Is it really wrong to tighten control on ancillaries?

Dr. Gee says it is wrong for the government to tighten control of physician-owned ancillary services, and we should fight it ("Reform: Good news, bad news, and politics," May 1, 2010). Really? Why? Medical costs are going through the roof. We spend twice as much as the average developed nation on health care without any better results-actually, with the worst results. Medical inflation has been running at two times the rate of inflation for decades and is unsustainable.

One of the contributing causes is physician ownership of labs and imaging centers. In our specialty, physician ownership of radiation centers not only unduly influences patient education and options of treatment for prostate cancer, it limits the choice of treatment and raises the cost for the patient, the payer, and society, with no proven benefit when outcomes are measured.

There are many other factors contributing to the high cost of modern U.S. medicine compared to that of other Western nations, but if we don't take the lead in lowering cost, outsiders will attempt to do so and do it badly. Places like the VA, Mayo Clinic, Kaiser Permanente, Cleveland Clinic, and Intermountain Healthcare in Salt Lake City have developed systems that deliver high-quality care at lower costs by eliminating the tremendous waste in the system. If we don't do it soon, our patients, our practices, our families, the economy, and our nation will suffer. Since we are all in the same boat, let's grab an oar and pull together.

Dr. Gee responds:

Dr. Frankel states that "one of the contributing causes" of skyrocketing medical costs is "physician ownership of labs and imaging centers." Imaging has evolved; the first CT devices were huge machines located only in hospitals. As technology advanced, cost came down, images improved, and availability of this wonderful technology spread. Advanced imaging is now vital to the practice of every specialty.

Why should a group of urologists not be able to offer their patients the same efficient and rapid diagnosis with "on-site" CT imaging as in a large medical center in Houston? Many would argue that imaging in physician offices, for which insurance companies reimburse much less than they do for hospitals, actually brings costs down by eliminating the "middle man" of hospital-based imaging.

Regarding radiation therapy, I am not aware of any peer-reviewed literature that suggests outcomes of IMRT delivered by a physician-owned facility is any different than outcomes when delivered by large medical centers. The devices are the same.

Most urologists are "small business" owners. We must not only provide competent urologic care but must also manage our businesses well or we will not survive. Many physician practices, not only in urology, have come to realize that having ancillary services available for their patients is not only good medicine but good business.

William F. Gee, MD
Lexington, KY