Physician-owned Hospitals Research Articles

Comparison of Commercial Negotiated Price and Cash Price Between Physician-Owned Hospitals and Other Hospitals in the Same Hospital Referral Region

This cross-sectional study compares commercial negotiated prices and cash prices between physician-owned hospitals and other hospitals in the same hospital referral region (HRR) using price information available through the Hospital Price Transparency Rule.

Elective Hand Surgery Is Delayed among Private Insurance Holders.

Patients with private healthcare plans often defer nonemergent or elective procedures toward the end of the year once they have met their deductible. No previous studies have evaluated how insurance status and hospital setting may affect surgical timing for upper extremity procedures. Our study aimed to evaluate the influence of insurance and hospital setting on end-of-the-year surgical cases for elective carpometacarpal (CMC) arthroplasty, carpal tunnel, cubital tunnel, and trigger finger release, and nonelective distal radius fixation. Insurance provider and surgical dates were gathered from two institutions' electronic medical records (one university, one physician-owned hospital) for those undergoing CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation from January 2010 to December 2019. Dates were converted into corresponding fiscal quarters (Q1-Q4). Using the Poisson exact test, comparisons were made between the case volume rate of Q1-Q3 and Q4 for private insurance and then for public insurance. Overall, case counts were greater in Q4 than the rest of the year at both institutions. There was a significantly greater proportion of privately insured patients undergoing hand and upper extremity surgery at the physician-owned hospital than the university center (physician owned: 69.7%, university: 50.3%; P < 0.001). Privately insured patients underwent CMC arthroplasty and carpal tunnel release at a significantly greater rate in Q4 compared with Q1-Q3 for both institutions. Publicly insured patients did not experience an increase in carpal tunnel releases during the same period at both institutions. Privately insured patients underwent elective CMC arthroplasty and carpal tunnel release procedures in Q4 at a significantly greater rate than publicly insured patients. This finding suggests private insurance status, and potentially deductibles, influence surgical decision making and timing. Further work is needed to evaluate the impact of deductibles on surgical planning and the financial and medical impact of delaying elective surgeries.

Reconsidering the Ban on Physician-Owned Hospitals to Combat Consolidation

Reconsidering the Ban on Physician-Owned Hospitals to Combat Consolidation

Vertical Integration Versus Physician Owners: Trends in Practice Structure Among Breast Cancer Surgeons.

The objective of this study was to document changes in physician practice structure among surgeons who treat women with breast cancer. We merged cancer registry records from 5 large states with Medicare Part B claims to identify each surgeon who treated women with breast cancer. We added information from SK&A surveys and extensive internet searches. We analyzed changes in breast surgeons' practice structure over time. We assigned each surgeon-year a practice structure type: (1) small single-specialty practice; (2) single-specialty surgery or multispecialty practice with ownership in an ambulatory surgery center (ASC); (3) physician-owned hospital; (4) multispecialty; (5) employed. In 2003, nearly 74% of breast cancer surgeons belonged to small single-specialty practices. By 2014, this percentage fell to 51%. A shift to being employed (vertical integration) accounted for only a portion of this decline; between 2003 and 2014, the percentage of surgeons who were employed increased from 10% to 20%. The remainder of this decline is due to surgeons opting to acquire ownership in an ASC or a specialty hospital. Between 2003 and 2014, the percentage of surgeons with ownership in an ASC or specialty hospital increased from 4% to 17%. Dramatic changes in surgeon practice structure occurred between 2003 and 2014 across the 5 states we examined. The most notable was the sharp decline in the prevalence of the small single-specialty practice and large increases in the proportion of surgeons either employed or with ownership in ACSs or hospitals.

Physician investment in hospitals: Specialization, selection, and quality in cardiac care

Physician ownership of hospitals involves several competing economic forces. Physician-owners may be incentivized to “cherry-pick” and treat profitable patients at their facilities. However, physician-owned hospitals are often specialized and may provide higher-quality care for well-matched patients. Using multiple identification approaches, I document no significant mortality improvement for cardiac patients treated at physician-owned hospitals. Using aggregate data on ownership to infer physician-owner preferences in a hospital choice model, my results rule out significant cherry-picking within physician-owners’ patient populations. However, both facility location and a healthier overall patient population among physician-owners drive advantageous selection of patients into physician-owned hospitals.

