title: Linkages between utilization of prostate surgical pathology services and physician self-referral.
abstract: OBJECTIVE
  Federal law prohibits a physician from referring Medicare patients for procedures or services to health care entities in which the physician has a financial relationship. This law has exceptions which enable physicians to self-refer under certain conditions. This study evaluates the effects of self-referral on use rates of surgical pathology services performed in conjunction with prostate biopsies and whether such changes are linked to urologist self-referral arrangements.
  A targeted market area case study design was employed to identify the sample from Medicare claims data. The sample included male beneficiaries who resided in geographically dispersed counties; were continuously enrolled in Medicare fee-for-service (FFS) during 2005-2007; and who met the criteria to be a potential candidate to undergo a prostate biopsy.
  
  
  RESULTS
  Prostate biopsy procedures per 1000 male Medicare beneficiaries in each county; counts of surgical pathology specimens (jars) associated with prostate biopsy procedures per 1000 male Medicare beneficiaries in each county.
  
  
  RESULTS
  Regression analysis shows the self-referral share (percentage) of total utilization was associated with significant increases in the use rate of prostate surgical pathology specimens (p<.01). The use rate of prostate surgical pathology specimens (jars) would be 41.5 units higher in a county where the self-referral share of total utilization was 50% compared to a county with no self-referral (share equals 0%).
  
  
  CONCLUSIONS
  The findings show that urologist self-referral of prostate surgical pathology services results in increased utilization and higher Medicare spending. The results suggest that exceptions in federal and state self-referral prohibitions need to be reevaluated.
authors.affiliation: Georgetown University.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Mitchell
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data; D018584:Physician Self-Referral / Q000706:statistics & numerical data*; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D014481:United States
keywords: Prostate Biopsies; Surgical Pathology Services; Urologist Self-Referral