Orthopedic surgeons with ownership interests in ASCs or specialty hospitals are more likely to perform common outpatient procedures than physician non-owners, according to new research published in the August issue of Archives of Surgery.
For the study, which was supported by the Idaho Hospital Association and Georgetown University, Jean M. Mitchell, PhD, a professor at the Georgetown Public Policy Institute in Washington, D.C., analyzed 5 years of claims data from a large private insurer in Idaho.
In a direct comparison of outpatient orthopedic procedures performed by surgeons with ownership interests in ASCs or specialty hospitals and surgeon non-owners, Dr. Mitchell discovered that patients of physician-owners were 54% to 129% more likely to undergo carpal tunnel repair, 33% to 100% more likely to have their rotator cuffs repaired and 27% to 78% more likely to undergo arthroscopic surgery.
Dr. Mitchell says her research "clearly suggests that financial incentives linked to ownership of either specialty hospitals or ambulatory surgery centers influence physicians' practice patterns."
This is the second time in as many years that Dr. Mitchell has focused her research on physician-owners. In the July 2008 issue of the journal Medical Care, she reported that physician-owners of 2 specialty hospitals in Tulsa, Okla., were more likely to refer patients for surgery and imaging procedures than non-owners were.
David Shapiro, MD, chair of the Ambulatory Surgery Center Association and a partner at the Ambulatory Surgery Company, a consulting firm based in Tallahassee, Fla., voices concerns with the study's findings, which he says are based on a limited sample size and restricted patient population.
"Any assertion made by Dr. Mitchell that the surgeries performed were not medically necessary is not supported by the data, and as a physician, my No. 1 priority is to provide the highest quality care and medical expertise to my patients," says Dr. Shapiro. "I believe that standard extends to my colleagues in ASCs throughout the country."
The decision to undergo the orthopedic-repair procedures identified in this study involve a mutual decision between the physician and patient, most likely after more conservative treatment options have failed, says Dr. Shapiro. He says the drivers of increased surgical volumes in ASCs are patient-centered and based on greater conveniences and high satisfaction rates, not the financial incentives of surgeons.
Daniel Cook
