College of Public Health

Physician-ownership of Cardiac Hospitals Linked to Wide Disparities in Mortality Following Angioplasty

April 25, 2012 • Uncategorized

Physician owners tout the lower mortality rates and higher quality ratings in their own cardiac specialty hospitals. Yet a recent study published in the April 2012 issue of the journal Health Affairs found that these same physicians have offsetting higher mortality rates when they admit Medicaid, uninsured, and minority patients to non-cardiac hospitals. The outstanding results reported by some cardiac hospitals may have less to do with physician characteristics than with the cream skimming of the more profitable patients by some physicians to facilities in which they have an ownership interest.

The mortality rates reported by physician-owned, cardiac hospitals reflect only those low-risk patients who were selected for treatment for those facilities. By treating low-risk patients at the cardiac hospital and high-risk patients at the non-cardiac hospital, the reported quality outcomes for both hospitals were found to be misleading.

Even after accounting for differences in physician training and experience, mortality rates were more than three times higher for patients who were not admitted to the physician-owned cardiac hospitals, and after adjusting for patient severity and physician volume, the overall mortality for these physician-owned hospitals was not different from the state average for all hospitals.

This study highlights the conflicts of interests that emerge when physicians become part-owners in hospitals. Physicians have an incentive to treat low-risk, profitable patients at their own facilities while referring less profitable patients who lack adequate health insurance to the community hospitals.

“We know that there is significant variation in mortality between high-performing and low-performing hospitals. What is new about this study is that such differences persist even when the cardiologist is the same in both hospitals. The most significant predictor of in-hospital mortality was the type of hospital where the procedure was performed, not the physician who did the procedure,” said Liam O’Neill, PhD, lead author of the study, who is an associate professor of Health Management and Policy at the College of Public Health at the University of North Texas Health Science Center in Fort Worth.

Dr. O’Neill had one co-author, Dr. Arthur Hartz, who is a professor of Internal Medicine at the University of Utah School of Medicine. The study was based on hospital data collected by the Texas Department of State Health Services and included more than 210,000 angioplasties performed at Texas hospitals during 2004 to 2007.

To read the full abstract of the paper, visit: http://content.healthaffairs.org/content/31/4/806.abstract