"....These health systems MAY be pressuring their physicians to keep patients local. I suspect this is the case"
In fact, after wondering how to say it ....when I told my local Pulmonologist (whose major interest was asthma) that I was going to Mayo and to forward my scans to Mayo, she suggested I be diagnosed there (by her) and treated at Mayo!!!! I of course said no. That certainly was not in my best interests.
She ordered a needle biopsy that her own Radiologist refused to do because it was too dangerous and would not obtain enough sample. Then they said they could do the other lung instead! The PET scan showed uptick in both lungs Like what would that prove? Mayo never even did the needle biopsy. I have read that needle biopsies are not recommended, and Pulmonologists should do bronchoscopy ones instead. Mayo scheduled me for immediate surgery (bronchoscopy and removal in one sitting). It was cancer. I shutter to think what they would have done to me locally had I not been proactive and had traditional Medicare.