If Doctor Recommends Surgery, Has Interest in
Surgery Center, You May Want Second Opinion
Study finds physicians with ownership in surgery
center do twice as many operations
April
7, 2010 If your doctor is recommending surgery, you may want to see if
he or she owns an interest in the surgery center where the operation is
to be performed. When doctors become invested in an outpatient surgery
center, they perform on average twice as many surgeries as doctors with
no such financial stake, according to a new study from the University of
Michigan Health System.
Our data suggest that physician behavior changes
after investment in an outpatient facility. Through what some have
labeled the triple dip, physician owners of surgery centers not only
collect a professional fee for the services provided, but also share in
their facilitys profits and the increased value of their investment.
This creates a potential conflict of interest, says study author John
Hollingsworth, M.D., M.S., a
Robert Wood Johnson Clinical Scholar at the
U-M Medical School.
To the extent that owners are motivated by
profit, one potential explanation for our findings is that these
physicians may be lowering their thresholds for treating patients with
these common outpatient procedures, Hollingsworth adds.
The study looked at all patients in Florida who
underwent one of five common outpatient procedures: carpal tunnel
release, cataract excision, colonoscopy, knee arthroscopy and
myringotomy with tympanostomy tube placement (a procedure to insert
tubes in the ear).
The researchers determined which doctors were
owners of a surgery center. They then compared surgery use among owners
in two time periodsbefore and after they acquired ownershipwith that
of physicians who remained non-owners.
Results of the study appear in the April issue of
Health Affairs. The findings include:
Owners operated on an average of twice as many
patients as non-owners.
While caseloads increased overall between the
earlier and later time periods for all physicians, the increases were
more rapid and dramatic among owners.
The number of surgery centers has increased nearly
50 percent over the last decade, largely driven by the investment of
physicians, who had a stake in 83 percent of these facilities. For
doctors, investment may give them more control over their practice
environment, from scheduling cases to purchasing surgical equipment. For
patients, these centers often have shorter wait times than hospitals and
may provide more amenities.
There are some definite advantages for surgeons,
as well as patients, associated with care at surgery centers. However,
we need to better understand the implications of these new findings, in
particular their overall effect on health care expenditures. Insofar as
our results are due to lowered treatment thresholds, policymakers should
consider, at the very least, requiring all physicians to disclose their
financial interests to their patients, Hollingsworth says.
Additional authors: Zaojun Ye, research associate
in urology at U-M; Seth A. Strope, assistant professor of surgery at
Washington University in St. Louis; Sarah L. Krein, research associate
in internal medicine at U-M; Ann T. Hollenbeck, partner at Honigman
Miller Schwartz and Cohn LLP in Detroit; and Brent K. Hollenbeck,
associate professor of urology at U-M
Funding: Hollingsworth is a Robert Wood Johnson
Clinical Scholar; Hollenbeck is supported in part by a Mentored Research
Scholarship Grant from the
American Cancer Society
