There is no evidence that physician-owned hospitals systematically cherry-pick the most profitable patients, though they may treat slightly healthier patients, according to a study published last week by BMJ.
The results contest past findings that POHs select less severe cases and wealthier patients. Specifically, in 2005 and 2006, the Medicare Payment Advisory Commission published two studies that found specialty physician-owned hospitals treat fewer Medicaid patients and take less severe cases.
The BMJ study looked at a list of more than 2,000 acute care hospitals across the United States, which included 219 POHs. Researchers sought to determine the proportion of POH patients that used Medicaid or were from ethnic and racial minority groups. The study also examined hospital performance based on patient experience metrics, care processes, risk-adjusted 30-day mortality rates, readmission rates, costs of care, care payments and Medicare market share, to determine if POHs deliver the same level of quality and value as non-POHs.
Researchers found POHs tend to be smaller, usually less than 100 beds, for-profit and located in urban areas. Slightly more than half of the POHs studied were nonspecialty hospitals.
The study highlighted the following findings on POH patient populations:
- Most POH patients were slightly younger than non-POH patients.
- POH patients were less likely to be admitted to the hospital through the emergency department than non-POH patients.
- POH patients are equally likely to be black or Hispanic, and use Medicaid or Medicare.
- POH patients had similar prevalence of chronic diseases and predicted mortality scores.
- POHs and non-POHs had similar patient experience scores, processes of care, risk-adjusted 30-day mortality rates, 30-day readmission rates, costs and payments for the following procedures: acute myocardial infarction, congestive heart failure and pneumonia.
The authors concluded that POH patients may be slightly healthier, but results do not otherwise indicate that POHs select patients based on their profitability. Based on their findings, the authors hypothesized POH patients may be slightly healthier due to the hospital size. Since POHs tend to be smaller, they are less likely to have the capabilities and/or subspecialty expertise to take on complex and critically ill patients. Similarly, the study also indicates that POHs do not provide lower value care or threaten the financial viability of surrounding hospitals, the authors wrote.
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