Physicians who refer the most patients to physician-owned ambulatory surgical centers (ASCs) disproportionately send privately insured patients to these ASCs while sending Medicaid enrollees to hospital outpatient departments, according to a new study of referral patterns in the Pittsburgh and Philadelphia metropolitan areas, published March 18 as a Health Affairs web exclusive.
The study was designed to test whether having an ownership stake in an ASC would affect the types of patients a physician would refer to the facility. Because no public records identify physician-owners of ASCs, lead author Jon Gabel and colleagues analyzed the referral patterns of physicians who accounted for the top 50 percent of physician-referrers to each physician-owned ASC, then compared referral patterns for these physicians with the referral patterns of high referrers to hospital outpatient departments and nonphysician-owned ASCs.
They found that in calendar year 2003, the top 50 percent of physician-referrers to physician-owned ASCs in the two metropolitan areas referred strikingly few Medicaid and self-pay/indigent patients either to the physician-owned ASC or to other facilities. Even though 11 percent of Pennsylvanians are enrolled in Medicaid and 10 percent of the state’s population is uninsured, Medicaid patients made up only 1.4 percent of all referrals for these high referrers/physician-owners, and self-pay indigent patients accounted for only 1.8 percent of referrals for this group. Read the abstract.: