1688 EXPANSION OF LITHOTRIPTER OWNERSHIP AND URETEROSCOPY USE: A NATURAL EXPERIMENT

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111688 EXPANSION OF LITHOTRIPTER OWNERSHIP AND URETEROSCOPY USE: A NATURAL EXPERIMENT Hung-Jui Tan, J. Stuart Wolf, Brent K. Hollenbeck, Zaojun Ye, and John M. Hollingsworth Hung-Jui TanHung-Jui Tan Ann Arbor, MI More articles by this author , J. Stuart WolfJ. Stuart Wolf Ann Arbor, MI More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck Ann Arbor, MI More articles by this author , Zaojun YeZaojun Ye Ann Arbor, MI More articles by this author , and John M. HollingsworthJohn M. Hollingsworth Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, Michigan has had limited urologist investment in lithotripters due to strict Certificate of Need legislation. However, between 2005 and 2006, the ownership landscape changed when two large lithotripsy providers offered partnership shares to urologists in the State for the first time. Those who acquired shares were incentivized to perform shockwave lithotripsy preferentially over ureteroscopy (URS), and rates of URS may have fallen due to technology substitution. We explored this possibility using population-based data. METHODS From the Michigan files of the State Ambulatory Surgery Database (2004 to 2007), we abstracted discharges for URS performed at hospital-based outpatient departments. We measured differences between patients who underwent URS in the year before (2004) and after (2007) ownership expansion. We calculated annual rates of URS in Michigan and evaluated for significant changes over time. Finally, we compared these rates to those from Florida, which already had a high penetration of physician ownership, over the same time interval. RESULTS Compared to patients treated prior to ownership expansion, those who underwent URS after ownership expansion were older (P<0.001), less likely to be White (P<0.001), less likely to have private health insurance (P<0.001), and more likely to have a higher Charlson comorbidity index (P<0.001). However, the magnitudes of these differences were small. As Figure 1 shows, rates of URS in Michigan remained relatively stable despite ownership expansion (P=0.129 for the temporal trend); and there were no significant differences in the rates of change of URS between Michigan and Florida during the time of ownership expansion (P=0.479). CONCLUSIONS The introduction of physician-ownership of lithotripter units in Michigan was not associated with decreased rates of URS. Despite the financial incentives, technology substitution does not appear to occur on a significant scale at the population-level, at least as it pertains to the management of stone disease. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e679 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung-Jui Tan Ann Arbor, MI More articles by this author J. Stuart Wolf Ann Arbor, MI More articles by this author Brent K. Hollenbeck Ann Arbor, MI More articles by this author Zaojun Ye Ann Arbor, MI More articles by this author John M. Hollingsworth Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...