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Invited Critique
February 21, 2011

Is Self-referral Driving Increased Utilization?Comment on “Opening of Ambulatory Surgery Centers and Procedure Use in Elderly Patients”

Author Affiliations

Author Affiliation: Department of Surgery, Albany Medical College, Albany, New York.

Arch Surg. 2011;146(2):194. doi:10.1001/archsurg.2010.315

This article by Hollingsworth and colleagues is timely and important. These 4 procedures (colonoscopy, endoscopy, and cataract and breast surgery) constitute 75% of all Medicare payments to ASCs. In defined hospital service areas, the opening of an ASC resulted in increased procedure utilization by the Medicare population for what they described as discretionary procedures (cataract surgery, colonoscopy, and upper gastrointestinal tract endoscopy) but no corresponding increase in imperative procedures, such as breast operations. While I trust the accuracy of their data analysis, the use of value-laden terms such as discretionary to describe endoscopy and cataract surgery implies that all of these procedures did not have appropriate medical indications.

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