Who Should Be Screened for Marijuana Use? All Adults? All Seniors? Or Nobody?

Abstract

T he United States is undergoing a dramatic change in the organization of medical services. Before the last decade most US physicians worked in practices they or other doctors owned.However, the number of independent US medical practices is plummeting. A 2018 survey found that about a third of US physicians are now employed directly or indirectly by hospitals or hospital-owned practices. That same survey found that only 31% of physicians had an independent medical practice-down from 48.5% in 2012. (See Young et al., 2021; Physicians Foundation, 2018.) So what impact does hospital ownership have on medical practices? Hospitals boast that the integration of services improves the quality of medical care. But the jury is still out on this issue.Critics suggest that the consolidation of medical practices is often a prelude to raising prices. They are also concerned that the integration of medical practices will lead to medical overuse and waste through the increasing referral of patients for profitable hospital services.A new study suggests that the change in the pattern of US healthcare services is a concern. Gary J. Young of Northeastern University and colleagues found that hospital ownership of medical practices led to an increased rate of expensive, inappropriate medical imaging.These researchers used claims data to study patients with three conditions: (1) uncomplicated low back pain; (2) nontraumatic knee pain without effusion (swelling), and (3) shoulder pain without effusion. They wanted to know whether physicians employed directly by hospitals ordered more MRI scans than doctors in independent practices.They gathered data on physician employment from Medicare claims data and the records of healthcare organizations. The study included 583 primary care