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Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 43

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is especially persuasive because of the “skill by association” phenomenon.

Skill by association is a simple concept: A healthcare provider I trust tells me that there’s another specialist that he or she

trusts. I logically assume that the quality of the specialist mirrors that of my physician. The problem is that when the doctor, in fact, owns the specialist in question, he or she has a personal fnancial incentive for me to go to that specialist for care,

regardless of the quality . This isn’t to say that doctors who own practices don’t care whether their patients are prosthetically successful or not – clearly, they do. But their ownership interest in the prosthetic facility arguably makes them something less than a truly objective decision-maker in that regard. And the potential lack of transparency about why the doctor may be referring you to a specifc prosthetist is something that you need to know.

There does appear to be a growing trend of physicians owning prosthetic facilities in the United States. At a national conference of orthotists and prosthetists that I attended in late September, I was asked on numer-ous occasions about the Stark Law and the legality of referring patients to a doctor-owned facility, and I heard others talking about it at length as well. So the issue isn’t going to disappear unless Congress decides to amend the Stark Law, which is unlikely to happen anytime soon.

Once you resign yourself to the fact that this is the current reality, you need to ask yourself, “What should I do, now that I know this?” The answer is, you need to be aware of it, and you need to take charge of the situation by bringing it to the surface.

When your doctor recommends that you go to a specifc facility, it’s completely appropriate for you to ask whether he or she has any ownership interest in that business. If you’re already at the facility, it’s completely appropriate for you to ask the prosthetist if he or she is employed by a physician/physician group or to identify who the owner(s) of the business are.

Conclusion

The Stark Law does permit doctors to refer their patients to a prosthetic facility they own, provided they set up the arrangement consistent with the requirements of the “ancillary services” exception. Your job as a patient is to understand when that’s happen-ing, so that you can decide whether you’re comfortable with that kind of arrangement or not. If you are, then receiving care at the physician-owned location is an informed choice you’re making. If you aren’t, then you’ll look for treatment elsewhere. Either way, it’s your choice, and you’re making it based upon a complete understanding of the relationships between the relevant parties.

As I wrote in my “skill by association” blog post several months ago:

[t]he only people who have a vested inter-est in changing things are the ones who are in many ways the least equipped to do so – the pain-pump-pushing, emotion-ally shattered new amputees who have to deal with the person sitting next to them talking incomprehensibly about artifcial limbs.

Is that fair? Probably not. Losing an arm or leg is one of the most disorienting, disempowering experiences a person can have. However, at some point after our amputations, we have to take that frst step toward reclaiming control of our lives. This seems like as good a place as any to start.

When your doctor recommends that you go to a specifc facility, it’s completely appro-priate for you to ask whether he or she has any ownership interest in that business.

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