It's not #1, because under federal laws like the Stark Law, a doctor generally cannot get a bonus for ordering an independent lab test, scan, or blood work sent to an outside facility.

Well, I have a tiny bit of experience with this. My GP and I had a couple of conversations as he got within a decade of retirement age, and he wondered if he should sell his practice to another doctor, or to a roll-up of private equity, as has become the fashion.

As a sole proprietor, he made more money by seeing more patients. If he sold to PE, there are “daily counts” of how many patients seen, time spent, and so on. Maybe it doesn’t affect some doctors, but I’m sure it does for others. Additionally his practice was too small to interest PE, and once he made the decision he “built” it, first by adding space in the strip mall where he was located, then adding additional (young) doctors, and finally changing the name of the practice to something generic.

Additionally, (and I do not know if this was part of it or not, we didn’t really get *that* detailed about things), he brought the “lab testing” in house, so instead of sending things out, much of that work was done in a couple of rooms next door. The billing was separated too, so I paid for “the labs” in one room, and settled the medical bills at checkout.

As I am interested in such things, I had similar conversations with my Dentist (who retired, and sold the business to a young couple rather than a roll-up) and even my veterinarian practice (Mrs. Goofy was friends with one of the vets). It’s been two years and the vets report “no changes”, which is good. The dental practice has, after 20 years of never changing an employee, turned over every single assistant, hygienist, even the receptionist.

(No, I[m not having these kinds of conversations with the new doc or dentist; I built up a trust level with the older ones over 20 years, an as they knew I had business experience, investing interest, and some prowess we would have conversations not usually found in the small rooms of a normal practice. I don’t have that with the new people, and that’s OK. It’s strictly fee-for-service now.)