Evaluation of costs and outcomes of physician-owned hospitals across common surgical procedures - 13/10/19

Doi : 10.1016/j.amjsurg.2019.10.008

Junu Bae ^a,^b, J. Madison Hyer ^b, Anghela Z. Paredes ^b, Ayesha Farooq ^b, Daniel R. Rice ^b, Susan White ^c, Diamantis I. Tsilimigras ^b, Aslam Ejaz ^b, Timothy M. Pawlik ^b,^⁎
^a Ohio State University College of Medicine, Columbus, OH, USA
^b Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
^c Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, OH, USA

^∗Corresponding author. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave, Suite 670, USA.Department of SurgeryThe Urban Meyer III and Shelley Meyer Chair for Cancer ResearchProfessor of Surgery, Oncology, Health Services Management and PolicyThe Ohio State UniversityWexner Medical Center395 W. 12th AveSuite 670USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 13 October 2019

Abstract

Introduction

The Affordable Care Act introduced restrictions on the creation of new physician-owned hospitals (POH). We sought to define whether POH status was associated with differences in care.

Methods

Patients undergoing one of ten surgical procedures were identified using Medicare Standard Analytic Files. Patient and hospital-level characteristics and outcomes between POH and non-POH were compared.

Results

Among 1,255,442 patients identified, 14,560 (1.2%) were treated at POH. A majority of POHs were in urban areas (n = 30, 90.9%) and none were in low socioeconomic status areas. Patients at POH were slightly younger (POH:72, IQR:68–77 vs. non-POH:73, IQR:69–79) and healthier (CCI; POH:2; IQR: 1–3 vs. non-POH: 3; IQR: 1–4). Patients at non-POH had higher odds of postoperative complications (OR:1.67, 95%CI:1.55–1.80) and slightly higher medical expenditures (POH:$11,347, IQR:$11,139-$11,936 vs. non-POH:$13,389, IQR:$11,381–$19,592).

Conclusions

POH were more likely to be located in socioeconomic advantaged areas, treat healthier patients and have lower associated expenditures.

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Highlights

•	POHs were more likely to be located in socioeconomic advantaged areas and select healthier patients.
•	Operations at a POH hospitals were associated with lower health care expenditures.
•	POH typically saw healthier patients for more outpatient-based profitable surgical procedures.

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Keywords : Physician-owned hospitals