The impact of physician-owned specialty orthopaedic hospitals on surgical volume and case complexity in competing hospitals.
Published studies of physician-owned specialty hospitals have typically examined the impact of these hospitals on disparities, quality, and utilization at a national level. Our objective was to examine the impact of newly opened physician-owned specialty orthopaedic hospitals on individual competing general hospitals. We used Medicare Part A administrative data to identify all physician-owned specialty orthopaedic hospitals performing total hip arthroplasty (THA) and total knee arthroplasty (TKA) between 1991 and 2005. We identified newly opened specialty hospitals in three representative markets (Durham, NC, Kansas City, and Oklahoma City) and assessed their impact on surgical volume and patient case complexity for the five competing general hospitals located closest to each specialty hospital. The average general hospital maintained THA and TKA volume following the opening of the specialty hospitals. The average general hospital also did not experience an increase in patient case complexity. Thus, based on these three markets, we found no clear evidence that entry of physician-owned specialty orthopaedic hospitals resulted in declines in THA or TKA volume or increases in patient case complexity for the average competing general hospital.
Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Iowa City, IA 52242, USA.
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D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D016536:Competitive Medical Plans / Q000706:statistics & numerical data*; D019981:Health Care Sector / Q000706:statistics & numerical data*; D006302:Health Services Research; D018578:Hospital-Physician Relations; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D018854:Managed Competition / Q000706:statistics & numerical data; D016344:Medicare Part A / Q000706:statistics & numerical data; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010067:Ownership / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States