Perverse Incentives Promote Higher Costs | Robert Nelson, MD | LinkedIn

I recently had a conversation with a local neurologist who I wished to utilize as a referral physician for my patients. He is employed by a large well-respected healthcare system. By all measures, the employed doctors and the organization are top-notch in the industry and represent all the major specialties. He was detailing some of the services that they could provide to outpatients in their clinic when I asked whether he performed diagnostic or therapeutic lumbar punctures on non-emergent stable patients. He informed me that the average reimbursement for him to do an LP in the office was about $40 and that he could see two patients in the time it took him to do one LP, which reimburse about 3x the fee compared to the LP. So $40 vs. $240 for an hour of work: That’s a no-brainer.

So how do their patients get the lumbar puncture if they need it? They are referred to the Radiology group of the same employer where the procedure is done under ultrasound guidance (cheater scope) which is billed at $1500. Before you say that ultrasound guided LP’s are so much safer, etc… The use of ultrasound technology and the marginal increase in safety in low risk patients and does not justify the difference in cost. Most all neurologists and neurosurgeons will confirm this.

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