Docs/Owners at Surgery Centers Operate More Often, Says Study

Doctors invested in outpatient surgery centers perform about twice as many surgeries as doctors with no such financial stake, according to a new study in the April issue of Health Affairs.

"Our data suggest that physician behavior changes after investment in an outpatient facility," said study author John Hollingsworth, MD, a Robert Wood Johnson Clinical Scholar at the University of Michigan Medical School, in Ann Arbor, in a media release.

"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 facility's profits and the increased value of their investment," Hollingsworth said. "This creates a potential conflict of interest. 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."

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 in the ear.

The researchers determined which doctors were owners of a surgery center. They then compared surgery use among owners in two time periods—before and after they acquired ownership—with that of physicians who remained non-owners.

The study also found that while caseloads increased overall between the earlier and later time periods for all physicians—regardless of whether or not they had a financial stake in the surgery center—the increases were more rapid and dramatic among owners.

The number of surgery centers has increased nearly 50% over the last decade, largely driven by the investment of physicians, who had a stake in 83% of these facilities. Investment gives doctors more control over their practice, from scheduling to purchasing equipment. For patients, these centers often have shorter wait times than hospitals, according to the report.

"There are some definite advantages for surgeons, as well as patients, associated with care at surgery centers," Hollingsworth said. "However, we need to better understand the implications of these new findings, in particular their overall effect on healthcare 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."