To the Editor:
You sound a necessary alarm about the growing practice of physicians referring patients to health-care facilities in which they have a financial interest (front page, June 2). However, you overlooked an area of health care in which this practice is extensive and expensive: home infusion therapy, particularly for AIDS patients.
Infusion therapy -- medications and nutrients delivered intravenously or through feeding tubes -- used to be available only in hospitals. But since the early 1980's, these treatments increasingly have been provided to acquired immune deficiency syndrome patients in their homes, enabling them to avoid costly and debilitating hospital stays.
But as home infusion companies began to compete for patients, they offered physicians financial incentives to refer patients to them. As documented in our recent report, "Making a Killing on AIDS: Home Health Care and Pentamidine," these deals include limited partnerships, stock options and clinical consulting fees. Especially in those cases when physicians provide the home infusion treatments, the potential exists for overuse because the doctor has an incentive to perform more procedures than are necessary. Such arrangements elevate physician profits over patient care.
Take the example of T2 Medical, a Georgia-based national home-infusion company with local offices in New York City and on Long Island. T2's partnerships with physicians enrich doctors and help the company enjoy 50 percent gross profit margins, but they inflate the cost of patient care. Cytovene, a drug that prevents virally induced blindness in AIDS patients, costs $4,000 for two weeks when provided by T2 in Atlanta; a local competitor charges $1,100.
To protect vulnerable people with AIDS, and to curb health care inflation, Congress should prohibit by law physician partnerships in infusion companies, and indeed, in all health-care facilities. Such conflicts of interest are medically and morally offensive.
Commissioner of Consumer Affairs
New York, June 12, 1991