Editorial Comment

Abstract

Urologists are coming under close scrutiny by third-party payers and the government for their ownership of ancillary services, including laboratory services such as blood work and pathology, imaging equipment, treatment facilities including surgicenters, lithotripters, and intensity-modulated radiation therapy. These relationships have not gone unnoticed in the lay press and are frequently recounted on the front pages of the nation's more prominent newspapers. In this article, Hollingsworth and colleagues at the University of Michigan looked at whether urologist investment in lithotripters in the state of Michigan changed practice patterns, specifically with regard to ureteroscopy (URS) and shock wave lithotripsy (SWL). The authors queried the state's ambulatory surgery database to perform their study. I found it interesting that more than half of the urologists in the state of Michigan participated in these limited SWL partnerships. Interestingly, the rate of URS compared with SWL did not change after urologists became financial partners. There were some differences in race, insurance, and comorbidities that were noted between the URS and SWL groups that were not well explained but may be simply because the uninsured may be seen more often at academic institutions or that older patients are more often anticoagulated, making them better suited for ureteroscopy. Interestingly, when compared with Florida, URS was more prevalent in Michigan, But similar differences would probably be noted for surgery compared with external beam radiation or brachytherapy for the treatment of prostate cancer. Use of Ureteroscopy Before and After Expansion of Lithotripter Ownership in MichiganUrologyVol. 78Issue 6PreviewTo determine whether ureteroscopy (URS) rates decreased following the expansion of lithotripter ownership in Michigan. Historically, Michigan has had limited urologist investment in lithotripters owing to strict Certificate of Need legislation. However, 2 of the nation's largest lithotripsy providers formed Michigan subsidiaries in 2005 and 2006, thereby altering the ownership landscape. Urologists who acquired partnership shares were incentivized to perform shock wave lithotripsy preferentially over URS. Full-Text PDF