Skip to main content
SpringerLink
Log in

The Impact of Physician-owned Specialty Orthopaedic Hospitals on Surgical Volume and Case Complexity in Competing Hospitals

  • Symposium: ABJS Carl T. Brighton Workshop on Health Policy Issues in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Published studies of physician-owned specialty hospitals have typically examined the impact of these hospitals on disparities, quality, and utilization at a national level. Our objective was to examine the impact of newly opened physician-owned specialty orthopaedic hospitals on individual competing general hospitals. We used Medicare Part A administrative data to identify all physician-owned specialty orthopaedic hospitals performing total hip arthroplasty (THA) and total knee arthroplasty (TKA) between 1991 and 2005. We identified newly opened specialty hospitals in three representative markets (Durham, NC, Kansas City, and Oklahoma City) and assessed their impact on surgical volume and patient case complexity for the five competing general hospitals located closest to each specialty hospital. The average general hospital maintained THA and TKA volume following the opening of the specialty hospitals. The average general hospital also did not experience an increase in patient case complexity. Thus, based on these three markets, we found no clear evidence that entry of physician-owned specialty orthopaedic hospitals resulted in declines in THA or TKA volume or increases in patient case complexity for the average competing general hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B

Similar content being viewed by others

References

  1. Birkmeyer JD, Sharp SM, Finlayson SR, Fisher ES, Wennberg JE. Variation profiles of common surgical procedures. Surgery. 1998;124:917–923.

    PubMed  CAS  Google Scholar 

  2. Casalino LP, Devers KJ, Brewster LR. Focused factories? Physician-owned specialty facilities. Health Aff. 2003;22:56–67.

    Article  Google Scholar 

  3. Casey J. The case for specialty hospitals. Mod Healthc. 2004;34:21–22.

    PubMed  Google Scholar 

  4. Center for Medicare & Medicaid Services. Study of physician-owned specialty hospitals required in section 507(c)(2) of the medicare modernization act of 2003. Center for Medicare & Medicaid Services; 2005.

  5. Cram P, Rosenthal GE, Vaughan-Sarrazin MS. Cardiac revascularization in specialty and general hospitals. N Engl J Med. 2005;352:1454–1462.

    Article  PubMed  CAS  Google Scholar 

  6. Cram P, Rosenthal GE, Vaughan-Sarrazin MS, Wolf B, Katz JN. A comparison of total hip and knee replacement in specialty and general hospitals. J Bone Joint Surg Am. 2007;89:1675–1684.

    Article  PubMed  Google Scholar 

  7. Devers KJ, Brewster LR, Ginsburg PB. Specialty hospitals: focused factories or cream skimmers? Issue Brief Cent Stud Health Syst Change. 2003;62:1–4.

    PubMed  Google Scholar 

  8. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273–287.

    PubMed  Google Scholar 

  9. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EtL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288–298.

    PubMed  Google Scholar 

  10. Fong T. Not so special. Doc ownership in specialty hospitals scrutinized by healthcare panel. Mod Healthc. 2003;33:20–21.

    PubMed  Google Scholar 

  11. Government Accountability Office. Report to the Congress: Physician-owned specialty hospitals. Washington, DC: Government Accountability Office; 2005:1–51.

  12. Guterman S. Specialty hospitals: a problem or a symptom? Health Aff. 2006;25:95–105.

    Article  Google Scholar 

  13. Herzlinger RE. Specialization and its discontents: The pernicious impact of regulations against specialization and physician ownership on the US healthcare system. Circulation. 2004;109:2376–2378.

    Article  PubMed  Google Scholar 

  14. Hwang CW, Anderson GF, Diener-West M, Powe NR. Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals. Med Care. 2007;45:720–728.

    Article  PubMed  Google Scholar 

  15. Kahn CN, III. Intolerable risk, irreparable harm: the legacy of physician-owned specialty hospitals. Health Aff. 2006;25:130–133.

    Article  Google Scholar 

  16. Katz JN, Bierbaum BE, Losina E. Case mix and outcomes of total knee replacement in orthopaedic specialty hospitals. Med Care. 2008;46:476–480.

    Article  PubMed  Google Scholar 

  17. Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.

    Article  PubMed  Google Scholar 

  18. Losina E, Barrett J, Baron JA, Levy M, Phillips CB, Katz JN. Utilization of low-volume hospitals for total hip replacement. Arthritis Rheum. 2004;51:836–842.

    Article  PubMed  Google Scholar 

  19. Losina E, Barrett J, Mahomed NN, Baron JA, Katz JN. Early failures of total hip replacement: effect of surgeon volume. Arthritis Rheum. 2004;50:1338–1343.

    Article  PubMed  Google Scholar 

  20. Mitchell JB, Bubolz T, Paul JE, Pashos CL, Escarce JJ, Muhlbaier LH, Wiesman JM, Young WW, Epstein RS, Javitt JC. Using Medicare claims for outcomes research. Med Care. 1994;32(7 Suppl):JS38–51.

