In this paper we compare physician referral patterns, quality, patient satisfaction, and community benefits of physician-owned specialty versus peer competitor hospitals. Our results are based on evidence gathered from site visits to six markets, 2003 Medicare claims, patient focus groups, and Internal Revenue Service data. Although physicianowners are more likely than others to refer to their own facilities and treat a healthier population, there are rationales for these patterns aside from motives for profit. Specialty hospitals provide generally high-quality care to satisfied patients. Uncompensated care plus specialty hospitals' taxes represent a greater burden, in percentage terms, than community benefits provided by nonprofit providers. [Health Affairs 25, no. 1 (2006): 106-118] A s pa rt o f t h e m e d i c a r e p r e s c r i p t i o n d ru g, Improvement, and Modernization Act (MMA) of 2003, Congress established an eighteenmonth moratorium on the development and expansion of new physicianowned specialty hospitals. The central concern among policymakers is whether these hospitals enjoy an unfair competitive advantage relative to other community hospitals. During the moratorium, Congress required the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS) to report on two different aspects of this issue. At issue is whether specialty hospitals' physician-owners are able to control the referral of patients, choosing between their own facilities and other hospitals in the community, in a way that results in favorable selection. Other related issues are whether specialty hospitals provide high-quality care, how their patients perceive care, and what types of community benefits they contribute in their markets. Although the con-1 0 6 J a n u a r y / F e b r u a r y 2 0 0 6

BACKGROUND:Studies have shown that follow‐up care for cancer patients differs by physician specialty, and that coordination between specialists and generalists results in better care. Little is known, however, regarding which specialties of physicians provide care to long‐term cancer survivors.METHODS:The authors used Surveillance, Epidemiology, and End Results data from 1992 through 1997 that were linked to 1997‐2003 Medicare data to identify persons diagnosed >5 years earlier with bladder, female breast, colorectal, prostate, or uterine cancer. Physician specialties were assigned by combining Medicare data with the American Medical Association Masterfile and the Unique Physician Identification Number Registry. The percentage of long‐term survivors who visited physicians of interest was determined by analyzing Medicare outpatient claims submitted 6 to 12 years after initial diagnosis.RESULTS:Over the entire study period, 46% of female breast cancer survivors, 26% of colorectal cancer survivors, and 14% of prostate cancer survivors saw hematologists/oncologists. Radiation oncologists were seen by 11%, 2%, and 14% of breast, colorectal, and prostate cancer survivors, respectively. Survivors also sought care from specialists related to their cancer: 19% of breast cancer survivors had a cancer‐coded visit with a surgeon, 26% of colorectal cancer survivors visited a gastroenterologist, and 68% of prostate cancer survivors visited a urologist. The percentage of survivors who visited cancer and cancer‐related physicians declined each year. In contrast, nearly 75% of female breast, colorectal, and prostate cancer survivors saw primary care providers, and these percentages did not decrease annually.CONCLUSIONS:The findings of the current study underscore the need to include both primary care providers and cancer‐related specialists in education and guidelines regarding cancer survivorship. Cancer 2009. © 2009 American Cancer Society.

Objective. To examine the number of cancer specialists identified in three national datasets, the effect of combining these datasets, and the use of refinement rules to classify physicians as cancer specialists. Data Sources. 1992-2003 linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data and a cancer-free comparison population of Medicare beneficiaries, Unique Physician Identification Number (UPIN) Registry, and the American Medical Association (AMA) Masterfile. Study Design. We compared differences in counts of cancer specialists identified in Medicare claims only with the number obtained by combining data sources and after using rules to refine specialty identification. Data Extraction. We analyzed physician specialty variables provided on Medicare claims, along with the specialties obtained by linkage of unencrypted UPINs on Medicare claims to the UPIN Registry, the AMA Masterfile, and all sources combined. Principle Findings. Medicare claims identified the fewest number of cancer specialists (n 5 11,721) compared with 19,753 who were identified when we combined all three datasets. The percentage increase identified by combining datasets varied by subspecialty (187 percent for surgical oncologists to 50 percent for radiation oncologists). Rules created to refine identification most affected the count of radiation oncologists. Conclusions. Researchers should consider taking the additional effort and cost to refine classification by using additional data sources based on their study objectives.

The PGP demonstration, which used a payment model similar to the Medicare Accountable Care Organization (ACO) program, resulted in small reductions in Medicare expenditures and inpatient utilization, and improvements in process quality indicators. Judging from this demonstration experience, it is unlikely that Medicare ACOs will initially achieve large savings. Nevertheless, ACOs paid through shared savings may be an important first step toward greater efficiency and quality in the Medicare fee-for-service program.

Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.