| 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 Date | Comment |
| 1. | Tue, 3/13/07 11:00 PM | If it is part of his practice and he allows patients to choose where to have them done, OK. If not serious. |
| 2. | Wed, 3/14/07 12:20 AM | Depends 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. |
| 3. | Wed, 3/14/07 12:23 AM | No 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) |
| 4. | Wed, 3/14/07 1:58 AM | It depends if his prescribing practices change as a result of the purchase. |
| 5. | Wed, 3/14/07 2:57 AM | on if he orders more x-rays than before. |
| 6. | Wed, 3/14/07 3:22 AM | Depends on the degree to which this leads to overuse /inappropraite use of imaging -- the overuse is almsot inevitable however. |
| 7. | Wed, 3/14/07 12:53 PM | on whether he is using xrays excessively and without good diagnostic reason |
| 8. | Wed, 3/14/07 1:53 PM | who is reading the xrays. This may be a convenience issue for the MD but quality of the reading needs to be considered |
| 9. | Wed, 3/14/07 1:56 PM | Depends on whether Jones has had radiology training |
| 10. | Wed, 3/14/07 2:34 PM | This 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. |
| 11. | Wed, 3/14/07 6:08 PM | The patient should be given a choice of service providers unless there is a compelling reason not to. Proceedures are more accurate for this physician. |
| 12. | Wed, 3/14/07 7:23 PM | Indications for obtaining the studies. |
| 13. | Wed, 3/14/07 10:04 PM | is he ordering tests inappropriately? |
| 14. | Wed, 3/14/07 10:10 PM | Ok, 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. |
| 15. | Thu, 3/15/07 1:32 PM | This depends on the ethics of Dr. Jones. A POTENTIAL for COI, doesn't mean that there will be COI. |
| 16. | Thu, 3/15/07 2:38 PM | It 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. |
| 17. | Fri, 3/16/07 11:29 AM | on 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. |
| 18. | Fri, 3/16/07 12:53 PM | If he can document that he is following nationally recognized practice guidelines for ordering xrays, there is no COI. |
| 19. | Mon, 3/19/07 4:58 PM | NO COI. This is vertical integration and a standard business practice. Health care delivery is a business as much as a public service. |
| 20. | Mon, 3/19/07 5:30 PM | It may be that this is the best way to provide care and convenience. |
| 21. | Tue, 3/20/07 5:02 AM | provided the xrays technician is capable, and Dr Jones has the ability to read the radiographs correctly or utilize qualified radiologist to interpret difficult films. |
| 22. | Mon, 3/26/07 3:14 PM | see 10 above |
| 23. | Mon, 4/23/07 1:29 PM | Although 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. |
| 24. | Mon, 4/23/07 3:41 PM | It would be OK if Dr. Jones only uses the x-ray machine when truly indicated |
| 25. | Thu, 4/26/07 12:26 PM | If 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. |
| 26. | Thu, 4/26/07 9:19 PM | again if it improves access for patients fine, but indications would be the key |
| 27. | Thu, 4/26/07 9:22 PM | No 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. |
| 28. | Tue, 5/8/07 12:04 AM | Needs to meet federal requirements/CLIA. |
| 29. | Tue, 5/8/07 3:29 PM | ..... |
| 30. | Tue, 5/8/07 7:06 PM | if it is an option and not a requirement for the patient to do the xrays at the office. |