Doctors who own surgical centers perform twice as many surgeries as doctors who don’t, according to an article in Health Affairs magazine that recently came to our attention.

“Many physicians confronting declining reimbursement from insurers have invested in ambulatory surgery centers, where they perform outpatient surgical and diagnostic procedures,” reads the abstract of the article, published in April 2010. “An ownership stake entitles physicians to a share of the facility’s profits from self-referrals. This arrangement can create a potential conflict of interest between physicians’ financial incentives and patients’ clinical needs. Our analysis of Florida data for five common procedures revealed a significant association between physician-ownership and higher surgical volume. Possible remedies include revising federal law to require disclosure of investment arrangements; reducing facility payments to dilute ownership incentives; and reforms (such as accountable care organizations) that discourage an excessive rate of procedures.”

The article, whose lead author is Dr. John M. Hollingsworth, a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan in Ann Arbor, reviewed carpal tunnel releases, cataract excisions, colonoscopies, knee arthroscopies and ear tube placements performed in Florida between 2003 and 2005.

The article did not conclude that there was a cause-and-effect relationship; it did say that high-volume surgeons may choose an ownership position for convenience, among other things. But it did point out that the ownership stake made for a potential conflict of interests.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...