Becoming a Health Policy Analyst

Since 2006, this debate has focused on specialty hospitals’ possible “unfair” competitive advantage. Little research has addressed whether specialty hospitals adversely affect the financial viability of general hospitals and their ability to care for low-income, uninsured and Medicaid patients.

Despite initial challenges recruiting staff and maintaining service volumes and patient referrals, general hospitals were generally able to respond to the initial entry of specialty hospitals with few, if any, changes in the provision of care for financially vulnerable patients, according to a new study by the Center for Studying Health System Change (HSC) of three markets with established specialty hospitals in Indianapolis, Phoenix and Little Rock, Ark.

In addition, safety net hospitals (community hospitals) that care for a disproportionate share of financially vulnerable patients reported limited impact from specialty hospitals since safety net hospitals generally do not compete for insured patients. In my opinion, the only way to come to an objective conclusion is to treat all patients equally. I believe that the provision of services to the patient should not be based on provider financial incentives and that physicians should always prioritize the needs of patients when determining at which facility care is provided.

It should be recommended that physicians should divulge to a patient any ownership interest in health care facilities, including specialty hospitals. The patient should be fully informed of his/her choices and be allowed to make the final determination as to where to receive care. Further, physicians with ownership interests in health care facilities should continue to adhere to the highest standards of quality and appropriateness of care without overutilization for financial gain. During my research, I found a transcript from a hearing by the U.S. SenateCommittee on Finance.

It’s entitled “Physician owned Specialty Hospitals: Profits before Patients? ” It’s date May 6, 2006, and provides the opening statement by Senator Chuck Grassley (TheHill. com). In the statement he noted recent oversight work by the committee, which raised serious questions about specialty hospitals and whether they serve the best interest of the patients being treated at them, or if they are serving the best interests of the physicians who own and operate them.

Further, the committee’s oversight work found that in spite of a congressional moratorium on new specialty hospitals and an administrative extension of that ban, it appears more than 40 specialty hospitals have opened. He stated that taken together, it is clear they’ve got a lot of serious questions that need to be answered. It is believed that this might have happened because the Center for Medicare and Medicaid (CMS) was not aggressive enough in keeping new specialty hospitals off the market (Young, 2006). In 2005, Congress gave CMS greater responsibility for overseeing specialty hospitals. According to The Hill.

com (2006), Senator Grassley indicated that “It is time for CMS to make a serious commitment to oversight of specialty hospitals. ” In 2009, the New England Journal of Medicine reported that Medicare currently pays for all hospitalizations, except those in which patients are hospitalized again within 24 hours after discharge for the same condition for which they had initially been hospitalized (Berenson, 2012). Specialized, physician-owned cardiac hospitals have grown rapidly. Physicians have also expanded their capability to provide cardiovascular and orthopedic diagnostic services in their offices.

In recent proposals to change inpatient prospective payment system, it was found that this would help dampen hospitals’ financial incentives to favor some kinds of patients and related investments (MedPac, 2006). Improving the accuracy of Medicare’s prices is necessary to ensuring good access to care for the elderly and disabled. MedPAC has recommended that the CMS establish an expert panel that would identify services that might be mispriced (Medicare, 2008). Data analyses of changes in the volume of services and the site of service, as we have shown, could inform the panel’s work.

The CMS could also update its assumptions about the cost of operating medical equipment. In addition, improving the accuracy of Medicare’s prices is another response to heading off a campaign by lobbyists for medical device makers, hospitals, and specialist’s physicians. Improving the accuracy of Medicare payment rates is a necessary but not sufficient step toward modernizing Medicare. Medicare and other payers face many problems, including a lack of coordination of care among providers, a lack of information and the tools to use it, and poorly targeted diffusion of technology.

References Berenson, Robert A. Paulus, Ronald A. , Kalman, Noah S. , (2012) Medicare’s Readmission- Reduction Program-A Positive Alternative. New England Journal of Medicine 366:15 1364-1366. Medicare Payment Advisory Commission: A Path to Bundled Payment around a Hospitalization. Medicare Payment Policy. Report to Congress. June 2008. Policy for Inpatient Readmissions: Promoting Greater Efficiency in Medicare. Report to Congress. June 2007. Young, Jeffery. Grassley, Baucus chide CMS on specialty hospitals. May 17, 2006. Retrieved May 7, 2012, from http://thehill. com.

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