Decreased costs with maintained patient satisfaction after total joint arthroplasty in a physician-owned hospital

ObjectiveComparing total joint arthroplasty (TJA) costs and patient-reported outcomes between a physician-owned hospital (POH) and a non-POH. MethodsCosts for each 90-day TJA episode at both facilities were determined, and patients were asked to complete a patient satisfaction questionnaire. ResultsAverage TJA episode cost was $19,039 at the POH, compared to $21,302 at the non-POH, a difference of $2,263 (p = 0.03), largely driven by decreased skilled nursing facility utilization in the POH group. There were no differences between groups for patient satisfaction. ConclusionTJA can be performed at reduced cost with comparable patient satisfaction at POHs, compared to non-POH facilities.

Changes in Hospital Outpatient Quality Reporting Program Brain CT Efficiency Performance, 2013 to 2018

Inefficient imaging practices merit renewed attention in preparation for full implementation of the Appropriate Use Criteria Program. This study's purpose is to quantify changes in outpatient brain CT imaging efficiency from 2013 to 2018, including changes in relative efficiency by hospital category. Imaging efficiency data were obtained from the Medicare Hospital Compare website. Summary statistics were calculated for rates of unnecessarily combined brain and sinus CT scans from 2013 to 2018. Relative performance was compared by hospital Medicare payment structure, type of ownership, and affiliation with a radiology residency program. The predictive value of these hospital characteristics on brain CT efficiency was determined using linear regression analysis. From 2013 to 2018, the mean frequency of unnecessarily combined brain and sinus CT scans decreased by 1.82% (95% confidence interval, 1.74%-1.90%). Proprietary and physician-owned hospitals exhibited a higher mean frequency of combined scans than other hospitals in 2013 (P < .001), and government-owned hospitals exhibited a lower mean frequency of combined scans than other hospitals in 2018 (P < .001). Radiology residency-affiliated hospitals exhibited no significant difference in 2013 but exhibited a higher mean frequency in 2018 (difference: 0.45%; 95% confidence interval, 0.29%-0.61%). Critical access hospital status and nonaffiliation with a radiology residency program were the strongest predictors of brain CT efficiency in the regression model. Recent changes in hospitals' relative brain CT efficiency suggest category-specific differences in responsiveness to quality improvement efforts and may foreshadow similar trends under forthcoming initiatives.

Understanding the Value of Total Shoulder Arthroplasties at Physician-Owned Hospitals.

Owing to concerns regarding higher cost, low quality of care and cherry-picking in physician-owned hospitals (POHs), the Affordable Care Act imposed sanctions that prevented the formation of new POHs. With an increasing utilization of total shoulder arthroplasties (TSAs), there is a need for re-evaluation and assessment of quality and cost of TSAs performed at these POHs. The 2011 to 2014 Medicare 100% Standard Analytical Files was used to identify patients undergoing a reverse TSA or anatomic TSA at POHs and non-POHs. Multivariate regression analyses were used to assess differences in 90-day and 1-year outcomes between the two groups. A total of 1,626 (2.2%) patients received a TSA at a POH (N = 50). No notable differences were noted between POH versus non-POHs regarding 90-day surgical site infections (P = 0.645), dislocation (P = 0.068), periprosthetic fractures (P = 0.556), revision arthroplasty (P = 0.114), pulmonary embolism (P = 0.155), deep vein thrombosis (P = 0.208), acute myocardial infarction (P = 0.219), sepsis (P = 0.288), urinary tract infections (P = 0.186), all-cause readmissions (P = 0.427), 1-year dislocations (P = 0.475), 1-year periprosthetic fractures (P = 0.697), and 1-year revision arthroplasties (P = 0.225). TSAs performed at POHs had higher odds of postoperative stiffness at 90-day (odds ratio 1.39; P < 0.001) and 1-year follow-up points (odds ratio 1.51; P < 0.001). TSAs at POHs had markedly lower risk-adjusted 90-day charges (-$8,904) and 90-day costs (-$1,659). Apart from slightly higher rates of stiffness and renal complications, patients undergoing TSAs at POHs seem to have similar outcomes as compared to non-POHs, while having lower costs of care. The findings suggest a need for further research, evaluating the value of care at POHs. Level III.

