Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital.
We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals.
We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders. We used pre-post comparisons and difference-in-differences analysis to evaluate changes in practice patterns for physician owners and nonowners over the time period spanned by the entry of the specialty hospital.
Findings suggest the introduction of financial incentives linked to ownership coincided with a significant change in the practice patterns of physician owners, whereas such changes were not evident among physician nonowners. After physicians established ownership interests in a specialty hospital, the frequency of use of surgery, diagnostic, and ancillary services used in the treatment of injured workers with back/spine disorders increased significantly.
Physician ownership of specialty hospitals altered the frequency of use for an array of procedures rendered to patients treated at these hospitals. Given the growth in physician-owned specialty hospitals, these findings suggest that health care expenditures will be substantially greater for patients treated at these institutions relative to persons who obtain care from nonself-referral providers.
"They make a distinction between 'hard' economic integration strategies such as equity ownership (Mitchell, 2008) and 'soft' non-economic integration strategies such as physician involvement in hospital decision making (Ibay, 2007). On the one hand, economic integration encompasses hospitals provision of monetary payments to physicians to provide, manage or improve clinical services and to perform organizational activities (Burns et al. 2008). "
[Show abstract][Hide abstract] ABSTRACT: Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment.
[Show abstract][Hide abstract] ABSTRACT: Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
The Journal of the American Board of Family Medicine 01/2009; 22(1):62-8. DOI:10.3122/jabfm.2009.01.080102 · 1.98 Impact Factor
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