Doctors who own their own outpatient surgery centers perform nearly twice as many surgeries as those who don't, according to a study published this week in Health Affairs.

Using data from a Florida health database listing all outpatient surgeries performed in the state between 2003 and 2005, the researchers found that physician-owners of surgery centers, called surgicenters, performed, typically, hundreds more of one of several common procedures than their non-owning counterparts.

This could be a concern because of the possibility that doctors self-refer more of their patients for surgery if they stand to gain more financially, warns the study's author.

"There is a potential conflict of interest with ownership since physician-owners of a surgery center collect not only their professional fee for the surgical service provided, but also share in the facility's profits," says Dr. John Hollingsworth, a urologist, Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan in Ann Arbor and lead author of the paper.

How the study worked

For the study, the scientists looked at five common outpatient procedures: carpal tunnel surgery, cataract removal, colonoscopy, knee arthroscopy and a chronic ear infection treatment, usually performed on kids, called myringotomy with tympanostomy tube placement.

The researchers chose these procedures because indications "can be a little gray at times," observes Hollingsworth.

"By nature, outpatient surgery is somewhat discretionary. It's different from emergent procedures," he tells DOTmed News.

And to make sure they were comparing similar groups, the researchers had to control for different population features, as patients who saw physician-owners were on average somewhat healthier. But even controlling for that, it seems physician-owners performed 366 more colonoscopies, 204 cataract excisions and 53 knee arthroscopies than non-owning doctors.

In an interesting twist, the researchers also checked to see if physicians who owned surgical centers performed more procedures than in the years before they bought into one. To do this, they tracked physicians who before 1999 didn't own a center, and compared their rate of surgery after they bought into one in 2000. What they found was intriguing: a 50 percent increase in procedures.

Self-referral questions

Under federal provisions passed in the 1990s to limit the exploitation of self-referral, collectively known as the Stark law, physicians are restricted in what types of centers they can own. But there are carve-outs for the surgicenters, also called ambulatory surgical centers.

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