Time to Consider a New Look at Physician-Owned Hospitals to Increase Competition in Health Care?

Time to Consider a New Look at Physician-Owned Hospitals to Increase Competition in Health Care?

Evaluation of costs and outcomes of physician-owned hospitals across common surgical procedures

IntroductionThe Affordable Care Act introduced restrictions on the creation of new physician-owned hospitals (POH). We sought to define whether POH status was associated with differences in care. MethodsPatients undergoing one of ten surgical procedures were identified using Medicare Standard Analytic Files. Patient and hospital-level characteristics and outcomes between POH and non-POH were compared. ResultsAmong 1,255,442 patients identified, 14,560 (1.2%) were treated at POH. A majority of POHs were in urban areas (n = 30, 90.9%) and none were in low socioeconomic status areas. Patients at POH were slightly younger (POH:72, IQR:68–77 vs. non-POH:73, IQR:69–79) and healthier (CCI; POH:2; IQR: 1–3 vs. non-POH: 3; IQR: 1–4). Patients at non-POH had higher odds of postoperative complications (OR:1.67, 95%CI:1.55–1.80) and slightly higher medical expenditures (POH:$11,347, IQR:$11,139-$11,936 vs. non-POH:$13,389, IQR:$11,381–$19,592). ConclusionsPOH were more likely to be located in socioeconomic advantaged areas, treat healthier patients and have lower associated expenditures.

39. Anterior cervical discectomy and fusions (ACDFs) at physician-owned hospitals: is it time to reconsider the sanctions of the Affordable Care Act (ACA)?

BACKGROUND CONTEXT Due to concerns regarding higher cost and low quality of care provided in physician-owned hospitals, the Affordable Care Act (ACA) imposed sanctions that prevented the formation of new physician-owned hospitals and limited expansion of current facilities. With the demand of spine care growing across the United States, there is a need for re-evaluation and assessment of quality of spine surgical care provided at these physician-owned hospitals. PURPOSE The current study utilizes a national Medicare dataset to assess whether elective 1- to 3-level anterior cervical discectomy and fusions (ACDFs) being performed at physician-owned hospitals are safe and cost-efficacious as compared to non-physician-owned hospitals. STUDY DESIGN/SETTING Retrospective review of 100% Medicare Claims Database. PATIENT SAMPLE The 2005-2014 Medicare 100% Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level ACDFs (81.02 and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals and were cross-referenced to identify records of patients receiving elective ACDFs at these hospitals from the SAF100 database. OUTCOME MEASURES Ninety-day complications, readmissions, and costs. METHODS Multivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions and costs between the two groups, while controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and Elixahuser Comorbidity Index. RESULTS After controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and ECI, undergoing ACDFs at physician-owned hospital was associated with lower odds of cardiac complications (OR 0.80 [95% CI 0.73-0.86]; p CONCLUSIONS The results of the study suggest that elective 1- to 3-level ACDFs at physician owned hospitals have significant cost-savings (over $1,900/case), while having lower odds of experiencing 90-day medical complications and readmissions. The findings call into the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

128. Posterior lumbar fusions (PLFs) at physician-owned hospitals: reconsidering the restrictions of the Affordable Care Act (ACA)

