Doctors invested in an outpatient surgery center perform, on average, twice as many surgeries as doctors with no such financial stake, according to a new study from researchers at the University of Michigan Health System. In what some have called a “triple dip” these physician-owners of surgery centers not only collect professional fees for their services, but also share in their facilities’ profits and benefit from the increased value of their investment.

 

“Our data suggest that physician behavior changes after investment in an outpatient facility,” says John Hollingsworth, a Robert Wood Johnson Clinical Scholar at the U-M Medical School, who authored the study in the April issue of Health Affairs. “This creates a potential conflict of interest."

 

Hollingsworth says that one potential explanation for the study’s 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. 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 researchers say while the number of surgery centers has increased nearly 50 percent over the last decade, largely driven by the investment of physicians who had a stake in 83 percent of these facilities. For doctors, investment may give them more control over their practice environment, from scheduling cases to purchasing surgical equipment. For patients, these centers often have shorter wait times than hospitals and may provide more amenities.

 

Hollingsworth says while surgery centers provide some advantages for surgeons and patients it is important to better understand the implications of the study’s 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,” he says.