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Research

Access, quality, and costs of care at physician owned hospitals in the United States: observational study

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4466 (Published 02 September 2015) Cite this as: BMJ 2015;351:h4466
  1. Daniel M Blumenthal, clinical fellow1,
  2. E John Orav, associate professor2,
  3. Anupam B Jena, associate professor3,
  4. David M Dudzinski, instructor1,
  5. Sidney T Le, medical student4,
  6. Ashish K Jha, KT Li professor of international health5
  1. 1Department of Internal Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
  2. 2Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
  3. 3Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
  4. 4University of California, San Francisco, San Francisco, CA, USA
  5. 5Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
  1. Correspondence to: D M Blumenthal dblumenthal1{at}mgh.harvard.edu
  • Accepted 6 August 2015

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.

Footnotes

  • We thank Jie Zheng for her assistance with data collection and analysis, and Dan Liebman and Garret Johnson for their assistance with data analysis and formatting.

  • Contributors: DMB, EJO, ABJ, and AKJ made substantial contributions to the conception and design of this project. DMB, EJO, ABJ, DMD, STL, and AKJ assisted with data acquisition, analysis, and interpretation of data for this manuscript. DMB, EJO, and AKJ drafted the manuscript. DMN, EJO, ABJ, DMD, and AKJ revised the manuscript critically for important intellectual content. DMB is the guarantor. All authors approved of the final version to be published. All authors, external and internal, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: This study was funded using internal resources from the Department of Health Policy and Management at the T H Chan School of Public Health at Harvard University. ABJ reports funding from the Office of the Director, National Institutes of Health early independence award (grant 1DP5OD017897-01).

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work

  • Ethical approval: This study was approved by the Office of Human Subjects Research at Harvard University’s T H Chan School of Public Health.

  • Data sharing: No additional data available.

  • Transparency: The lead author (DMB) affirms that this manuscript is an honest, accurate and transparent account of the study being reported, that no aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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