The Emergence of Physician-Owned Specialty Hospitals

Iglehart, John K.

doi:10.1056/nejmhpr043631

Cited by 92 publications

(77 citation statements)

References 9 publications

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“…Estimat-ing the productivity and quality of these hospitals, however is confounded by several factors. As Iglehart (2005) notes, superior physician productivity and quality may result from repeatedly performing a narrow set of procedures. On the other hand, selective admission of patients can also be a driver of superior outcomes.…”

Section: Literaturementioning

confidence: 99%

The Effects of Focus on Performance: Evidence from California Hospitals

2011

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We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization-at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely, faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply "cherry-picking" easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g., operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects. We use hospital level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization -at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply "cherry-picking" easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm-level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g. operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects.

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Section: Literaturementioning

confidence: 99%

The Effects of Focus on Performance: Evidence from California Hospitals

2011

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“…Similar concerns over declining reimbursement and uncertainty surrounding new delivery models motivate alignment for hospitals and healthcare systems [3,11,23,25,33,34,36,37,49], Lovrien and Peterson [33] noted, ''Effective partnerships between hospitals and physicians are required to optimize the delivery system and ensure effective coordination of care while maintaining appropriate financial returns for the hospital.'' Further, the need to provide emergency room coverage has driven hospitals to engage orthopaedic surgeons and other physicians [1,3,43].…”

Section: Hospital/healthcare System Perspective On Factors Driving Almentioning

confidence: 99%

“…From the hospital perspective, regaining this profit center makes alignment with the physician-owners attractive [8,25,51,54]. One earlier study noted: ''Most specialist initiatives are designed to compete directly for a share of the most profitable health-care system facility and ancillary revenue sources'' [11].…”

Section: Drivers Motivating Orthopaedic Surgeons To Align With Hospitalsmentioning

confidence: 99%

Factors Driving Physician-Hospital Alignment in Orthopaedic Surgery

Page

Butler

Bozic

2013

Clinical Orthopaedics &Amp; Related Research

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Background The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Questions/purposes Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. Methods We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physicianhospital alignment. Literature searches were performed in both MEDLINE 1 and Health Business TM Elite. Results Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Conclusions Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

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“…Nur wenn der Markterfolg in die Definition von Innovation eingeschlossen wird, ergeben sich die wirklich wesentlichen Schlussfolgerungen fü r die Vorgehensweise, die Beurteilungskriterien, die Risikoeinschätzung und die Erfolgskontrolle. Innovation ist nicht an kleine agile Einheiten gebunden, sondern In den USA fü hrten DRGs zu einer Zunahme von so genannten ambulanten surgical centers [4,5]. Diese bearbeiten organisatorisch ausgeschieden besonders erfolgreich das Geschä ftsfeld des ambulanten Operierens, wä hrenddem große Allgemeinkrankenhäuser das Nachsehen haben [5].…”

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“…Innovation ist nicht an kleine agile Einheiten gebunden, sondern In den USA fü hrten DRGs zu einer Zunahme von so genannten ambulanten surgical centers [4,5]. Diese bearbeiten organisatorisch ausgeschieden besonders erfolgreich das Geschä ftsfeld des ambulanten Operierens, wä hrenddem große Allgemeinkrankenhäuser das Nachsehen haben [5]. …”

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Innovationsmanagement - Leitlinien für die erfolgreiche Innovation im OP-Bereich

Schüpfer¹,

Babst²

2005

OP-Journal

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The Emergence of Physician-Owned Specialty Hospitals

Cited by 92 publications

References 9 publications

The Effects of Focus on Performance: Evidence from California Hospitals

The Effects of Focus on Performance: Evidence from California Hospitals

Factors Driving Physician-Hospital Alignment in Orthopaedic Surgery

Innovationsmanagement - Leitlinien für die erfolgreiche Innovation im OP-Bereich

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