Physician ownership of diagnostic and therapeutic equipment deserves transparent discussion of the risks and benefits, supported by data where available.
Pat Fulgham, MD, of Urology Clinics of North Texas, Dallas, summarized the literature on this subject at the 2010 AUA annual meeting in San Francisco, concluding that the evidence is weak or absent to prove that ownership increases utilization.
In order to further study this question, three large urology groups with different imaging ownership models recently conducted a comparison of CT utilization rates in their respective practices. One of the authors (Dr. Dowling) presented these data at the 2010 Large Urology Group Practice Association Symposium, which was held during the AUA annual meeting in San Francisco.
For the study, three large urology groups were chosen to reflect different ownership models. Integrated Medical Professionals (IMP) in Melville, NY, is a group of 87 urologists with no ownership of CT; The Urology Center of Colorado (TUCC), Denver, is a group of 18 urologists who own equipment and capture 100% of CT scans ordered by their physicians; and Urology Associates of North Texas (UANT), is a 49-physician group whose physicians own equipment but only capture 57% of scans ordered by the group.
The number of CT scans ordered and/or billed for in these groups was then indexed to the number of unique patients assessed by a physician with that diagnosis for a 1-year period to derive a utilization rate in each practice.
No differences among groups
Bottom line: Physician ownership of diagnostic and therapeutic equipment deserves transparent discussion of the risks and benefits, supported by data where available. There is emerging evidence that ownership of high-tech imaging by urologists does not increase utilization. This study of three different practices with three different ownership models in three different geographic areas of the U.S. showed remarkably similar utilization rates among the study participants and their patients.
As practices become more facile with analyzing clinical and administrative databases, utilization rates for diagnostic and therapeutic procedures may be better defined.
Dr. Baum is a urologist in private practice in New Orleans. He is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically.
Dr. Dowling is medical director of Urology Associates of North Texas, a 49-physician, community-based, single-specialty group in the Dallas-Fort Worth metroplex.