|
E-mail this page to a friend!
Senior Citizen Health & Medicine
When Specialty Cardiac Hospitals Come to Town the
Rate of Heart Procedures Jumps
Questions raised about heart operations on marginal
patients
 March 7, 2007 Senior citizens, well aware that
heart disease is their biggest threat to survival, have probably been
encouraged to see the large number of specialty cardiac hospitals
opening up around the country. A new study in the Journal of the
American Medical Association (JAMA) has found, however, that this
proliferation also seems to increase the number of coronary procedures
aimed at restoring blood flow to the hearts of patients
(revascularization) in the regions where these cardiac hospitals open.
An editorial asks if it is "too much of a good thing."
Specialty hospitals, which provide care limited to
specific medical conditions or procedures, are opening at a rapid pace
across the United States, according to background information in the
article.
Proponents argue that specialty hospitals provide
higher quality health care and greater cost-efficiency by concentrating
physician skills and hospital resources needed for managing complex
diseases.
Critics claim that specialty hospitals focus
primarily on low-risk patients and provide less uncompensated care,
which places competing general hospitals at significant financial risk.
However, specialty hospitals raise an additional
concern beyond their potential to simply redistribute cases within a
health care market. Specialty hospitals are typically smaller than
general hospitals and have high rates of physician ownership. Physician
owners may have stronger financial incentives for providing services
that fuel greater utilization, the authors write.
Brahmajee K. Nallamothu, M.D., M.P.H., of the VA
Health Services Research and Development Center of Excellence, Ann
Arbor, Mich., and colleagues conducted a study to determine whether the
opening of specialty cardiac hospitals was associated with greater
utilization of coronary revascularization services.
The researchers calculated annual population-based
rates for total revascularization (coronary artery bypass graft [CABG]
plus percutaneous coronary intervention [PCI]), CABG, and PCI of
Medicare beneficiaries from 1995 through 2003.
Hospital referral regions (HRRs) were used to
categorize health care markets into those where
(1) cardiac hospitals opened (13),
(2) new cardiac programs opened at general hospitals (142), and
(3) no new programs opened (151).
The researchers found that overall, rates of change
for total revascularization were higher in HRRs after cardiac hospitals
opened when compared with HRRs where new cardiac programs opened at
general hospitals and HRRs with no new programs.
Four years after their opening, the relative
increase in adjusted rates was more than 2-fold higher in HRRs where
cardiac hospitals opened (19.2%) when compared with HRRs where new
cardiac programs opened at general hospitals (6.5%) and HRRs with no new
programs (7.4%).
Although we are unable to comment directly on the
appropriateness of these procedures, these findings raise the concern
that the opening of cardiac hospitals may lead to greater procedural
utilization beyond the simple addition of capacity to a market. This is
particularly worrisome since cardiac hospitals may not substantially
improve clinical outcomes when compared with general hospitals with
similar procedural volumes, the researchers write.
...our findings may have important policy
implications. The Centers for Medicare & Medicaid Services recently
issued their final report to Congress implementing a strategic plan for
specialty hospitals.
"Their plan primarily involves revisions to the
inpatient prospective payment systems to level the playing field
between specialty and general hospitals and limit financial incentives
for investing in certain services simply due to profitability. It also
proposes new gain-sharing and value-based payment approaches to better
align physician and hospital incentives toward improving care at general
hospitals.
"Reforms directly related to physician ownership
include enhanced transparency of financial relationships. More stringent
measures, such as limiting investments by physician owners, were not
included. The extent to which additional measures are needed will
require further data on appropriateness of care at specialty hospitals
as well as the impact of greater utilization of these procedures on
patient outcomes.
Editor's Note: This project was supported by a
grant from the Agency for Healthcare Research and Quality. Dr.
Nallamothu completed part of this work while supported as a clinical
scholar under a K12 grant from the National Institutes of Health.
Editorial:
Physician-Owned Specialty Hospitals
and Coronary Revascularization Utilization Too Much Of A Good Thing?
In an accompanying editorial, Peter Cram, M.D.,
M.B.A., and Gary E. Rosenthal, M.D., of the University of Iowa Carver
College of Medicine, Iowa City, Iowa examine the findings of Nallamothu
and colleagues.
The emergence of specialty hospitals is in an
early state of evolution but may represent the beginning of a
fundamental reorganization in the ways in which hospitals are structured
and care is delivered.
"Specialization already permeates most sectors of
the U.S. economy and is associated with both increased efficiency and
product quality. Although there is no fundamental reason hospital care
should differ, the current findings suggest that physician ownership of
specialty hospitals may be problematic if such ownership increases the
use of services for patients with marginal indications.
"As specialty hospitals evolve, vigilance will be
needed to determine if benefits are being delivered as promised and if
untoward effects on the delivery system are emerging. In the meantime,
all hospitals will need to look carefully at specialty hospitals to see
what, if any, lessons can be gleaned from their successes and failures.
Editor's Note: Dr. Cram is the recipient of a K23
career development award from the National Center for Research
Resources, National Institutes of Health. This research was also
supported by a grant from the Health Services Research and Development
Service, Veterans Health Administration, Department of Veterans Affairs.
Financial disclosures none reported.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
