Advertisement

Syndicate

Physician Resources Home arrow Medical News arrow Opening of specialty cardiac hospitals associated with increase in rate of cardiac procedures
Opening of specialty cardiac hospitals associated with increase in rate of cardiac procedures
Written by NetDoc.com Medical News Feed   
The opening of a specialty cardiac hospital is associated with an increase in the rate of coronary revascularization in a region, compared to new cardiac programs opened at general hospitals, according to a study in the March 7 issue of JAMA.

 

 

Specialty hospitals, which provide care limited to specific medical conditions or procedures, are opening at a rapid pace across the United States, according to background information in the article. Proponents argue that specialty hospitals provide higher quality health care and greater cost-efficiency by concentrating physician skills and hospital resources needed for managing complex diseases. Critics claim that specialty hospitals focus primarily on low-risk patients and provide less uncompensated care, which places competing general hospitals at significant financial risk.

“However, specialty hospitals raise an additional concern beyond their potential to simply redistribute cases within a health care market. Specialty hospitals are typically smaller than general hospitals and have high rates of physician ownership. Physician owners may have stronger financial incentives for providing services that fuel greater utilization,” the authors write.

Brahmajee K. Nallamothu, M.D., M.P.H., of the VA Health Services Research and Development Center of Excellence, Ann Arbor, Mich., and colleagues conducted a study to determine whether the opening of specialty cardiac hospitals was associated with greater utilization of coronary revascularization services. The researchers calculated annual population-based rates for total revascularization (coronary artery bypass graft [CABG] plus percutaneous coronary intervention [PCI]), CABG, and PCI of Medicare beneficiaries from 1995 through 2003. Hospital referral regions (HRRs) were used to categorize health care markets into those where (1) cardiac hospitals opened (n = 13), (2) new cardiac programs opened at general hospitals (n = 142), and (3) no new programs opened (n = 151).

The researchers found that overall, rates of change for total revascularization were higher in HRRs after cardiac hospitals opened when compared with HRRs where new cardiac programs opened at general hospitals and HRRs with no new programs. “Four years after their opening, the relative increase in adjusted rates was more than 2-fold higher in HRRs where cardiac hospitals opened (19.2 percent) when compared with HRRs where new cardiac programs opened at general hospitals (6.5 percent) and HRRs with no new programs (7.4 percent).”

“Although we are unable to comment directly on the appropriateness of these procedures, these findings raise the concern that the opening of cardiac hospitals may lead to greater procedural utilization beyond the simple addition of capacity to a market. This is particularly worrisome since cardiac hospitals may not substantially improve clinical outcomes when compared with general hospitals with similar procedural volumes,” the researchers write.

“...our findings may have important policy implications. The Centers for Medicare & Medicaid Services recently issued their final report to Congress implementing a strategic plan for specialty hospitals. Their plan primarily involves revisions to the inpatient prospective payment systems to ‘level the playing field’ between specialty and general hospitals and limit financial incentives for investing in certain services simply due to profitability. It also proposes new ‘gainsharing’ and value-based payment approaches to better align physician and hospital incentives toward improving care at general hospitals. Reforms directly related to physician ownership include enhanced transparency of financial relationships. More stringent measures, such as limiting investments by physician owners, were not included. The extent to which additional measures are needed will require further data on appropriateness of care at specialty hospitals as well as the impact of greater utilization of these procedures on patient outcomes.”
(JAMA. 2007;297:962-968. Available to the media at www.jamamedia.org)

Editor's Note: This project was supported by a grant from the Agency for Healthcare Research and Quality. Dr. Nallamothu completed part of this work while supported as a clinical scholar under a K12 grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

EDITORIAL: PHYSICIAN-OWNED SPECIALTY HOSPITALS AND CORONARY REVASCULARIZATION UTILIZATION — TOO MUCH OF A GOOD THING?

In an accompanying editorial, Peter Cram, M.D., M.B.A., and Gary E. Rosenthal, M.D., of the University of Iowa Carver College of Medicine, Iowa City, Iowa examine the findings of Nallamothu and colleagues.

“The emergence of specialty hospitals is in an early state of evolution but may represent the beginning of a fundamental reorganization in the ways in which hospitals are structured and care is delivered. Specialization already permeates most sectors of the U.S. economy and is associated with both increased efficiency and product quality. Although there is no fundamental reason hospital care should differ, the current findings suggest that physician ownership of specialty hospitals may be problematic if such ownership increases the use of services for patients with marginal indications. As specialty hospitals evolve, vigilance will be needed to determine if benefits are being delivered as promised and if untoward effects on the delivery system are emerging. In the meantime, all hospitals will need to look carefully at specialty hospitals to see what, if any, lessons can be gleaned from their successes and failures.”
(JAMA. 2007;297:998-999. Available to the media at www.jamamedia.org)

Editor's Note: Dr. Cram is the recipient of a K23 career development award from the National Center for Research Resources, National Institutes of Health. This research was also supported by a grant from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs. Financial disclosures – none reported.

 

 
< Prev   Next >

Common Diseases

Swine Flu - Updates and information on H1N1 2009 (AKA Swine Influenza) pandemic.

Ankylosing spondylitis - Current protocols for diagnosis and treatment options.

Wegener granulomatosis - Autoimmune etiology and clinical course.

Diabetes - disease and management information, including diagnosis, typical treatment plans and diabetes supplies.

Advertisement

Medical Careers

The US medical jobs market has stayed hot for health care providers. Whether you believe that a provider shortage is in the offing or that the ratio of physicians-to-patients is too high, physician jobs and nursing jobs abound.

A wide variety of medical jobs can be found in the netdoc health care job listings. Particular strengths include permanent and locum tenens physician jobs, nursing jobs across the US, and radiology positions.

Other resources include physician salary information, medical career guidance, and the ability to post physician jobs.

Polls

When hiring your medical practice office manager, what was the most important consideration?
 
Copyright 2005 - 2019 Medical Resource Group, LLC. All rights reserved.