Hospital ownership of doc groups leads to higher costs -AND- UC medical centers ready to provide in-patient care for confirmed cases of Ebola

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Sun Nov 9 21:32:30 PST 2014


 
October 22, 2014
 
Hospital ownership of doc groups leads to higher costs
 
 
Fierce Healthcare
 
 
By Ilene MacDonald
Hospitals and healthcare systems may want to rethink plans to acquire physician practices to increase care coordination. A new study finds that hospital ownership of physician groups in California led to a 10 to 20 percent increase in overall costs.
James C. Robinson, Ph.D., of the University of California, School of Public Health, Berkeley, and Kelly Miller, of the Integrated Healthcare Association in Oakland, California, published their findings in the latest issue of the Journal of the American Medical Association. They conducted the study to determine whether total expenditures per patient were higher in physician organizations owned by local hospitals or multihospital systems compared with physician organizations owned by participating physicians.
Robinson and Miller analyzed date on total expenditures for care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. Of the 158 organizations studied, 118--or 75 percent--were physician-owned, 19 organizations--or 12 percent--were owned by local hospitals and 21 organizations (13 percent) were owned by multihospital systems.
The researchers found that the average expenditure per patient across all physician organizations increased by 16.5 percent between 2009 and 2012, from $2,954 to $3,443. By 2012, expenditures per patient had increased to an average of $3,066 in physician-owned organizations, $4,312 in local hospital-owned organizations and $4,776 in multihospital system-owned organizations.
After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3 percent higher than did physician-owned organizations, according to the study. Organizations owned by multihospital systems incurred expenditures 19.8 percent higher than physician-owned organizations. The largest physician organizations incurred expenditures per patient 9.2 percent higher than the smallest organizations.
"These findings are in contrast to the hope and expectation that organizational consolidation of physicians with hospitals would result in greater coordination, and hence lower expenditures," the authors wrote. "Policymakers must strive to ensure that hospital acquisition of medical groups and physician practices does not lead to higher expenditures."
They also noted that antitrust law and policy must strike the appropriate balance between permitting hospital acquisitions that improve efficiency and preventing acquisitions that increase expenditures. "Reform of payment methods by Medicare and private insurers should focus on the total expenditures made on behalf of patients by the physicians and facilities involved in their care to promote coordination but also to create incentives for efficiency and price reductions," the authors said.
In reaction to the study, some health policy experts told the Los Angeles Times that organizations can achieve care coordination without consolidation and the acquisitions just reduce competition and increase prices.
"There may be some be cost efficiencies internally, but the savings aren't passed along to the consumer or the employer paying for the care," Suzanne Delbanco, executive director of Catalyst for Payment Reform, an employer-backed group in San Francisco, told the publication.
But the California Hospital Association (CHA) said the partnerships are a good method to align financial incentives among providers and deliver care more efficiently.
"There needs to be a new way to transition from providing care to being part of a team that manages health," Anne McLeod, senior vice president for public policy and transformation at CHA, told the Times.
To learn more:
- here's the study abstract
- read the article 
 
 
 
November 3, 2014
 
UC medical centers ready to provide in-patient care for confirmed cases of Ebola
 
 
CMA Alert


Last month, the University of California (UC) Office of the President informed the California Department of Public Health (CDPH) that all five UC medical centers were ready to provide in-patient care for Californians who have confirmed cases of Ebola.

According to the UC Senior Vice President for Health Sciences and Service John Stobo, M.D., the UC medical centers—which include Davis, Irvine, Los Angeles, San Diego and San Francisco facilities—are “committed to addressing the health needs of this population and the public at large, as well as ensuring the safety of our health care workers.” These UC hospitals will closely coordinate with CDPH and local health officers in the event that Ebola infections occur in California.

“All of the UC medical centers specialize in complex care and operate as or staff level one trauma centers,” said Ron Chapman, M.D., director of CDPH and state health officer. “We appreciate their leadership role in willingness to treat Ebola patients.” However, Dr. Chapman said that all California hospitals are expected to screen, identify and isolate any patients with Ebola virus risk.

CDPH is reviewing guidelines set by the Centers for Disease Control and Prevention Services (CDC) for Ebola preparedness, screening and treatment guidance to ensure that the UC medical centers have the most up-to-date information on how to treat and care for Ebola patients, should confirmed Ebola cases appear in California.

CDPH has also committed to helping UC obtain the necessary personal protective equipment (PPE), should the hospitals have sourcing challenges. The CDC recently updated its PPE guidance, aligning them with California’s already stronger infection control standards. State officials will also work with these medical centers to ensure that medical waste generated from the treatment of an Ebola patient will be properly handled and disposed.

The CDPH published information for all sectors of California health care providers and consumers on itswebsite. It has also developed an interim case report form for reporting suspected cases of Ebola to CDPH and has distributed CDC guidance on specimen collection, transport, testing and submission for patients suspected of having Ebola.

CDPH has also posted interim guidelines for Ebola medical waste management and recommended that all health care facility environmental services personnel and infection control staff work together to develop facility-specific protocols for safe handling of Ebola related medical waste. 
 
 
 
 
 
Bryan Sloane
Deputy Editor, CAL/AAEM News Service
 
Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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