BACKGROUND CONTEXT Due to perceptions and concerns about unnecessary high resource utilization/costs and low quality of care provided in physician owned hospitals, the Affordable Care Act (ACA) of 2010 imposed restrictions on existing physician-owned hospitals from expanding. PURPOSE The current study aimed to assess differences in 90-day costs and outcomes between patients undergoing elective 1-to-3 level posterior lumbar fusions (PLFs) at physician-owned hospitals vs non-physician–owned hospitals. STUDY DESIGN/SETTING Retrospective review of 2007-2014 100% Medicare Standard Analytical Files (SAF100) database. PATIENT SAMPLE The 2007-2014 Medicare 100% Standard Analytical Files (SAF100) database was queried using International Classification of Diseases, 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level posterior lumbar fusions (81.07, 81.08 and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals and were cross-referenced to identify records of patients receiving elective posterior lumbar fusions at these hospitals from the SAF100 database. OUTCOME MEASURES Ninety-day complications, readmissions, charges and costs. METHODS Multivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions, charges and costs between the two groups. RESULTS A total of 6,679 (2.9%) patients received an elective posterior lumbar fusion at a physician-owned hospital (N=39; 2.2%) whereas 225,090 (97.1%) received surgery at non-physician–owned hospital (N=1,774; 97.8%). After controlling for age, gender, region, hospital factors (socioeconomic status area, urban vs rural location and volume) and ECI, undergoing surgery at physician-owned hospital was associated with lower odds of thromboembolic complications (OR 0.66 [95% CI 0.53-0.82]; p CONCLUSIONS Our results suggest that patients undergoing elective 1-to-3 level PLFs at physician-owned hospitals have fewer charges and costs over the 90-day episode of care, while having lower odds of experiencing urinary tract infections, thromboembolic complications and renal complications within 90-days of the surgery. The findings call into the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Posterior lumbar fusions at physician-owned hospitals – is it time to reconsider the restrictions of the Affordable Care Act?

Background ContextCaused by perceptions regarding unnecessary healthcare resource utilization, high costs of care, and financial incentives towards “cherry-picking” cases in physician owned hospitals, the Affordable Care Act (ACA) of 2010 imposed restrictions on existing physician-owned hospitals from expanding. Despite an increasing number of individuals requiring access to spine surgical care, no study has evaluated the surgical safety and costs of elective posterior lumbar fusions (PLFs) being performed in physician-owned vs. non-physician-owned hospitals. PurposeWe assessed differences in 90-day costs and outcomes between patients undergoing elective 1- to 3-level PLFs at physician-owned hospitals vs. nonphysician-owned hospitals. Study DesignRetrospective cohort study of 2007 to 2014 100% Medicare claims database. Patient SampleThe 2007 to 2014 Medicare 100% Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level PLFs (81.07, 81.08, and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals. These provider codes were cross-referenced to identify records of patients receiving elective PLFs at these hospitals from the SAF100 database. Outcome MeasuresNinety day complications, readmissions, emergency department (ED) visits, charges, and costs. MethodsMultivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions, charges and costs between the two groups. ResultsA total of 6,679 (2.9%) patients received an elective PLF at a physician-owned hospital (N=39; 2.2%) whereas 225,090 (97.1%) received surgery at nonphysician-owned hospital (N=1,774; 97.8%). After controlling for age, gender, region, hospital factors (socio-economic status area, urban vs. rural location and volume) and Elixhauser co-morbidity index, undergoing surgery at physician-owned hospital was associated with lower odds of thromboembolic complications (OR 0.66 [95% CI 0.53–0.82]; p<.001), urinary tract infections (OR 0.87 [95% CI 0.79–0.95]; p=.002) and renal complications (OR 0.52 [95% CI 0.43–0.63]; p<.001) within 90-days following the surgery. Patients undergoing PLFs at physician-owned hospitals vs. nonphysician-owned hospitals also had lower risk-adjusted inpatient charges (−$10,218), inpatient costs (−$2,302), 90-day charges (−$9,780) and 90-day costs (−$2,324). No significant differences were noted between physician-owned and nonphysician-owned hospitals with regards to 90-day wound complications (OR 1.08 [95% CI 0.94–1.22]; p=.279), pulmonary complications (OR 1.06 [95% CI 0.97–1.17]; p=.187), cardiac complications (OR 0.92 [95% CI 0.83–1.01]; p=.089), septic complications (OR 0.77 [95% CI 0.56–1.01]; p=.073), all-cause ED visits (OR 0.96 [95% CI 0.89–1.04]; p=.311), revision surgery (OR 1.09 [95% CI 0.72–1.59]; p=.653) and readmissions (OR 0.98 [95% CI 0.89–1.08]; p=.680). ConclusionOur results suggest that patients undergoing elective 1- to 3-level PLFs at physician-owned hospitals do not experience a greater number of complications and/or readmissions while having lower risk-adjusted charges and costs over the 90-day episode of care. The findings call on the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals.

