Laboratory Test Ordering at Physician Offices with and without On-Site Laboratories

Bishop, Tara F.; Federman, Alex D.; Ross, Joseph S.

doi:10.1007/s11606-010-1409-7

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…While patient convenience is often cited as one justification for self‐referral, some evidence refutes this contention, as few advanced imaging procedures are performed on the same day as the related office visit (Medicare Payment Advisory Commission ; Sunshine and Bhargavan ). To our knowledge, only three recent articles have examined how self‐referral affects use of other ancillary services, in particular clinical laboratory testing, anatomic pathology services, and intensity modulated radiation therapy (Bishop, Federman, and Ross ; Mitchell , ).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services

Mitchell

Reschovsky

Reicherter

2016

Health Services Research

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Objective. To examine whether the course of physical therapy treatments received by patients who undergo total knee replacement (TKR) surgery differs depending on whether the orthopedic surgeon has a financial stake in physical therapy services. Data. Sample of Medicare beneficiaries who underwent TKR surgery during the years 2007-2009. Study Design. We used regression analysis to evaluate the effect of physician selfreferral on the following outcomes: (1) time from discharge to first physical therapy visit; (2) episode length; (3) number of physical therapy visits per episode; (4) number of physical therapy service units per episode; and (5) number of physical therapy services per episode expressed in relative value units. Principal Findings. TKR patients who underwent physical therapy treatment at a physician-owned clinic received on average twice as many physical therapy visits (8.3 more) than patients whose TKR surgery was performed by a orthopedic surgeon who did not self-refer physical therapy services (p < .001). Regression-adjusted results show that TKR patients treated at physician-owned clinics received almost nine fewer physical therapy service units during an episode compared with patients treated by nonselfreferring providers (p < .001). In relative value units, this difference was 4 (p < .001). In contrast, episodes where the orthopedic surgeon owner does not profit from physical therapy services rendered to the patient look virtually identical to episodes where the TKR surgery was performed by a surgeon nonowner. Conclusions. Physical therapists not involved with physician-owned clinics saw patients for fewer visits, but the composition of physical therapy services rendered during each visit included more individualized therapeutic exercises.

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Section: Conceptual Frameworkmentioning

confidence: 99%

Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services

Mitchell

Reschovsky

Reicherter

2016

Health Services Research

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“…A rare reason for ordering unnecessary expensive investigations may be the personal financial interest of the requesting physician which is not only unethical but should undergo strict audit procedures. Study shows that physicians who had an investment interest in an off-site clinical laboratory advised excessive and unnecessary diagnostic services to the patients [ 6 ]. An audit cycle performed on test request forms in a primary care setting decreased the number of test requests and improved the trend of ordering investigations among the general practitioners [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Study states that pre-analytical errors in completing request forms may lead to incorrect interpretation and poor patient diagnosis and treatment [ 5 ]. Another major factor is lack of adequate training in ordering laboratory tests by the physicians and their use for non-targeted and vague therapeutic purposes [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Injudicious use of laboratory facilities in tertiary care hospitals at rawalpindi, pakistan: a cross-sectional descriptive study

Malik

Khan

Ansari

et al. 2013

BMC Health Serv Res

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BackgroundIn recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern and has led to concurrent rise in the laboratory errors and the health care costs. The aim of the study was to find out the frequency of incomplete laboratory request forms, inappropriate test requests at various professional levels and the financial impact of uncollected reports at Armed Forces Institute of Pathology (AFIP) and Combined Military Hospital (CMH) Laboratory Rawalpindi.MethodsThe cross-sectional descriptive study was conducted during a three month period from April to June 2012 at AFIP and CMH Laboratory Rawalpindi. A total of 1000 laboratory request forms were collected and scrutinized for completion from AFIP (n=500) and CMH Rawalpindi laboratory (n=500). 536 request forms of costly/specialized tests from different departments of AFIP were studied to find out the professional level of test request. The total number of tests performed at AFIP during the study period and number of uncollected reports were noted. The financial impact of these uncollected reports was also calculated. Collection of data and sorting were done manually. Patient confidentiality was maintained. Microsoft excel software and SPSS-17 were used for analysis. The study was approved by the Institutional Ethical Review Committee.ResultsOut of a total of 1000 forms studied none was completely filled with clinical notes being present in only 2.4% and 13% of forms sent to CMH and AFIP respectively. 62% of the expensive investigations were requested by specialists while 38% were ordered by residents and general practitioners but the percentage of avoidable expensive tests ordered by the general practitioners and residents was significantly higher than the specialists(p<0.001). A total of 9026 (40%) and 5046 (22%) diagnostic test reports were not collected from the Chemical pathology and Hematology departments respectively. Financial impact of uncollected reports from all the departments at AFIP collectively amounted to Pakistani Rupees (PKR) 3338201.ConclusionProcessing incomplete laboratory request forms and injudicious use of laboratory facilities leads to incorrect interpretation of laboratory test results affecting outcome of the overall treatment.

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“…[26][27][28] The findings in this study also accord with prior research documenting the increased use of clinical lab tests associated with self-referral. [29][30][31] One potential justification for the higher number of jars per biopsy is an increased likelihood of detecting prostate cancer. Yet an analysis of cancer detection rates by self-referral status shows the reverse.…”

Section: Discussionmentioning

confidence: 99%

Urologists’ Self-Referral For Pathology Of Biopsy Specimens Linked To Increased Use And Lower Prostate Cancer Detection

Mitchell

2012

Health Affairs

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Federal law allows physicians in some circumstances to refer patients for additional services to a facility in which the physician has a financial interest. The practice of physician self-referral for imaging and pathology services has been criticized because it can lead to increased use and escalating health care expenditures, with little or no benefit to patients. This study examined Medicare claims for men in a set of geographically dispersed counties to determine how the "in-office ancillary services" exception affected the use of surgical pathology services and cancer detection rates associated with prostate biopsies. I found that self-referring urologists billed Medicare for 4.3 more specimens per prostate biopsy than the adjusted mean of 6 specimens per biopsy that non-self-referring urologists sent to independent pathology providers, a difference of almost 72 percent. Additionally, the regression-adjusted cancer detection rate in 2007 was twelve percentage points higher for men treated by urologists who did not self-refer. This suggests that financial incentives prompt self-referring urologists to perform prostate biopsies on men who are unlikely to have prostate cancer. These results support closing the loophole that permits self-referral to "in-office" pathology laboratories.

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Laboratory Test Ordering at Physician Offices with and without On-Site Laboratories

Abstract: In a nationally representative sample of visits to physician-owned group practices, specialist owners with on-site laboratories were more likely to order five common laboratory tests, potentially resulting in millions in excess healthcare spending.

Cited by 14 publications

References 15 publications

Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services

Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services

Injudicious use of laboratory facilities in tertiary care hospitals at rawalpindi, pakistan: a cross-sectional descriptive study

Urologists’ Self-Referral For Pathology Of Biopsy Specimens Linked To Increased Use And Lower Prostate Cancer Detection

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