Organizational boundaries of medical practice: The case of physician ownership of ancillary services

Health Economics Review

Volumn 2, Issue 1, 2012, Pages 1-8

  Schneider, John E ^a   Ohsfeldt, Robert L ^a,b   Scheibling, Cara M ^a   Jeffers, Sarah A ^a  

^a ICON PLC   (United Kingdom)

^b TEXAS A AND M UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONCEPTUAL FRAMEWORK; COST CONTROL; ECONOMY OF SCOPE; HEALTH CARE CONCEPTS; HEALTH CARE COST; HEALTH CARE QUALITY; HUMAN; IN OFFICE ANCILLARY SERVICE; MEDICAL PRACTICE; MEDICAL SERVICE; PATIENT CARE; PHYSICIAN; PRIORITY JOURNAL; REIMBURSEMENT; SCOPE OF PRACTICE; TRANSACTION ECONOMY; VERTICAL INTEGRATION;

EID: 84971281663     PISSN: None     EISSN: 21911991     Source Type: Journal    
DOI: 10.1186/2191-1991-2-7     Document Type: Article

References (114)

1. American Hospital Association: Impact of limited-service providers on communities and full-service hospitals. Trendwatch 2004, 6(2):1-8.
2. Casalino LP, Devers KJ, Brewster LR: Focused factories? Physician-owned specialty facilities. Health Aff 2003, 22(6)56-57.
3. Fine A: The specter of specialty hospitals, part I Hospitals & Health Networks; 2004.
4. Iglehart JK: The emergence of physician-owned specialty hospitals. N Engl J Med 2005, 352(1):78-84.
5. Kahn CN: Intolerable risk, irreparable harm: the legacy of physician-owned specialty hospitals. Health Aff 2006, 25(1):130-133.
6. Kimbol AS: The debate over specialty hospitals: how physician-hospital relationships have reached a new fault line over these "focused factories". J Health Law 2005, 38(4):633-672.
7. Mitchell JM: Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns? Med Care 2008, 46(7):732-737
8. Gabel JR, et al: Where do I send thee? Does physician-ownership affect referral patterns to ambulatory surgery centers? Health Aff 2008, 27(3): w165-w174.
9. Hollingsworth JM, et al: Physician-ownership of ambulatory surgery centers linked to higher volume of surgeries. Health Aff 2010, 29(4):683-689
10. Mitchell JM: Effect of physician ownership of specialty hospitals and ambulatory surgery centers on frequency of use of outpatient orthopedic surgery. Arch Surg 2010, 145(8):732-738
11. Cicka MP: Physician ownership and use of in-office advanced diagnostic imaging equipment: are IDTF standards a meaningful response to overutilization, quality, and costs? J Health Life Sci Law 2009, 2(2):161, 163-86.
12. Hollingsworth JM, et al: Imaging use among employed and self-employed urologists. J Urol 2010, 184(6):2480-2484
13. Levin DC, et al: Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend. J Am Coll Radiol 2008, 5(2):105-109
14. MedPAC: Report to the Congress: Aligning Incentives in Medicare Washington: Medicare Payment Advisory Commission; 2010.
15. Pursell D, et al: Stark II and physician compensation models: integrating business and legal issues. J Health Law 2005, 38(1):45-76.
16. Sandrick K, Stark Laws: Then and Now. Trustee 2008, 61(2):33-35.
17. Stout SM, Warner DC: How did physician ownership become a federal case? the stark amendments and their prospects. HEC Forum 2003, 15(2):171-187.
18. Tayon KJ: Key changes and new interpretations involving the Phase III regulations. J Health Care Compliance 2008, 10(1):13-73.
19. MedPAC: Impact of physician self-referral on use of imaging services within an episode. 2009, Chapter 4.
20. MedPAC: Report to Congress: Improving incentives in the Medicare program Washington: MedPAC; 2009.
21. MedPAC: Report to Congress: Medicare Payment Policy Washington: MedPAC; 2009.
22. Hillman BJ, Goldsmith J: Imaging: the self-referral boom and the ongoing search for effective policies to contain it. Health Affairs 2010, 2231-2236.
23. Benefits M, Physician Ownership of Medical Equipment: Med Benefits 2011, 28(3):5-6.
24. Bert JM: Ancillary services available to the orthopedic surgeon. Orthop Clin North Am 2008, 39(1):1-4, v.
25. Delitto A, Snyder-Mackler L: The diagnostic process: examples in orthopedic physical therapy. Phys Ther 1995, 75(3):203-211.
26. Freburger JK, Holmes GM, Carey TS: Physician referrals to physical therapy for the treatment of musculoskeletal conditions. Arch Phys Med Rehabil 2003, 84(12):1839-1849.