    PubMed  CAS  Google Scholar 

  21. Nallamothu BK, Lu X, Vaughan-Sarrazin MS, Cram P. Coronary revascularization at specialty cardiac hospitals and peer general hospitals in black Medicare beneficiaries. Circ Cardiovasc Qual Outcomes. 2008;1:116–122.

    Article  Google Scholar 

  22. Nallamothu BK, Wang Y, Cram P, Birkmeyer JD, Ross JS, Normand SL, Krumholz HM. Acute myocardial infarction and congestive heart failure outcomes at specialty cardiac hospitals. Circulation. 2007;116:2280–2287.

    Article  PubMed  Google Scholar 

  23. Norton EC, Garfinkel SA, McQuay LJ, Heck DA, Wright JG, Dittus R, Lubitz RM. The effect of hospital volume on the in-hospital complication rate in knee replacement patients [see comment]. Health Serv Res. 1998;33(5 Pt 1):1191–1210.

    PubMed  CAS  Google Scholar 

  24. Pham HH, Devers KJ, May JH, Berenson R. Financial pressures spur physician entrepreneurialism. Health Aff (Millwood). 2004;23:70–81.

    Article  Google Scholar 

  25. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139.

    Article  PubMed  Google Scholar 

  26. Reilly P. Picking patients. GAO: specialty hospitals serve fewer uninsured. Mod Healthc. 2003;33:6–7.

    Google Scholar 

  27. Rosenthal GE, Harper DL, Quinn LM, Cooper GS. Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. JAMA. 1997;278:485–490.

    Article  PubMed  CAS  Google Scholar 

  28. Schneider JE, Miller TR, Ohsfeldt RL, Morrisey MA, Zelner BA, Pengxiang L. The economics of specialty hospitals. Med Care Res Rev. 2008;65:531–553; discussion 554–563.

    Article  PubMed  Google Scholar 

  29. Shahian DM, Blackstone EH, Edwards FH, Grover FL, Grunkemeier GL, Naftel DC, Nashef SA, Nugent WC, Peterson ED. Cardiac surgery risk models: a position article. Ann Thorac Surg. 2004;78:1868–1877.

    Article  PubMed  Google Scholar 

  30. Shaw RE, Anderson HV, Brindis RG, Krone RJ, Klein LW, McKay CR, Block PC, Shaw LJ, Hewitt K, Weintraub WS. Updated risk adjustment mortality model using the complete 1.1 dataset from the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR). J Invasive Cardiol. 2003;15:578–580.

    PubMed  Google Scholar 

  31. Specialty Hospitals. Specialty Hospitals: geographic location, services provided and financial performance. Vol 04-167. Washington, DC: General Accounting Office; 2003:1–41.

    Google Scholar 

  32. The Dartmouth Institute. The Dartmouth Atlas of Healthcare. Available at: http://www.dartmouthatlas.org/. Accessed April 5, 2009.

  33. U.S. Census. U.S. Census 2000 Data. Available at: http://www.census.gov/main/www/cen2000.html. Accessed January 20, 2008.

  34. Voelker R. Specialty hospitals generate revenue and controversy. JAMA. 2003;289:409-410.

    Article  PubMed  Google Scholar 

  35. Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians’ services in the United States. N Engl J Med. 1993;328:621–627.

    Article  PubMed  CAS  Google Scholar 

  36. Wilson BC. My hospital was doomed. The Wall Street Journal. January 5, 2006:A, 20.

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA, 52242, USA

    Xin Lu MS, Tyson P. Hagen MD, Mary S. Vaughan-Sarrazin PhD & Peter Cram MD, MBA

  2. Center for Research in the Implementation of Innovative Strategies for Practice (CRIISP), Iowa City Veterans Administration Medical Center, Iowa City, IA, USA

    Tyson P. Hagen MD, Mary S. Vaughan-Sarrazin PhD & Peter Cram MD, MBA

Authors
  1. Xin Lu MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tyson P. Hagen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary S. Vaughan-Sarrazin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Cram MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Cram MD, MBA.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Appendix 1

Appendix 1

Locations of specialty and general hospitals in the three markets of interest ( denotes orthopaedic specialty hospitals, denotes teaching hospitals, and denotes general hospitals)

Durham, NC

Kansas City, MO

Oklahoma City, OK

About this article

Cite this article

Lu, X., Hagen, T.P., Vaughan-Sarrazin, M.S. et al. The Impact of Physician-owned Specialty Orthopaedic Hospitals on Surgical Volume and Case Complexity in Competing Hospitals. Clin Orthop Relat Res 467, 2577–2586 (2009). https://doi.org/10.1007/s11999-009-0855-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0855-1

Keywords

Search

Navigation