A study of referral patterns in the Philadelphia and Pittsburgh metropolitan areas indicates physicians who refer the most patients to physician-owned ambulatory surgery centers disproportionately send privately insured patients to these facilities and Medicaid enrollees to hospital outpatient departments.
Published online in Health Affairs, the study examines whether having an ownership stake in an ASC would affect the types of patients a physician would refer to the facility. Pennsylvania files do not indicate whether a hospital or facility is physician owned, the study said. We worked with the Hospital (& Healthsystem) Association of Pennsylvania, High Mark Blue Cross (and) Blue Shield, and Independence Blue Cross (and) Blue Shield to identify physician ownership.
Data were taken from 2003 and showed physician-owned ASCs accounted for a relatively small portion of the market: Pennsylvania discharges that year included 1,008,034 discharges from 28 physician-owned ASCs, 80 hospital outpatient departments, six for-profit ASCs and nine not-for-profit centers. Led by Jon Gabel of the University of Chicago, researchers found that for the top 50% of physician referrals to ambulatory surgery centers, 45% of Medicaid patients were referred to hospital outpatient departments, while 55% were referred to physician-owned centers. By comparison, physician owners sent 92% of privately insured patients to physician-owned ASCs.
In a seemingly contradictory statistic, 98% of uninsured and self-pay patients were referred to physician-owned ASCs. But a closer look showed that these patients most often received cosmetic surgery, suggesting that they received a service not covered by their health plan and probably had some sort of coverage, the study said.
The report concluded with remarks on what has been a long-standing debate on Capitol Hill: that physician ownership will have a negative effect on the uninsured and underinsured. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment, the study said. The findings from this paper are consistent with that fear. -- by Jessica Zigmond
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