Physicians practicing in hospitals: implications for a medical staff policy

Area of Science:

• Health Policy
• Medical Economics
• Healthcare Management

Background:

• Proposed Medicare payment reforms aimed to limit payments to hospitals with high inpatient physician service volumes.
• The policy could penalize physicians practicing at multiple hospitals differently, potentially leading to admission redirection.
• This redirection could threaten hospital financial viability if physicians shift Medicare admissions.

Purpose of the Study:

• To analyze physician practice patterns and hospital affiliations.
• To assess the feasibility of large-scale admission shifting by physicians under proposed Medicare payment reforms.
• To evaluate the potential impact of physician admission redirection on hospital viability.

Main Methods:

• Utilized a national database to examine physician hospital affiliations and admission data.
• Calculated average hospital affiliations per physician.
• Determined the percentage of physicians affiliated with single versus multiple hospitals.
• Analyzed the distribution of Medicare patient admissions per physician within hospitals.

Main Results:

• Physicians are affiliated with an average of 1.56 hospitals; 62% are affiliated with only one.
• On average, 90% of a physician's admissions occur at a single hospital.
• A small percentage of physicians (20%) account for a majority (60%) of Medicare patient admissions in an average hospital.

Conclusions:

• The findings suggest that large-scale admission shifting by physicians to avoid Medicare payment penalties is unlikely.
• The concentration of Medicare admissions among a few physicians in most hospitals limits the potential for widespread redirection.
• Policy implications regarding the effectiveness and potential unintended consequences of the proposed Medicare payment reforms are discussed.