When Surgeons Become Owners of Surgery Centers, They Do More Surgeries, Says New WCRI Study

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The last two decades have seen substantial growth in the use of ambulatory surgical centers (ASC) and the number of physicians who have ownership interests in these centers. In Florida, orthopedic surgeons who owned ASCs did between 52 and 111 percent more surgery than orthopedic surgeons who were not owners, according to a new study from the Workers Compensation Research Institute (WCRI).

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This is just one example of physician self-referral—a growing issue being addressed by state and federal poliymakers concerned about spiraling health care costs.

Orthopedic surgeons who owned ambulatory surgical centers (ASC) did between 52 and 111 percent more surgery than orthopedic surgeons who were not owners. One of the more important reasons for this is the financial incentives arising from ownership, according to a new study of ASCs in Florida from the Workers Compensation Research Institute (WCRI). Surgeons who are owners not only are paid the surgeon’s fee, but also receive a share of the profits of the surgery center.

The study, Why Surgeon Owners of Ambulatory Surgical Centers Do More Surgery Than Non-Owners, examined 941 surgeons – some of whom ultimately became owners of surgery centers. It compared the number of knee, shoulder, and wrist surgeries that each surgeon did before becoming an owner with the number performed after becoming an owner. The study found that the average surgeon did 14-22 percent more surgery after becoming an ASC owner. The study did not determine whether or not these additional surgeries were necessary.

The study also found other important reasons why orthopedic surgeons who own ASCs do more surgery than orthopedic surgeons who are not owners. According to the study’s author, Dr. Christine Yee, “ASCs are more likely to recruit high-volume surgeons to become owners. Similarly, high-volume surgeons are more likely to become owners of surgery centers.” Dr. Yee also noted that surgery centers are often more efficient than hospital outpatient departments, so the surgeons were able to schedule and perform more surgeries once they were affiliated with surgery centers.

“This is just one example of physician self-referral – a growing issue being addressed by state and federal policymakers concerned about spiraling health care costs,” commented Dr. Richard Victor, the Institute’s Executive Director. “As payers limit price increases for physician services, the physicians look for other avenues to supplement their income – ownership of surgery centers and MRI facilities as well as physician dispensing of prescription drugs have become much more common.”

For more information regarding this report or to purchase it, visit: http://www.wcrinet.org.

ABOUT WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. WCRI is recognized as a leader in providing objective, credible, and high-quality information about public policy issues involving workers' compensation systems. WCRI's members include employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand. For more information about WCRI, visit: http://www.wcrinet.org.

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Andrew Kenneally
Workers Compensation Research Institute
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