27. Gilbert FJ, et al: Does early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomised controlled trial. Health Technol Assess 2004, 8(17), iii, 1-iii, 131.
28. Jacofsky D, Lyman J: The efficient delivery of elective orthopedic care. J Arthroplasty 2007, 22(7 Suppl 3):2-5.
29. Baker LC: Acquisition of MRI equipment by doctors drives up imaging use and spending. Health Aff 2010, 29(12):2252-2259.
30. Hillman BJ, Goldsmith J: Imaging: the self-referral boom and the ongoing search for effective policies to contain it. Health Aff 2010, 29(12):2231-2236.
31. Hughes DR, Bhargavan M, Sunshine JH: Imaging self-referral associated with higher costs and limited impact on duration of illness. Health Aff 2010, 29(12):2244-2251.
32. Levin DC, et al: Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral. J Am Coll Radiol 2008, 5(12):1206-1209.
33. Mitchell JM, Sass TR: Physician ownership of ancillary services: indirect demand inducement or quality assurance? J Health Econ 1995, 14(3):263-289.
34. Mitchell JM, Scott E: Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics. JAMA 1992, 268(15):2055-2059.
35. Romano DH: Self-referral of imaging and increased utilization: some practical perspectives on tackling the dilemma. J Am Coll Radiol 2009, 6(11):773-779.
36. Sunshine J, Bhargavan M: The practice of imaging self-referral does not produce much one-stop service. Health Aff 2010, 29(12):2237-2243.
37. Coase RH: The Nature of the Firm. In The Nature of the Firm: Origins, Evolution, and Development. Edited by: Williamson OE, Winter SG. New York: Oxford University Press; 1993:18-33.
38. Furubotn EG, Richter R: Institutions and Economic Theory: The Contribution of the New Institutional Economics Ann Arbor: The University of Michigan Press; 1997.
39. Milgrom P, Roberts J: Economics, Organization and Management Englewood Cliffs: Prentice Hall; 1992.
40. Teece DJ, Pisano G: The dynamic capabilities of firms: an introduction. Ind Corp Change 1994, 3(3):537-556.
41. Williamson OE: Comparative economic organization: the analysis of discrete structural alternatives. Adm Sci Q 1991, 36(2):269-296.
42. Williamson OE: The economics of governance. Am Econ Rev 2005, 95(2):1-18.
43. Perry MK: Vertical Integration: Determinants and Effects. In Handbook of Industrial Organization. Volume 1. Edited by: Schmalensee R, Willig RD. Amsterdam: Elsevier Science Publishers B.V; 1989.
44. Panzar JC, Willig RD: Economies of scope. Am Econ Rev 1981, 71(2):268-272.
45. Teece DJ: Economies of scope and the scope of the enterprise. J Econ Behav Organ 1980, 1(3):223-247.
46. Chandler AD: Scale and Scope: The Dynamics of Industrial Capitalism Cambridge: The Belknap Press/Harvard University Press; 1990.
47. Hill CWL: Diversification and Economic Performance: Bringing Structure and Corporate Management Back into the Picture. In Fundamental Issues in Strategy: A Research Agenda. Edited by: Rumelt RP, Schendel DE, Teece DJ. Boston: Harvard Business School Press; 1994:297-321.
48. Danneels E: The dynamics of product innovation and firm competencies. Strateg Manage 2002, 23:1095-1121.
49. Helfat CE, et al: Dynamic Capabilities: Understanding Strategic Change in Organizations Malden: Blackwell Publishing; 2007.
50. Skinner W: The focused factory. Harv Bus Rev 1974, 52(3):113-120.
51. Nelson RR, Winter SG: An Evolutionary Theory of Economic Change Cambridge: Belknap; 1982.
52. Chandler AD: Organizational capabilities and the economic history of the industrial enterprise. J Econ Perspect 1992, 6(3):79-100.
53. Wruck KH, Jensen MC: Science, specific knowledge, and total quality management. J Accounting Econ 1994, 18:247-287.
54. Greve HR: Organizational Learning from Performance Feedback: A Behavioral Perspective on Innovation and Change Cambridge: Cambridge University Press; 2003.
55. Aiken AB, et al: Easing the burden for joint replacement wait times: the role of the expanded practice physiotherapist. Healthc Q 2008, 11(2):62-66.
