Physician division of labor and patient selection for outpatient procedures.
Little is known about the ability of incentives to influence decisions by physicians regarding choices of settings for care delivery. In the context of outpatient procedural care, the emergence of freestanding ambulatory surgery centers (ASCs) as alternatives to hospital-based outpatient departments (HOPDs) creates a unique opportunity to study this question. We advance a model where physicians' division of labor between ASCs and HOPDs affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs). This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals.
Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6218, USA.
Guy
G
David
Mark D
MD
Neuman
D000368:Aged; D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures; D005260:Female; D005431:Florida; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D018579:Patient Selection; D010816:Physician Incentive Plans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D013531:Surgicenters / Q000706:statistics & numerical data*