Trends in PET scanner ownership and leasing by nonradiologist physicians.

PURPOSE: The aim of this study was to examine growth trends in ownership or leasing of private-office PET scanners by nonradiologist physicians. MATERIALS AND METHODS: The Medicare Part B Physician/Supplier Procedure Summary Master Files for 2002 through 2007 were used to collect the following data for each PET-related Current Procedural Terminology((R)) code: 1) annual procedure volume, 2) places of service for the procedures, and 3) specialties of the physicians filing the claims. To determine ownership or leasing, only technical and global claims that occurred in the nonhospital, private-office setting were included in the study. Professional component-only claims were not included. Procedure volume and growth trends were compared between radiologists and other specialties. RESULTS: Between 2002 and 2007, radiologist-owned Medicare PET scans increased by 259%, whereas nonradiologist-owned or nonradiologist-leased scans grew by 737%. Five specialty groups accounted for 95% of all nonradiologist PET volume in 2007: internal medicine subspecialties (28,324 studies in 2007), medical oncology (14,320 studies), cardiology (13,724 studies), radiation oncology (9,563 studies), and primary care (2,398 studies). In 2002, of all Medicare PET examinations performed on units owned or leased by physicians, the share for nonradiologists was 13%; their share rose to 24% in 2007. CONCLUSION: Although a large percentage of PET scans in private offices are done by radiologists, the growth rate among nonradiologists was far higher between 2002 and 2007 (259% for the former, 737% for the latter). The disproportionately rapid growth of PET scans performed on units owned by nonradiologists raises concern about self-referral at a time when policymakers are struggling to contain costs and reduce radiation exposure.

Housing repossessions, evictions and common mental illness in the UK: results from a household panel study.

BACKGROUND: The numbers of housing repossessions and evictions in the UK are increasing. This study investigates whether repossessions and evictions increase the likelihood of common mental illness and examine patterns over time. METHODS: Data come from the core longitudinal panel of the British Household Panel Survey (N = 12,390) of adults living in private households. Multivariate fixed-effects regression models are used with weighted data. Common mental illness is measured by the 12-item General Health Questionnaire. RESULTS: Housing repossession is associated with an increased risk of common mental illness (adjusted odds ratio 1.61, 95% confidence interval 1.10 to 2.36), whereas eviction from rented property shows no increased risk (0.97, 0.76 to 1.20). The pattern over time shows a clear increase in the years before repossession. CONCLUSIONS: Repossession of owned property, although a relatively rare event in the panel, significantly increases the risk of common mental illness immediately after the event. In contrast, eviction from rented property is a more common event but is not associated with an increased risk of common mental illness. This difference in association may be due to losing the security of owned housing and the often transitory nature of the rented housing population.

Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral.

PURPOSE: The aim of this study was to examine recent nationwide trends in the ownership or leasing of computed tomographic (CT) scanners in private offices by nonradiologist physicians. METHODS AND MATERIALS: The Medicare Part B fee-for-service data sets for 2001 though 2006 were used to identify all CT scans performed in nonhospital, private-office settings. Ownership or leasing of CT scans was determined by tabulating all global and technical-component-only claims. Professional-component claims were excluded. The specialty of the owner or lessee was determined using Medicare's physician specialty codes. Procedure volume trends and growth rates among all nonradiologist physicians as a group were compared with those among radiologists. Individual specialty volume trends and growth rates were also studied. RESULTS: From 2001 to 2006, Medicare private-office CT scan volume in facilities owned by radiologists increased by 85%. CT scan volume in facilities owned or leased by nonradiologist physicians as a group increased by 263%. The nonradiologic specialties with the largest volumes in 2006 were primary care (192,255 scans), internal medicine subspecialties other than cardiology and medical oncology (184,991 scans), urology (125,850 scans), cardiology (104,739 scans), and medical oncology (61,976 scans). Excluding CT scans performed in independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' private-office CT market share rose from 16% in 2001 to 28% in 2006. CONCLUSIONS: The majority of Medicare private-office CT scans are done in facilities owned by radiologists. However, nonradiologist physicians are acquiring or leasing CT scanners in increasing numbers, and the growth trend is much more rapid among them than it is among radiologists (85% among radiologists from 2001 to 2006, compared with 263% among nonradiologists). As a result, nonradiologists' market share has increased considerably. At a time when both cost containment and reduction in radiation exposure are urgent priorities, the self-referral opportunities resulting from this trend should be of concern to payers and policymakers.

[Financing problems of capital goods: part 1: leasing as a solution?]. / Finanzierungsproblematik von Investitionsgütern: Teil 1: Leasing als Ausweg?

