>Finally, the cardiologist you see in the office is almost certainly not doing stents for you as those are very distinct skillsets (in the US).
Umm, what? No. It's exceedingly rare for an interventional cardiologist in the US not to do office work. The average number of PCI/yr is like 50 or something. Plus if one spent all one's time in the cath lab, they'd have a spinal fusion, knee replacement, thyroid cancer, and cataracts.
But what you are trying to get at is that there is law about self-referral ("Stark law") but in reality there are exceptions that render it fairly useless
> But what you are trying to get at is that there is law about self-referral ("Stark law") but in reality there are exceptions that render it fairly useless
What are the exceptions that render it useless? I have never heard of them in my 10+ years of hearing about it.
I did not know that I-cards do office work, not my area of medicine.
IR is in the angio lab daily without cataracts, thyroid cancer, etc., so that part of your statement is clearly not true.
I also don't understand what you mean about knee replacements... humans are generally capable of standing without requiring surgical intervention.
> What are the exceptions that render it useless? I have never heard of them in my 10+ years of hearing about it.
It sounds so unlikely that there is a blanket rule that you can’t refer to something you have a shareholding in. If you own a shareholding in a hospital you work at, you can’t refer internally for a test?
I just don’t believe that.
Edit: I did some hunting. ‘Per click’ payments or bonus payments based on volume are illegal. Rents must be fair market etc.
> It looks like owning a chunk of the place you refer to is fine
The article you link to says that anyone can be liable even if she didn't realize her referral violates the law.
I cannot imagine any reasonable physician risking this after the decades of training required to get a doctor. I would not, for sure.
From the article you sent:
Some of the most widely used regulatory exceptions are longstanding and foundational across healthcare organizations. These include:
In-office ancillary services exception: Allows physicians in the same practice to refer patients internally for DHS such as lab work or therapy, as long as certain supervision, location, and billing criteria are met.
Rental of office space exception: Permits lease agreements between a physician and an entity, but only if the space is used exclusively for legitimate business purposes, rent is fair market value, and the agreement is in writing for at least one year.
Employment exception: Protects compensation arrangements between hospitals and employed physicians, as long as compensation is consistent with fair market value and is not based on referral volume.
Personal service arrangements exception: Covers contracts where a physician provides services (like medical directorships) to a DHS entity. The agreement must outline duties, last at least one year, and pay a fixed, fair-market-value fee unrelated to referrals.
Each of these exceptions includes detailed requirements, and missing even one element, like failing to document the arrangement in writing, can render the exception invalid. This is especially important when physicians have investment interests in joint ventures or ancillary service providers.
At the diffuse 401k ownership level, individual actions are not relevant - the Stark law is clearly dealing with the first case and that was how this whole discussion began.
Nah, by 2021 Prasad's reputation had gone into the shitter
I actually think he's just grifting and the notoriety he achieved went to his head. His pre-2020 takes were better reasoned and at least worth engaging with. I could see his takes shifting with popular misinformation ideas in real time as it contributed to his success
IMO this is worse than if he were just wrong. I think he knows better, but then he talked himself into a box, and doesn't have the people and political skills to survive on a bigger stage.
One can make the argument that Prasad has his title of Professor due to the stature he gained with his ill-founded contrarianism and subsequent notoriety. He was promoted in 2022 at the somewhat astonishing age of 39, at a time when his actual scientific output was not particularly high
The whole thing is kind of fascinating. Some of his "skeptic" fellow travelers like Cifu and Mandrola still carry water for him. Presumably he has a champion in Bob Wachter who also likes to fly the "contrarian" flag.
COVID really brought out a lot of crazies from UCSF and Stanford
Same here. Also, I studied Latin and Greek in school and have kept studying them in various ways since then. I think this test is significantly biased toward vocabulary with these origins; dozens of tested words are directly recognizable as the "ordinary" Latin or Greek words for some concepts, or direct combinations of common Latin or Greek roots.
A lot of prestigious and scholarly vocabulary in English has come in through Latin and Greek (at various points in the history of English!), so you can learn that vocabulary or make it more memorable or more transparent either by studying Latin and Greek as languages, or just by studying some of their common morphemes (e.g. there are lists of Latin and Greek roots that may be given to medical or life sciences students to help them learn to recognize the meaning of terminology coined from these languages, even without speaking the languages).
But I think it's actually unrepresentative of the English language as a whole if we're literally thinking about vocabulary size rather than historical prestige of some part of the vocabulary. For example, foreign foods like "nori", "pandan", "dolma", "vichyssoise"[1], or "berbere" are often used as English words and would probably appear in large English dictionaries nowadays. None of that was tested in this quiz. I saw one foreign political term which I guessed at, and one or two German loanwords which I knew (I've also studied German), and almost everything else was Latin or Greek origins!
[1] apparently coined by a French-speaking American based on French roots?
Of course. American varsity soccer players play ~5 times a week for four months a year, August through November.
February through April is the Spring season and varsity teams are forbidden from playing too much. D1 and D2 teams can only train 8 hours per week, of which at most 4 hours per week may be coached!
And then 4 months of the year are off-season and there is no structured training at all!
This is a ridiculously small amount of time compared to a 15 year old Spanish kid playing in a farm team.
And they're doing this part-time stuff until they're 22 or 23. A typical European professional player would have been playing full time since they were 16.
> college soccer is essentially another international semi-pro league
... except no where near at the level of European farm teams.
Yeah, I just literally use table sugar, which is 1:1 glucose:fructose. Maurten et al using 1:0.8, close enough! And I don't believe the hydrogel thing is any magic, just marketing.
But yeah, this is a thing. There is some gut distress for sure at higher levels of intake. See guy finishing second -- still under 2 hrs! immediately puking, which is fairly common at the high intakes. I've heard of Blumenfeld (the triathlete) taking like 200g/hr or more. Insane. Though he's had some epic GI disasters too, lol.
The hydrogel textures (not maurten but naak, but close enough), for me, allow while racing to swallow a full 40g gel in half a second without feeling the sugary taste a lot, which is nice. Compared to thick syrup-like gels, it’s a way better experience in a marathon.
But I only buy for actual races, rest of the time, I do my own 1:0.8 mix with a bit of thickener, in soft flasks. Much more cost effective.
Umm, what? No. It's exceedingly rare for an interventional cardiologist in the US not to do office work. The average number of PCI/yr is like 50 or something. Plus if one spent all one's time in the cath lab, they'd have a spinal fusion, knee replacement, thyroid cancer, and cataracts.
But what you are trying to get at is that there is law about self-referral ("Stark law") but in reality there are exceptions that render it fairly useless