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ASCs in the news: Study finds physician-owners of ASCs refer more privately-insured patients to surgery centers

Ambulatory Surgery Reimbursement Update, March 25, 2008

The physicians who refer the most patients to physician-owned ASCs send more privately-insured patients to ASCs while sending Medicaid enrollees to hospital outpatient departments, reports a new study by Health Affairs.

The study, entitled "Where Do I Send Thee? Does Physician-Ownership Affect Referral Patterns To Ambulatory Surgery Centers?" examines the referral patterns of physicians in the Pittsburgh and Philadelphia metropolitan areas, according to the Health Affairs Web site.

The study found that physicians referred approximately 55% of Medicaid patients to the physician-owned ASC but that they referred approximately 45% to hospital outpatient departments. However, they referred more than 90% of patients with more lucrative commercial or Blue Cross insurance to physician-owned ASCs.

The study noted that hospitals have traditionally used profits from privately-insured patients to subsidize care for uninsured patients and Medicaid enrollees. As ASCs have spread, there has been concern that they, and physicians involved in them, would adversely impact hospital resources by directing lucrative patients to their own facilities while sending low-paying patients elsewhere, according to the Web site.

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