56. Davis S, Machen MS, Chang L: The beneficial relationship of the colocation of orthopedics and physical therapy in a deployed setting: Operation Iraqi Freedom. Mil Med 2006, 171(3):220-223.
57. Dutton RP, et al: Daily multidisciplinary rounds shorten length of stay for trauma patients. J Trauma 2003, 55(5):913-919.
58. Duxbury P: The physician-owned physical therapy department. Orthop Clin North Am 2008, 39(1), 49-53-vi-vii.
59. Davenport TE, et al: Current status and correlates of physicians' referral diagnoses for physical therapy. J Orthop Sports Phys Ther 2005, 35(9):572-579.
60. Rosenberger PH, et al: Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes. Arthroscopy 2005, 21(5):562-569.
61. Williamson OE: The Mechanisms of Governance New York: Oxford University Press; 1996.
62. Williamson OE: Transaction Cost Economics: The Natural Progression (Nobel Prize Lecture, December 8, 2009). Am Econ Rev 2010, 100(3):673-690.
63. Robinson JC: A New Institutional Economics of Health Care. In The State, Politics, and Health: Essays for Rudolf Klein. Edited by: Day P et al. Cambridge: Blackwell; 1996:.
64. BLS: Usual Weekly Earnings of Wage and Salary Workers: Third Quarter 2011. News Release Washington: Bureau of Labor Statistics; 2011.
65. CMS: National Health Expenditure Fact Sheet Baltimore: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services; 2011.
66. AHRQ: National Healthcare Disparities Report: Patient Perception of Need (Data from Medical Expenditure Panel Survey, 2005) AHRQ Pub. No. 09-0002. 2009 Rockville: Agency for Health Care Research and Quality; 2008.
67. Castillo RC, et al: Use and perceived need of physical therapy following severe lower-extremity trauma. Arch Phys Med Rehabil 2005, 86(9):1722-1728.
68. Carey TS, Garrett J: Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina Back Pain Project. Ann Intern Med 1996, 125(10):807-814.
69. Ogulata SN, et al: Personnel and patient scheduling in the high demanded hospital services: a case study in the physiotherapy service. J Med Syst 2008, 32(3):221-228.
70. Beattie P, et al: Longitudinal continuity of care is associated with high patient satisfaction with physical therapy. Phys Ther 2005, 85(10):1046-1052.
71. Meijboom BR, Bakx SJWGC, Westert GP: Continuity in health care: lessons from supply chain management. Int J Health Plann Manage 2010, 25(4):304-317.
72. O'Neill W: The physician-owned imaging center. Orthop Clin North Am 2008, 39(1):37-48.
73. Rozich JD, D'Amore L, Sloan J: Physician-owned imaging centers: the future is now. Med Group Manage J 2000, 47(5):48-53.
74. Wallace RA: Physician owned and operated: a good thing. W V Med J 2008, 104(2):4-5.
75. Weeks RB: The physician-owned occupational health department. Orthop Clin North Am 2008, 39(1):55-69, vii.
76. Gozalez-Diaz M, Vazquez L: Make-or-Buy Decisions: A New Institutional Economics Approach. In New Institutional Economics: A Guidebook. Edited by: Brousseau E, Glachant J. Cambridge: Cambridge University Press; 2008:.
77. Teece DJ, et al: Understanding corporate coherence: theory and evidence. J Econ Behav Organ 1994, 23:1-30.
78. Iizuka T: Experts' agency problems: evidence from the prescription drug market in Japan. Graduate School of International Management, Aoyama Gakuin University 2006.
79. Dulleck U, Kerschbamer R: On doctors, mechanics, and computer specialists: the economics of credence goods. J Econ Lit 2006, 44(1):5-42.
80. Culyer AJ: The Dictionary of Health Economics Northampton: Edward Elgar; 2005.
81. Dranove D, Wehner P: Physician-induced demand for childbirths. J Health Econ 1994, 13(1):61-73.
82. Afendulis CC, Kessler DP: Tradeoffs from Integrating Diagnosis and Treatment in Markets for Health Care. National Bureau of Economic Research Working Paper Series, No. 12623. Cambridge 2006.
83. Gruber J, Owings M: Physician Financial Incentives and Cesarean Section Delivery. Rand J Econ 1996, 27(1):99-123.
84. Jurges H: Physician-induced demand for medical services in germany: new evidence from conbined district and individual level data. MEA-Universitat Mannheim. Mannheim 2007.
85. Perneger TV, Charvet-Berard A, Perrier A: Patient assessments of the most important medical decision during a hospitalization. J Gen Intern Med 2008, 23(10):1659-1665.
