title: In-office imaging capabilities among procedure-based specialty practices.
abstract: BACKGROUND
  Stark law's in-office ancillary services exception permits physicians to furnish designated health services in the office, including advanced imaging.
  
  
  OBJECTIVE
  To determine whether arrangements tailored to fit this loophole spur utilization.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Procedure-based specialty clinics participating in the National Ambulatory Medical Care Survey.
  
  
  METHODS
  Using restricted data files (2006-2008), we identified specialty practices with on-site advanced imaging capabilities (ie, computed tomography, magnetic resonance imaging, and/or positron emission tomography). We then characterized these practices and the physicians who worked in them over a variety of factors. Finally, we performed multivariable regression to evaluate the association between imaging use and the availability of in-office imaging.
  
  
  RESULTS
  Fourteen percent of practices performed advanced imaging on site. While this proportion remained stable over the study period for most specialties, it rose significantly among orthopedic surgery clinics from 13.6% to 31.3% (P = .023 for the temporal trend). The availability of advanced imaging varied by practice organization and size. For instance, 32.6% of large single-specialty groups provided in-office imaging as compared to only 10.1% of solo/partnership practices. While less than a quarter of specialty visits were made to practices that offered advanced imaging, these locations generated a third of all advanced imaging studies. In fact, 1 in 11 visits (9.0%; 95% confidence interval = 6.8% to 11.6%; P = .030) to them resulted in advanced imaging.
  
  
  CONCLUSIONS
  The availability of in-office advanced imaging is associated with increased imaging use.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA kinks@med.umich.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Sakshaug
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008511:Medicine; D049268:Positron-Emission Tomography / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D011787:Quality of Health Care; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States
keywords: diagnostic imaging; physician practice patterns; utilization