Comparing The Mix Of Patients In Various Outpatient Surgery Settings

Winter, Ariel

doi:10.1377/hlthaff.22.6.68

Cited by 77 publications

(70 citation statements)

References 5 publications

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“…6 Ariel Winter demonstrated differences in case-mix between surgicenters and hospital outpatient departments and found that patients who were more medically complex tended to receive treatment at the latter. 7 Despite these advances, there remains a dearth of studies examining the effect of physicians' investment in surgicenters on surgery use. Jean Mitchell illustrated that the financial incentives linked to ownership influence the use of orthopedic procedures performed at specialty hospitals.…”

Section: Prior Studiesmentioning

confidence: 99%

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

et al. 2010

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Many physicians confronting declining reimbursement from insurers have invested in ambulatory surgery centers, where they perform outpatient surgical and diagnostic procedures. An ownership stake entitles physicians to a share of the facility's profits from self-referrals. This arrangement can create a potential conflict of interest between physicians' financial incentives and patients' clinical needs. Our analysis of Florida data for five common procedures revealed a significant association between physician-ownership and higher surgical volume. Possible remedies include revising federal law to require disclosure of investment arrangements; reducing facility payments to dilute ownership incentives; and reforms (such as accountable care organizations) that discourage an excessive rate of procedures.

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Section: Prior Studiesmentioning

confidence: 99%

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

et al. 2010

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“…Due to the significant growth in the number of ambulatory surgical procedures provided in the U.S. and associated overall costs [4], researchers have begun to examine differences in quality outcomes for procedures performed in freestanding ambulatory surgical centers (ASCs) and hospital-based outpatient departments (HOPDs) [5][6][7][8][9][10][11][12][13][14][15]. Overall, these studies have utilized varying risk-adjustment approaches and have generally produced mixed results.…”

Section: Introductionmentioning

confidence: 99%

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Chukmaitov

Harless

Menachemi

et al. 2009

Health Care Manag Sci

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This paper examines the empirical consistency of the Diagnosis Cost Groups/Hierarchical Condition Categories (DCG/HCC) risk-adjustment method for comparing 7-day mortality between hospital-based outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs). We used patient level data for the three most common outpatient procedures provided during the 1997-2004 period in Florida. We estimated base-line logistic regression models without any diagnosis-based risk adjustment and compared them to logistic regression models with the DCG/HCC risk-adjustment, and to conditional logit models with a matched cohort risk-adjustment approach. We also evaluated models that adjusted for primary diagnoses only, and then for all available diagnoses, to assess how the frequently absent secondary diagnoses fields in ambulatory surgical data affect risk-adjustment. We found that risk-adjustment using both diagnosis-based methods resulted in similar 7-day mortality estimates for HOPD patients in comparison with ASC patients in two out of three procedures. We conclude that the DCG/HCC risk-adjustment method is relatively consistent and stable, and recommend this risk-adjustment method for health policy research and practice with ambulatory surgery data. We also recommend using risk-adjustment with all available diagnoses.

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“…Young, unpublished data, 2010). 20,21,22,23 Finally, recent studies of RCs have found that they also engage in cream skimming the less severely ill patients but deliver less costly care, controlling for severity. 24,25 There is some evidence regarding quality standards practiced in such clinics and comparable levels of quality of care relative to physician offices.…”

Section: Radical and Disruptive Elements That Challenge Incumbentsmentioning

confidence: 99%

“…15,28 There is also some skepticism whether retail clinics can expand into more complex types of care and retain their current value proposition, thus limiting their ability to disrupt the status quo providers. 22 Overall, the scope for disruptive innovations in health care may be limited because patients find it notoriously difficult to assess the clinical dimensions of the medical services they buy. In fact, many patients use price and the quality of nonclinical dimensions of care, both of which are easily observed, to infer the quality of the clinical dimensions of care, thus offering few avenues for truly disruptive innovators to attract market share.…”

Section: Radical and Disruptive Elements That Challenge Incumbentsmentioning

confidence: 99%

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

Burns

David

Helmchen

2011

Population Health Management

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Strategic Response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics. AbstractRadical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care. Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such ''creative destruction'' and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: singlespecialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care. (Population Health Management 2011;14:69-77)

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Comparing The Mix Of Patients In Various Outpatient Surgery Settings

Cited by 77 publications

References 5 publications

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

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