86. Kaplan RM, Frosch DL: Decision making in medicine and health care. Annu Rev Clin Psychol 2005, 1:525-556.
87. Kiesler DJ, Auerbach SM: Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns 2006, 61(3):319-341.
88. Auerbach SM: Do patients want control over their own health care? A review of measures, findings, and research issues. J Health Psychol 2001, 6(2):191-203.
89. Benbassat J, Pilpel D, Tidhar M: Patients' preferences for participation in clinical decision making: A review of published surveys. Behav Med 1998, 24(2):81-88.
90. Blachar A, et al: Preauthorization of CT and MRI examinations: assessment of a managed care preauthorization program based on the ACR appropriateness criteria and the royal college of radiology guidelines. J Am Coll Radiol 2006, 3(11):851-859.
91. Hendel RC: Utilization management of cardiovascular imaging pre-certification and appropriateness. JACC Cardiovasc Imaging 2008, 1(2):241-248.
92. Smulowitz PB, Ngo L, Epstein SK: The effect of a CT and MR preauthorization program on ED utilization. Am J Emerg Med 2009, 27(3):328-332.
93. Weiner SN, Komarow M: Utilization management and noninvasive diagnostic imaging. Manag Care Interface 2005, 18(5):34-38.
94. Kouri BE, Parsons RG, Alpert HR: Physician self-referral for diagnostic imaging: review of the empiric literature. AJR 2002, 179:843-850.
95. Zientek DM: Physician entrepreneurs, self-referral, and conflicts of interest: an overview. HEC Forum 2003, 15(2):111-133.
96. Lurie JD, Bell JE, Weinstein J: What rate of utilization is appropriate in musculoskeletal care? Clin Orthop Relat Res 2009, 467(10):2506-2511.
97. Restuccia J, et al: High hospital admission rates and inappropriate care. Health Aff 1996, 15(4):156-163.
98. Siu AL, Manning WG, Benjamin B: Patient, provider and hospital characteristics associated with inappropriate hospitalization. Am J Public Health 1990, 80(10):1253-1256.
99. Siu AL, et al: Inappropriate use of hospitals in a randomized trial of health insurance plans. N Engl J Med 1986, 315(20):1259-1266.
100. Smith CB, et al: Overutilization of acute-care beds in veterans affairs hospitals. Med Care 1996, 34(1):85-96.
101. Bureau of Labor Statistics, Occupational Outlook Handbook: Bureau of Labor Statistics. 2010-11 edition. Washington: U.S. Department of Labor; 2010.
102. Pederson CD: Cause and effect. Understanding the production-profit relationship. MGMA Connex 2007, 7(2):40-45, 1.
103. Reschovsky JD, Hadley J, Landon BE: Effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients. Health Serv Res 2006, 41(4 Pt 1):1200-1220.
104. Kikano GE, Goodwin MA, Stange KC: Physician employment status and practice patterns. J Fam Pract 1998, 46(6):499-505.
105. PMIC: Medical Fees in the United States: Nationwide Charges for Medicare, Surgery, Laboratory, Radiology and Allied Health Services, 2010 Edition Los Angeles: Practice Management Information Corporation; 2009.
106. Casalino LP, et al: Benefits of and barriers to large medical group practice in the united states. Arch Intern Med 2003, 163(16):1958-1964.
107. Robinson JC: Physician-hospital integration and the economic theory of the firm. Med Care Res Rev 1997, 54(1):3-24.
108. Robinson JC: Consolidation of medical groups into physician practice management organizations. JAMA 1998, 279(2):144-149.
109. Robinson JC: Physician organization in California: crisis and opportunity. Health Aff 2001, 20(4):81-96.
110. Shortell SM, et al: Remaking Health Care in America: Building Organized Delivery Systems San Francisco: Jossey-Bass Publishers; 1996.
111. Ellis RP, McGuire TG: Provider behavior under prospective reimbursement. J Health Econ 1986, 5(2):129-151.
112. Harris JE: The internal organization of hospitals: some economic implications. The Bell J Econ 1977, 8(2):467-482.
113. McGuire TG: Physician Agency. In Handbook of Health Economics. Edited by: Culyer AJ, Newhouse JP. New York: Elsevier; 2000:461-536.
114. Pauly MV: Doctors and Their Workshops: Economic Models of Physician Behavior Chicago: The University of Chicago Press; 1980.