Access, quality, and costs of care at physician owned hospitals in the United States: observational study [美国医师所开诊所的接诊量、医疗质量和医疗费用：观察性研究]

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BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4466 (Published 02 September 2015)

Cite this as: BMJ 2015;351:h4466

Authors
Daniel M Blumenthal, clinical fellow, E John Orav, associate professor, Anupam B Jena, associate professor, David M Dudzinski, instructor, Sidney T Le, medical student, Ashish K Jha, KT Li professor of international health

Abstract
Objective: To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments.

Design: Observational study.

Setting: Acute care hospitals in 95 hospital referral regions in the United States, 2010.

Participants: 2186 US acute care hospitals (219 POHs and 1967 non-POHs).

Main outcome measures: Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share.

Results: The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia.

Conclusion: Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care.