Physician-owners of ASCs perform twice as many surgeries as their non-owner colleagues do, according to research appearing in the April issue of Health Affairs.

The study's authors say that discrepancy could be remedied by changes in federal law that would reduce facility fee payments to dilute ownership incentives and government reforms that would discourage the overuse of fee-for-service payment rewards.

In a review of carpal tunnel releases, cataract excisions, colonoscopies, knee arthroscopies and ear tube placements performed in Florida between 2003 and 2005 - where databases allow for the tracking of individual surgeons - the researchers compared facility use among owners and non-owners. They discovered caseloads increased for all physicians, but the increases were more rapid among physician-owners and would translate into a physician-owner performing an additional 16 carpal tunnel releases, 204 cataract removals, 366 colonoscopies, 53 knee arthroscopies and 15 ear tube placements each year.

Urologist John Hollingsworth, MD, a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan in Ann Arbor and the study's lead author, says physician-owners might already be high-volume surgeons who are more inclined to refer patients to facilities where they receive more timely care and enjoy better amenities, but he and his co-authors warn "an ownership stake entitles physicians to a share of the facility's profits from self-referrals, (which) can create a potential conflict of interest between physicians' financial incentives and patients' clinical needs."

While Dr. Hollingsworth says the study's findings don't necessarily demand drastic federal policy changes, he believes the findings should raise concerns over healthcare spending in the outpatient sector and "shines some light in areas where some of my surgery brethren might be uncomfortable."

Daniel Cook