Why go to the hospital Binge purchase doctor in recent years?
To coordinate care in hospitals, lower costs and upgrade patient experiences. To increase costs, get pricing power and reduce patient referrals, say skeptics.
Researchers at Stanford University opposed those arguments by comparing referral patterns between independent doctors and those working for hospitals.
Owned by a hospital “Dramatically increase” barriers He said that a doctor would recruit patients there instead of another, nearby hospital. Worse, from the reformers’ point of view, it increases the likelihood that patients will go to high-cost, low-quality hospitals.
“One of the things that surprised me the most was the paper quality and cost impact,” said economist Laurence Baker.
However, as the hospital referral pattern of doctors is not clarified, the quality of care of hospital-physician ownership findings “heads in the direction that may concern us,” he said.
The report is not the last word. More research is needed, the authors say. He said that the use of 2009 Medicare data does not reflect the quality improvement made in many hospitals Carolyn Steinberg, Vice president of trend analysis at the American Hospital Association.
Nevertheless, the paper raises questions about the hospital – doctor lockup and considers that consumers are in charge of where health services are purchased.
Doctors are the selling power of the hospital, although they do not like to think that way. Without doctors, there is no admission and no revenue to pay the hefty fixed expenses of hospitals.
So longtime physicians in hospitals were interested in the practice, including a part of the acquisition in the 1990s, with many lost money and Renewed boom in the last decade As the Affordable Care Act promised to squeeze costs.
But some researchers have closely studied the admission patterns of the practices of hospital-owned doctors next to the docks that work for themselves.
Baker and his colleagues analyzed millions of 2009 admissions using a model predicting inpatient hospital choice based on historical patterns.
The hospital’s ownership raised the possibility that an admitting doctor would send his patients up to a third to the owner’s hospital, they report. Doctors working in hospitals admitted on average 83 percent of their hospitalized patients to Proper Hospital.
What’s more, the researchers found that patients are “more likely to be treated in a high-cost, low-quality hospital when their physician’s practice is owned by that hospital.”
The authors used data on Medicare cost records as well as mortality and other quality gauges to score hospitals.
As policymakers attempt to revive a system Often annoys patients And saves billions of dollars Unnecessary careResearchers’ findings about hospital-owned practices are not consistent with the way systems are supposed to work.
“If these results are valid, it has big implications,” said Martin Gaynor, a health economist at Carnegie Mellon University. “Hospital acquisition of physician practices can harm rival hospitals and harm competition.”
A less alarming explanation is that hospitals employ doctors who already admit most of their patients to that hospital.
Steinberg of Aha said, “You would expect the institutions to get closer to the people already working.”
But data tests show that is not the case, Baker said. Further investigation is needed in this case, but, the results are “not convincing,” Gaynor said.
Steinberg said that with the passage of the Affordable Care Act, since the activity measured by the paper, “it really is a type of looking at the past.” “It would be interesting to know if affiliation with physicians allows hospitals to improve their quality.”
Health legislation encourages doctor-hospital collaboration, which is incorporated into groups called accountable care organizations that put participants on the hook for financial and quality outcomes.
The types highlighted by the steno paper – ACOs are considered to reduce incentives for market share for hospitals, raising prices and modest quality.
“I’m optimistic about the ACO,” Baker said. “But I think we should still focus on these issues.”