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. Objectives. To determine whether arrangements tailored to fit this loophole spur utilization. Research design. Cross-sectional. Subjects. Procedure-based specialty clinics participating in the National Ambulatory Medical Care Survey. Measures. 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.