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12. Dr. Jones buys an X-ray machine and hires a technician so that X-rays can be performed at his office, capturing the fees that these generate.
#Response DateComment
1.Tue, 3/13/07 10:57 PMon whether or not he is over prescribing unnecessary tests.
2.Tue, 3/13/07 11:00 PMIf it is part of his practice and he allows patients to choose where to have them done, OK. If not serious.
3.Tue, 3/13/07 11:30 PMIf Dr. Jones continues to prescribe films in an evidenced-based manner, there is no conflict of interest. If Dr. Jones prescribes films for specious reasons in order to generate income, there is a conflict of interest. Given the nature of healthcare in our country, Dr. Jones needs to think as a business-person if s/he is in private practice.
4.Wed, 3/14/07 12:20 AMDepends on whether the x-rays are appropriate for the patient condition. Tendency will be to over prescribe x-rays, thereby increasing health care costs and increasing revenue to physician.
5.Wed, 3/14/07 12:23 AMNo conflict if Dr. Jones is as qualified to oversee the performance and interpretation as outside sources and does not order more X-rays than appropriate (and thus finacially benefit from overuse of technology)
6.Wed, 3/14/07 12:53 AMAgain, counting on Dr. Jones' good character there would be no conflict of interests.
7.Wed, 3/14/07 1:16 AMIf the number of tests he orders exceeds the number prior to his purchase, this is a serious conflict.
8.Wed, 3/14/07 1:58 AMIt depends if his prescribing practices change as a result of the purchase.
9.Wed, 3/14/07 2:57 AMon if he orders more x-rays than before.
10.Wed, 3/14/07 3:00 AMIt depends on if the X-rays are necessary. If they are, then there is no COI and it provides a service to his patients (as long as all proper rules and regulations are followed and the priority is quality patient care. If any of the X-rays are not appropriately necessary, then it is a complete and serious COI.
11.Wed, 3/14/07 3:22 AMDepends on the degree to which this leads to overuse /inappropraite use of imaging -- the overuse is almsot inevitable however.
12.Wed, 3/14/07 12:53 PMon whether he is using xrays excessively and without good diagnostic reason
13.Wed, 3/14/07 1:53 PMwho is reading the xrays. This may be a convenience issue for the MD but quality of the reading needs to be considered
14.Wed, 3/14/07 1:56 PMDepends on whether Jones has had radiology training
15.Wed, 3/14/07 2:34 PMThis occurs commonly especially in adult cardiology practices. Interpretation of studies may be improved, over radiology reports that say "clinical correlation advised" but the numbers of studies increase some of which is from unnecessary testing.
16.Wed, 3/14/07 2:46 PMIt has potential for COI if he over-prescribes X-rays in order to gain extra income
17.Wed, 3/14/07 6:08 PMThe patient should be given a choice of service providers unless there is a compelling reason not to. Proceedures are more accurate for this physician.
18.Wed, 3/14/07 7:23 PMIndications for obtaining the studies.
19.Wed, 3/14/07 10:04 PMis he ordering tests inappropriately?
20.Wed, 3/14/07 10:10 PMOk, only in a rural or otherwise isolated setting wheere this is a service for patients. Even then, it would be better if this was financially an independent operation.
21.Thu, 3/15/07 4:21 AMThere is only a conflict of interest if the physician allows this to alter who he prescribes X-rays for. If he was honestly going to prescribe the X-ray regardless, then it is more convenient for the patient and I see no conflict of interest. The conflict arises if the physician begins over-prescribing X-rays to make more money.
22.Thu, 3/15/07 1:32 PMThis depends on the ethics of Dr. Jones. A POTENTIAL for COI, doesn't mean that there will be COI.
23.Thu, 3/15/07 2:38 PMIt depends on whethere patients are sent to the best place or the place they prefer for imaging, versus pressured to have services at the office.
24.Fri, 3/16/07 11:29 AMon whether this is a convenience for patients and whether the number usually ordered will pay for the extra costs or more tests have to be ordered.
25.Fri, 3/16/07 12:53 PMIf he can document that he is following nationally recognized practice guidelines for ordering xrays, there is no COI.
26.Sun, 3/18/07 3:17 PMIf the number of x-rays at the office increases drastically, then yes, thats a COI. Simply getting an x-ray machine may however, improve pt care if utilized appropriately.
27.Mon, 3/19/07 4:58 PMNO COI. This is vertical integration and a standard business practice. Health care delivery is a business as much as a public service.
28.Mon, 3/19/07 5:30 PMIt may be that this is the best way to provide care and convenience.
29.Tue, 3/20/07 5:02 AMprovided the xrays technician is capable, and Dr Jones has the ability to read the radiographs correctly or utilize qualified radiologist to interpret difficult films.
30.Mon, 3/26/07 3:14 PMsee 10 above
31.Mon, 4/23/07 1:29 PMAlthough a potential conflict of interest, if the availability in the office improves patient service (cost, wait time, and convenience) than there may be no conflict.
32.Mon, 4/23/07 3:41 PMIt would be OK if Dr. Jones only uses the x-ray machine when truly indicated
33.Thu, 4/26/07 12:26 PMIf the physician indiscriminately xrays all patients. However, a bonus if minimized access and distress for patients who medically need xray. physician must make sure machine is properly calibrated and operated.
34.Thu, 4/26/07 9:19 PMagain if it improves access for patients fine, but indications would be the key
35.Thu, 4/26/07 9:22 PMNo COI if he always give every patient the choice of getting X-rays at other locations and he always has good medical reasons for the X-rays.
36.Tue, 5/8/07 12:04 AMNeeds to meet federal requirements/CLIA.
37.Tue, 5/8/07 3:29 PM.....
38.Tue, 5/8/07 7:06 PMif it is an option and not a requirement for the patient to do the xrays at the office.