In-office imaging capabilities among procedure-based specialty practices

John M Hollingsworth, Joseph W. Sakshaug, Yun Zhang, Brent K Hollenbeck

    Research output: Contribution to journalArticlepeer-review


    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.
    Original languageEnglish
    JournalSurgical innovation
    Issue number4
    Early online date16 Oct 2013
    Publication statusPublished - Aug 2014


    • diagnostic imaging
    • physician practice patterns
    • utilization


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