0
Scientific Articles   |    
Orthopaedic Surgeons Do Not Increase Surgical Volume After Investing in a Specialty Hospital
G. William Woods, MD1; Daniel P. O'Connor, PhD1; Peggy Pierce, BBA1
1 Fondren Orthopedic Group LLP (G.W.W. and P.P.), and Joe W. King Orthopedic Institute (G.W.W. and D.P.O'C.), Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509. E-mail address for D.P.O'C.: info@jwkoi.com
View Disclosures and Other Information
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Investigation performed at the Fondren Orthopedic Group and the Joe W. King Orthopedic Institute, Houston, Texas

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1185-1190. doi: 10.2106/JBJS.D.02228
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: The number of surgical specialty hospitals with physician investors in the United States has increased in the last ten years. Opponents to these hospitals have argued that surgeon investors will perform more surgery in order to maintain the hospital's profitability. The purpose of the present study was to determine whether the surgical volume or the surgical rate increased for a group of ten orthopaedic surgeons after the opening of an orthopaedic surgery specialty hospital in which they held a financial interest.

Methods: We analyzed the practice data for ten orthopaedic surgeons during an interval spanning seven years before and eight years after the opening of an orthopaedic surgery specialty hospital in which they held a financial interest. The average rates of change in the number of surgical procedures per year for each period were computed and compared with use of regression analysis. The percentages of patients who underwent surgery before and after the opening of the specialty hospital were also compared.

Results: The ten orthopaedic surgeons did not increase their surgical volume or surgical rate after the specialty hospital opened. The ten surgeons performed an average of 4399 surgical procedures per year before the hospital opened and 4542 surgical procedures per year after the hospital opened. The rate of change in the number of surgical procedures per year (19.1 compared with 8.9 procedures per year) did not increase after the specialty hospital opened. The annual patient volume (16,019 compared with 15,982 patients) and the percentage of patients who underwent surgery (27.5% compared with 28.4%) did not significantly change after the specialty hospital opened.

Conclusions: The opening of an orthopaedic surgery specialty hospital did not increase the surgical volume or the surgical rate for ten orthopaedic surgeons who held a financial interest in the facility.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Daniel P. O'Connor
    Posted on June 28, 2005
    Dr. O'Connor et al respond to Drs. Sambandam and Gul
    Joe W. King Orthopedic Institute, Houston, Tx 77030

    We thank Drs. Sambandam and Gul for their comments. Their letter states that they “believe that financial investment in a specialty hospital may well change a surgeon’s practice patterns”, but they “do not have any evidence to support this belief.”

    Regrettably, arguments based on beliefs rather than evidence dominate the discussion of surgeon investment in specialty hospitals. We presented evidence, not our beliefs. We respond by presenting more evidence.

    In the first year of the study period, the ten orthopaedic surgeons were 32, 34, 36, 37, 37, 38, 40, 41, 44, and 47 years of age. There was no relation between surgeon age and either change in surgical volume (r = 0.13) or change in surgical rate (r = –0.03).

    To our knowledge, detailed 15-year trends for individual orthopaedic surgeons or group practices are not readily available. Our stated purpose was to determine whether one group changed its practice over time. Comparisons to other groups are not directly relevant to our purpose and would not affect our conclusions.

    Changes in surgical rates by orthopaedic subspecialization were: knee/sports medicine, –4.0%; foot and ankle, –3.0%; hand and upper extremity, +0.7%; spine, +3.0%; pediatric, +7.0%; and joint replacement, +10%. These relative changes were small in absolute terms, averaging a difference of 1 or 2 cases per surgeon per month.

    We appreciate the opportunity to present this additional evidence. We hope that evidence prevails over belief in the ongoing discussion of this issue.

    Sincerely,

    G. William Woods, MD,

    Daniel P. O’Connor, PhD,

    Peggy Pierce, BBA

    Senthil Nathan Sambandam
    Posted on June 17, 2005
    Other Factors Influencing Surgical Volume
    University Hospital Of North Staffordshire , Stoke on Trent, Uk ST46TB

    To the Editor:

    In contrast to the conclusions of this article, we believe that a financial investment in a specialty hospital may well change a surgeon's practice patterns. Even though we do not have any evidence to support this belief we disagree with the statistical evidence given by the author to justify conclusions like "the average number of surgical procedures per year performed by investing surgeons was not affected by the opening of the specialty hospital and the patient volume and the percentage of patients receiving surgery were not affected by the opening of the specialty hospital."

    This is a retrospective study in which the author has collected the number of procedures performed by 10 surgeons in a 15 year period (7 years before and 8 years after the start of financial interest in speciality hospital). This study considered only the number of operations and the rate of increase in the surgical practice as outcome variables. But these variables depend on many other factors. Over a period of 15 years, orthopedic practice patterns have a natural tendency to change. This study made no mention about the ages of the surgeons. Hence this study compares the number of operations performed by the surgeons when they were comparatively young and enthusiastic without financial interest in a speciality hospital to the number of operations performed by the same surgeon when he is older and presumably less surgically active, albeit with a financial interest. Hence, we think it is difficult to conclude that there is no change in the practice unless we know the normal trend, over a period of 15 years, of the number of surgeries performed and rate of change in the number of surgeries performed by surgeons who continued their practice in a full service hospital without financial interest in speciality hospitals.

    Furthermore, this study made no mention of the influence on operative rates of different sub-speciality interests. In some subspecialties, the rates of surgery have increased, while in others, there is a trend toward non operative management.

    Yours sincerely,

    Mr. Senthil Nathan Sambandam, MS, MRCS

    Mr. Arif Gul, MS, MRCS

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    NY - Icahn School of Medicine at Mount Sinai
    04/16/2014
    GA - Choice Care Occupational Medicine & Orthopaedics
    06/29/2012
    PA - Thomas Jefferson University