A Novel, Synergistic Model in Total Joint Arthroplasty: A Report of 2 Specialty Hospitals With Joint Ownership Between Physicians and Healthcare Systems

BackgroundIn 2010, the Affordable Care Act introduced new restrictions on the expansion of physician-owned hospitals (POHs) due to concerns over financial incentives and increased costs. The purpose of this study is to determine whether joint ventures between tertiary care and specialty hospitals (SHs) allowing physician ownership (POHs) have improved outcomes and lower cost following THA and TKA. MethodsAfter institutional review board approval, a retrospective review of consecutive series of primary THA and TKA patients from 2015 to 2016 across a single institution comprised of 14 full-service hospitals and 2 SHs owned as a joint venture between physicians and their health system partners. Ninety-day episode-of-care claims cost data from Medicare and a single private insurer were reviewed with the collection of the same demographic data, medical comorbidities, and readmission rates for both the SHs and non-SHs. A multivariate regression analysis was performed to determine the independent effect of the SHs on episode-of-care costs. ResultsOf the 6537 patients in the study, 1936 patients underwent a total joint arthroplasty at an SH (29.6%). Patients undergoing a procedure at an SH had shorter lengths of stay (1.29 days vs 2.23 days for Medicare, 1.15 vs 1.86 for private payer, both P < .001), were less likely to be readmitted (4% vs 7% for Medicare, P = .001), and had lower mean 90-day episode-of-care costs ($16,661 vs $20,579 for Medicare, $26,166 vs $35,222 for private payers, both P < .001). When controlling for the medical comorbidities and demographic variables, undergoing THA or TKA at an SH was associated with a decrease in overall episode costs ($3266 for Medicare, $13,132 for private payer, both P < .001). ConclusionEven after adjusting for a healthier patient population, the joint venture partnership with health systems and physician-owned SHs demonstrated lower 90-day episode-of-care costs than non-SHs following THA and TKA. Policymakers and practices should consider these data when considering the current care pathways.

Observations on the Medicare Value-Based Ranking of Hospitals During Fiscal Years 2015 and 2016.

Medicare's Value-Based Purchasing Program (VBPP) compensates hospitals based on value of care provided. VBPP's total performance score (TPS) components data were evaluated by hospital groups: physician-owned surgical hospitals (POSH), Kaiser Hospitals, University HealthSystem Consortium Hospitals, Pioneer Accountable Care Organization Hospitals, US News and World Report Honor Roll Hospitals, and other hospitals. Multilevel random coefficient models estimated mean and significance of TPS differences from fiscal year (FY) 2015 and FY 2016, by hospital type. Overall mean TPS for 2985 hospitals decreased from 41.65 to 40.25. POSH and Kaiser Hospitals had significantly higher TPS in FY 2015 and FY 2016. POSH Patient Experience Domain scores exceeded all other Patient Experience Domain scores. The Efficiency Domain scores of Kaiser greatly exceeded the scores of all groups. Results suggest that POSH and Kaiser Hospitals provide significantly greater value of care with consistency from year to year when compared with other groups studied.

Are Patients Undergoing an Anterior Cervical Discectomy and Fusion Treated Differently at a Physician-owned Hospital?

Retrospective case-control study. Physician-owned specialty hospitals focus on taking care of patients with a select group of conditions. In some instances, they may also create a potential conflict of interest for the surgeon. The effect this has on the surgical algorithm for patients with degenerative cervical spine conditions has not been determined. A retrospective review of all patients who underwent a 1- or 2-level anterior cervical discectomy and fusion between October 2009 and December 2014 at either a physician-owned specialty hospital or an independently owned community hospital were identified. Demographic information, the time course for treatment and the nonoperative treatment regimen were evaluated. In total, 115 patients undergoing surgery at a physician-owned specialty hospital and 149 patients undergoing surgery at an independent community hospital were identified. Demographic data between the groups including the presence of 12 medical comorbidities and insurance status was similar between the groups. The only difference that was identified was that patients at the surgeon-owned hospital were marginally younger than patients who had surgery at the independent hospital (49.7 vs. 50.0, P=0.048). No difference in the median number of months from the onset of symptoms to surgery (6.51 vs. 7.53 mo, respectively; P=0.55), from the onset of symptoms to the preoperative visit (6.02 vs. 6.02, P=0.64), or from the initial surgical consultation to surgery (0.99 vs. 1.02, P=0.31) was identified. No difference in the number of patients who underwent formal physical therapy (72.2% vs. 67.1%, P=0.42) or who had a cervical steroid injection (55.6% vs. 50.3%, P=0.25%) was identified between patients who had surgery at a physician-owned or independent hospital; however, patients who underwent surgery at the physician-owned hospital were more likely to have taken oral anti-inflammatories (93.0% vs. 83.9%, P=0.04). When comparing hospitals with similar resources, surgeons do not preferentially select younger, healthier patients with higher paying insurance to be treated at the physician-owned hospital. Furthermore, both the time from the onset of symptoms to surgery and the nonoperative treatment regimen were similar between patients treated at the 2 facilities.

