referrals, offers
to bill the patient a single fee for all aspects of the procedure.
The fee is then to be distributed, with a standard percentage
of the fee for all patients to be paid to the referring physician,
who provides the preoperative evaluation and postoperative care
of the patient and may provide special postoperative reports
to the ESWL entity. The offer may include a commitment by the
ESWL entity not to increase the fee paid to any referring physician
without similarly raising the fee paid to all referring physicians.
These payment arrangements are not disclosed to the patient.
This type of fee arrangement is considered by the American College
of Surgeons to be a form of "fee-splitting."
The College has long supported the principle that a patient
should have full knowledge of who is providing the professional
service and the charge for this service. This is best achieved
when the referring physician, and any other physician rendering
ESWL-associated professional services, makes a determination
of the appropriate fee for each individual patient and sends
the patient a statement for these professional services.
If all ESWL services are billed in a single statement, full
disclosure should be made of the amount of the fee that will
be paid to each physician who has rendered professional services
in connection with the procedure.
Reprinted from Bulletin of the American College
Vol. 71, No. 4, Page 21, April 1986