With specialty hospitals and ambulatory surgery centers becoming more common, legislators at all levels need to be wary when such facilities are physician owned, according to Dr. Jean Mitchell of Georgetown University. The incentives that go along with ownership heavily influence practice patterns for doctors, Mitchell writes in a report published in the latest issue of the Archives of Surgery. In other words, more patients are scheduled for procedures by doctors who own a facility than by those who don't.
"[F]requency of use for each of the orthopedic procedures examined was significantly higher for physician owners compared with physician nonowners," Mitchell said, as reported by MedPage Today.
While Mitchell's data is limited to the state of Idaho, she used data from 1995 through 2005. She also found that of the 42 ambulatory surgery centers in the state, only three are not owned by referring doctors.
The study specifically looked at results for three procedures: carpal tunnel surgery, rotator cuff repair and arthroscopic knee surgery. Patients who underwent carpal tunnel surgery were 54 to 129 percent more likely to do so at a surgeon-owned facility, when compared with nonowned facilities. The odds of a patient undergoing a rotator cuff surgery increased between 33 and 100 percent under such circumstances; arthroscopic surgical patients were between 27 percent and 78 percent more likely to go under the knife at facilities where doctors doubled as owners.
Mitchell believes that such patterns could have a domino effect on costs.
"The increased utilization that characterizes physician self-referral arrangements will continue to lead to higher health insurance premiums," she wrote. "[W]hich, in turn, are likely to result in more uninsured and underinsured persons."