By Liam O’Neill, and Arthur J. Hartz
Health Affairs, April 2012
Physician-owned cardiac specialty hospitals advertise that they have outstanding physicians and results. To test this assertion, we examined who gets referred to these hospitals, as well as whether different results occur when specialty physicians split their caseloads among specialty and general hospitals in the same markets. Using data on 210,135 patients who underwent percutaneous coronary interventions in Texas during 2004–07, we found that the risk-adjusted in-hospital mortality rate for patients treated at specialty hospitals was significantly below the rate for all hospitals in the state (0.68 percent versus 1.50 percent). However, the rate was significantly higher when physicians who owned cardiac specialty hospitals treated patients in general hospitals (2.27 percent versus 1.50 percent). In addition, several patient characteristics were associated with a lower likelihood of being admitted to a cardiac hospital for cardiac care, such as being African American or Hispanic and having Medicaid or no health insurance. After adjustment for patient severity and number of procedures performed, the overall outcomes for cardiologists who owned specialty hospitals were not significantly different from the “average outcomes” obtained at noncardiac hospitals. In contrast to previous studies, patient outcomes were found to be highly dependent on the type of hospital where the procedure was performed. To remove a potential source of bias and achieve a more balanced comparison, the quality statistics reported by physician-owned cardiac hospitals should be adjusted to incorporate the high rates of poor outcomes for the many procedures done by their cardiologists at nearby noncardiac hospitals.
http://content.healthaffairs.org/content/31/4/806.abstract
Comment:
By Don McCanne, MD
Primarily because of conflict of interest considerations, physician-owned specialty hospitals, such as the cardiac specialty hospitals reported in this study, have remained controversial.
Physician owners tout the lower mortality rates and higher quality ratings in their own cardiac specialty hospitals. This study confirms a very high patient selection bias with the disturbing result that these same physicians have offsetting higher mortality rates when they admit Medicaid, uninsured, and minority patients to noncardiac hospitals. Thus, overall these physicians are not improving their own personal performances but rather are cream skimming their patients whom the admit to their cardiac hospitals in which they have an ownership interest.
The single payer model supported by Physicians for a National Health Program not only provides the administrative efficiencies of establishing a single, equitably-funded, universal risk pool, but it also calls for elimination of for-profit ownership and for separate budgeting of capital improvements. Under such a model a cardiac specialty hospital would be built only if it best served the interests of the patients – all patients. It would not be built for the purpose of advancing the fame and fortune of physician owners.