Patients treated by doctors who had ownership interests in a specialty hospital or ambulatory surgery center were more likely to receive arthroscopic knee surgery or carpal tunnel and rotator cuff surgical repair than patients treated by physicians who had no such interests, according to a new study in the Archives of Surgery based on an analysis of five years of claims data from a large private insurer in Idaho.
Ownership sways surgery rates: study
The report, written by Jean Mitchell of the Georgetown Public Policy Institute at Georgetown University in Washington, examined outpatient surgical data from ambulatory surgery centers, specialty hospitals and community hospitals in Idaho for 2003 through 2007. The information came from claims data supplied by an unidentified private insurer that was reported to cover 326,000 individuals, or 40% of the regional market.
For carpal tunnel treatment, 33.1% of patients seen by physicians with ownership interests received surgery in 2003, compared with 24.2% of patients seen by doctors without ownership interests. In 2007, the gap widened to 32.8% of patients seen by doctors with ownership interest undergoing surgery compared with 17.2% for patients whose doctors had no ownership stake.
In 2003, the report said the "frequency of use" rate was 13.8% for rotator cuff patients whose doctors had ownership stakes and 13% for patients of those who did not. By 2003, the gap widened to 21.5% for patients of physician owners and 13.1% for patients of physicians without ownership stakes.
For patients with ligament sprains, cartilage tears, leg pain or other lower leg problems, there was a 33.4% rate of frequency of use of arthroscopic knee surgery for physician owners and a 30.5% rate for doctors with no ownership interest. For 2007, the surgery rate was 30.5% among patients of physician owners and 25% for patients whose doctors who had no ownership stake in 2003.
"These procedures are estimated to cost about $5,000 per case, which is two to three times higher than a course of physical and medical therapy," the report said. "If a substantial proportion of the increased frequency of surgery by physician owners is performed in marginal cases, then a share of the greater expenditures associated with self-referral represents inefficient spending."
The report concluded: "The increased utilization that characterizes physician self-referral arrangements will continue to lead to higher health insurance premiums, which in turn is likely to result in more uninsured and underinsured persons."
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