"Our data suggest that physician behavior changes after investment in an outpatient facility. Through what some have labeled the 'triple dip,' physician owners of surgery centers not only collect a professional fee for the services provided, but also share in their facility's profits and the increased value of their investment," study author Dr. John Hollingsworth of the University of Michigan Health System said in a statement. "This creates a potential conflict of interest."
The study, published in the journal Health Affairs, found outpatient surgical owners operated on an average of twice as many patients as non-owners and, while caseloads increased overall during the study period, the increases were more rapid and dramatic among the outpatient facility owners.
In response to the study, the Ambulatory Surgery Center Advocacy Committee, a group of ambulatory surgery center operators, state associations, and the ASC Association said ambulatory surgery centers are an increasing trend in healthcare made possible by changes in surgical techniques that are less invasive and drive surgeries from the hospital setting to outpatient clinics.
Ambulatory surgery center have resulted in high patient satisfaction rates, high levels of expertise, lower costs, Medicare savings and increased access to screenings such as colonoscopies.
Andrew Hayek - chairman of the Ambulatory Surgery Center Advocacy Committee and president and chief executive officer of Surgical Care Affiliates, 5,200 Medicare-certified outpatient facilities nationwide -- said in 2009, KNG Health Consulting produced a report, which found that 70 percent of ASC volume growth between 2000 and 2007 was due to migration from hospitals to ASCs.
"The two most frequent procedures done in ambulatory surgery centers are colonoscopies and cataract removal and the indications that a patient needs these two procedures are very clear," Hayek told United Press International. "Our research shows physicians choose where to perform surgery based on patient care, clinical quality, efficiency and cost savings for their patients -- these are areas in which ambulatory surgery centers excel.
"At Surgical Care Affiliates, for example, 40 percent of our case volume is performed by physicians who are not investors, which reflects physicians' focus on choosing a high-quality, low-cost site of care for their patients."