title: The relationship between competition and quality in procedural cardiac care.
abstract: BACKGROUND
  Anesthesiologists are frequently involved in efforts to meet perioperative quality metrics. The degree to which hospitals compete on publicly reported quality measures, however, is unclear. We hypothesized that hospitals in more competitive environments would be more likely to compete on quality and thus perform better on such measures. To test our hypothesis, we studied the relationship between competition and quality in hospitals providing procedural cardiac care and participating in a national quality database.
  
  
  METHODS
  For hospitals performing heart valve surgery (HVS) and delivering acute myocardial infarction (AMI) care in the Hospital Compare database, we assessed the degree of intrahospital competition using both geographical radius and federally defined metropolitan statistical area (MSA) to determine the degree of intrahospital competition. For each hospital, we then correlated the degree of competition with quality measure performance, mortality, patient volume, and per-patient Medicare costs for both HVS and AMI.
  
  
  RESULTS
  Six hundred fifty-three hospitals met inclusion criteria for HVS and 1898 hospitals for AMI care. We found that for both definitions of competition, hospitals facing greater competition did not demonstrate better quality measure performance for either HVS or AMI. For both diagnoses, competition by number of hospitals correlated positively with cost: partial correlation coefficients = 0.40 (0.42 for MSA) (P < 0.001) for HVS and 0.52 (0.47 for MSA) (P < 0.001) for AMI.
  
  
  CONCLUSIONS
  An analysis of the Hospital Compare database found that competition among hospitals correlated overall with increased Medicare costs but did not predict better scores on publicly reported quality metrics. Our results suggest that hospitals do not compete meaningfully on publicly reported quality metrics or costs.
authors.affiliation: From the Departments of Anesthesia & Critical Care and Health Studies, University of Chicago, Chicago, Illinois; and University of Chicago Pritzker School of Medicine, Chicago, Illinois.
authors.forename: David B
authors.initials: DB
authors.lastname: Glick
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.forename: Sean
authors.initials: S
authors.lastname: Apfelbaum
authors.forename: Benjamin
authors.initials: B
authors.lastname: Dauber
authors.forename: Joyce
authors.initials: J
authors.lastname: Woo
authors.forename: Avery
authors.initials: A
authors.lastname: Tung
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000592:standards*; D003365:Costs and Cost Analysis; D004465:Economic Competition; D017558:Elective Surgical Procedures / Q000191:economics / Q000592:standards; D006276:Health Facility Size; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery; D019990:Perioperative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D016896:Treatment Outcome; D014481:United States