Reconsidering the Affordable Care Act's Restrictions on Physician-Owned Hospitals: Analysis of CMS Data on Total Hip and Knee Arthroplasty.

Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA). With use of the U.S. Centers for Medicare & Medicaid Services (CMS) Inpatient Charge Data, we identified 45 physician-owned and 2,657 non-physician-owned hospitals that performed ≥11 primary TKA and THA procedures in 2014. Cost data, patient-satisfaction scores, and risk-adjusted complication and 30-day readmission scores for knee and hip arthroplasty patients were obtained from the multiyear CMS Hospital Compare database. Physician-owned hospitals received lower mean Medicare payments than did non-physician-owned hospitals for THA and TKA procedures ($11,106 compared with $12,699; p = 0.002). While the 30-day readmission score did not differ significantly between the 2 types of hospitals (4.48 compared with 4.62 for physician-owned and non-physician-owned, respectively; p = 0.104), physician-owned hospitals had a lower risk-adjusted complication score (2.83 compared with 3.04; p = 0.015). Physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital (93.9 compared with 87.9; p < 0.001) and overall hospital rating (93.4 compared with 88.4; p < 0.001). When controlling for hospital demographic variables, status as a non-physician-owned hospital was an independent risk factor for being in the upper quartile of all inpatient payments for Medicare Severity-Diagnosis Related Group (MS-DRG) 470 (odds ratio, 3.317; 95% confidence interval, 1.174 to 9.371; p = 0.024), which may be because of a difference in CMS payment methodology. Our findings suggest that physician-owned hospitals are associated with lower mean Medicare costs, fewer complications, and higher patient satisfaction following THA and TKA than non-physician-owned hospitals. Policymakers should consider these data when debating the current moratorium on physician-owned hospital expansion. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Physician-Owned Hospitals: Down but Not Out? The Evidence Versus the Hype: Commentary on an article by P. Maxwell Courtney, MD, et al.: "Reconsidering the Affordable Care Act's Restrictions on Physician-Owned Hospitals. Analysis of CMS Data for Total Hip and Knee Arthroplasty".

Physician-Owned Hospitals: Down but Not Out? The Evidence Versus the Hype: Commentary on an article by P. Maxwell Courtney, MD, et al.: "Reconsidering the Affordable Care Act's Restrictions on Physician-Owned Hospitals. Analysis of CMS Data for Total Hip and Knee Arthroplasty".

The Affordable Care Act's Effects On The Formation, Expansion, And Operation Of Physician-Owned Hospitals.

The Affordable Care Act (ACA) imposed new restrictions on the formation and expansion of physician-owned hospitals. These restrictions provided incentives for the hospitals and their owners to take preemptive actions before the effective dates of ACA provisions and modify their operations thereafter. We studied 106 physician-owned hospitals in Texas to determine how they responded to ACA restrictions. We found that there were significant pre-ACA increases in the formation, physician ownership, and physical capacity of physician-owned hospitals, which suggests that they reacted quickly to the policy changes. After the ACA's provisions took effect, the hospitals improved the use of their assets to generate increased amounts of services, revenue, and profits. We found no evidence that existing physician-owned hospitals stopped accepting Medicare to avoid the ACA restrictions, although some investors adopted a seemingly unsuccessful strategy of not accepting Medicare at physician-owned hospitals formed after implementation of the ACA. We conclude that the ACA restrictions effectively eliminated the formation of new physician-owned hospitals, thus accomplishing what previous legislative efforts had failed to do.

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.