Flawed Conclusions: Physician Ownership Linked to Higher Surgery Volume

There has been a lot of buzz on the web this past week concerning an article in this month's Health Affairs titled: Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries.  In this article, John M. Hollingsworth, M.D., of the University of Michigan in Ann Arbor, and colleagues used  Ambulatory Surgery Databases to analyze data from Florida from 2003 to 2005. They looked at all patients in Florida who underwent one
of five common outpatient procedures including  cataract extraction. They compared the number of surgeries
performed among ASC owners before and after they acquired ASC ownership with
that of physicians who were non-owners. They found that owners performed  twice as many procedures as non-owners.  Assuming that these are the facts of the study, you can't argue with numbers; what I have a problem with is the author's conclusion:

"To the extent that owners are motivated by profit, one potential
explanation for our findings is that these physicians may be lowering
their thresholds for treating patients with these common outpatient
procedures."

I find this conclusion offensive.  Lowering treatment parameters to generate profits?  Cataracts cause a decrease in one's vision, what patient is going to submit to eye surgery without the symptoms that warrant this surgery?  I have been a part-owner in River Drive Surgery Center for the past 8 years.  During this time, my cataract volume has certainly increased.  It is NOT because  profits have lowered by treatment parameters!  Here are some of the reasons that I can think of of the top of my head (I find it amazing the that author's of this paper couldn't come up with any of these):

• Patient friendliness.  Patients find the ASC setting much less
  daunting than the hospital setting.  They are not shuffled from
  department to department, they are treated as individuals in a very
  caring matter.
• Efficiencies. ASC's are much more efficient than hospitals.  When I did my cataract surgery in a hospital, I found myself sitting around for the room to be ready.  It was difficult to do more than 1 procedure per hour.  In my ASC, there is no waiting for a room, and no down time.  I am now able to perform 6 cataracts an hour, without rushing.
• Costs.  ASC's are able to deliver care that is far superior than hospitals at a fraction of the cost.  This saves insurance companies as well as patients money.
• Equipment.  By owning an ASC, surgeon-owners are now able to continually upgrade equipment.  At River Drive, we pride ourselves on always having the most current, cutting edge equipment.  This allows us to provide superior care to our patients!
• Patient Experience.  We strive ourselves into providing a superior patient experience and outcome.  We generally succeed, and because we do, patients are apt to refer their friends and family to us for their surgery.  Success breeds success!

In conclusion, I agree with Dr. Hollingsworth, owners of ASC's do more cataract surgery!  However, this is NOT because we have lowered our operating standards.  It IS because we strive to do a better job.  Obviously, we are succeeding!

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