So-What Study Finds That ASC Owners Perform More Surgery

ASC physician-owners perform 52% to 111% more surgeries than physicians who aren't facility co-owners, according to a recent study by the Workers Compensation Research Institute. In addition, the average surgeon does 14% to 22% more surgeries after becoming an owner than before.

For the study, researchers at the Cambridge, Mass.-based not-for-profit organization tracked the numbers of knee, shoulder and wrist arthroscopies and carpal tunnel release surgeries that 941 Florida orthopedic surgeons performed between 1997 and 2004. Some of the physicians whose practices were observed were or became ASC owners during this time.

Study author Christine A. Yee suggests that the increased surgical volume is a direct result of the financial incentives that physician-owners share in, which may raise self-referral concerns among policymakers. She also notes that the efficiency that ASCs offer over hospitals fosters volume. "ASCs are more likely to recruit high-volume surgeons to become owners," she says. "Similarly, high-volume surgeons are more likely to become owners of surgery centers."

The Ambulatory Surgery Center Association, however, disputes the research as "misleading and sensational due to the faulty assumptions and unsubstantiated conclusions the authors make." Its data is nearly 10 years old, it doesn't distinguish whether physicians are actually owners and it doesn't prove that any of the surgeries performed were unnecessary.

The surgical volume isn't just about financial incentives, says David Shapiro, MD, the association's immediate past president and board member. "ASCs have a 40-year history of quality outcomes and patient satisfaction," he says, adding that physician-ownership has led to technological advances that have fueled those outcomes. "The report presents statistical models while ignoring the obvious fact that ASCs' cost-effective option makes absolute sense."

David Bernard