The provision of financial support of hospitals by States for buying capital goods is becoming increasingly more limited. In order to still make investments, alternative forms of financing such as leasing must be considered in hospitals. However, the change from the classical form of dual financing and the decision to opt for a leasing model involves much more than just a question of costs. Leasing results in easily manageable expenditure, flexibility and adaptability for the choice of model but the leasing installments must be directly financed by the turnover from diagnosis-related groups and so lead to a reduction in the annual profit. In this article the authors try to give the reader an overview of the complex and sometimes counter-productive effect of financial instruments for investments in hospitals using leasing financing as an example. In the follow-up article the decision-making procedure using dynamic investment calculations will be demonstrated using a concrete example.

Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend.

PURPOSE: To study growth trends in the ownership of magnetic resonance imaging (MRI) examinations by nonradiologist physicians who either own the equipment outright or are involved in scan leasing arrangements. METHODS AND MATERIALS: Medicare Part B data sets from 2000 through 2005 were reviewed, and procedure codes for MRI examinations were selected. The focus was on only those procedures performed at nonhospital, private-office facilities. Using Medicare's physician specialty codes, all such studies were categorized according to the specialties of the physicians who performed them. Ownership was determined by including only those claims for global or technical-component-only reimbursement. Physicians owning or leasing MRI facilities would use one or the other of these two types of claims. Professional-component-only claims were not included. Procedure volumes and growth trends were compared among radiologists and other specialists. RESULTS: From 2000 to 2005, private-office MRI examinations performed by radiologists increased by 83%. During the same period, private-office MRI examinations performed by nonradiologist physicians, either through owning or leasing the equipment, increased by 254%. Excluding studies performed by independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' share of the private-office MRI market rose from 11% in 2000 to 20% in 2005. The nonradiologic specialties most actively involved in performing MRI were orthopedic surgery (161,296 Medicare studies in 2005), neurology (63,363 studies), primary care (58,092 studies), internal medicine subspecialties (34,317 studies), and neurosurgery (20,712 studies). CONCLUSIONS: In the private-office setting in 2005, radiologists performed most MRI examinations. However, the growth rate from 2000 to 2005 among nonradiologist physicians was far higher, 254% compared with 83% among radiologists. Because scans performed by nonradiologists through ownership or leasing are subject to self-referral, the much more rapid growth among those physicians should be of concern to policymakers and payers.

Trend analysis of dental practice rent and mortgage expenses: 1989-1995.

BACKGROUND: The authors analyzed trends for rent and mortgage, as reported by independent active private practitioners, for the period of 1989-1995. Rent and mortgage were analyzed overall and by different characteristics. METHODS: In the ADA's annual "Survey of Dental Practice," dentists reported gross billings and net incomes, as well as itemized practice expenses. The authors tabulated survey responses over time to develop trends and compare rent and mortgage expenses for each year. If trends over time were not exhibited, the authors combined multiple years of data to develop more reliable statistics. RESULTS: Approximately three-fourths of independent active private practitioners reported rent but no mortgage expenses. The percentages of practitioners who reported rent or mortgage was stable over time. The percentage reporting rent only as an expense increased with the number of dentists in the practice, the age of the reporting dentist and the number of office locations. In contrast, the opposite was true for dentists reporting mortgage only as an expense. CONCLUSIONS: The authors found that office rental is more common than is office ownership and that mortgages as a percentage of gross billings and in dollar amounts were similar to rents. They also found that because the cost of office space as a percentage of gross billings decreased as the number of dentists in the practice increased, limited economies of scale may be present in the cost of dental office space. PRACTICE IMPLICATIONS: There is not a large financial advantage to ownership, so renting is likely to remain an important way to acquire office space. As only limited economies of scale exist in office space expenses, many group practices may choose to rent office space.

An off year for consolidation. 1997 hospital mergers, acquisitions, joint ventures and long-term leases.

Because of a significant drop in the number of major corporate mergers and acquisitions, total hospital consolidation in 1997 was well off the record-setting pace of previous years. The number of hospitals involved in dealmaking dropped 18% to 627 compared with the previous year, according to Modern Healthcare's fourth annual roundup of consolidation activity. And there were only four corporate deals, compared with 11 in 1996.

Predictions bullish for industry's future.

What's around the corner and down the road for the textile rental industry? Four CEOs--Richard Farmer, William Leonard, Richard Senior, and James Stefoff--give their views on future industry profitability, evolutionary trends and specialization, healthcare market stability, and survival tactics.