Do specialty heart hospitals drive up heart care use? Study suggests the answer is yes

eart care services," says lead author Brahmajee Nallamothu, M.D., MPH, an assistant professor of cardiovascular medicine at the U-M Medical School and interventional cardiologist at the U-M Cardiovascular Center. He is also a member of the Health Services Research & Development Center at the Ann Arbor VA.

The authors emphasize that the specialty heart hospitals in the study are different from heart centers that operate as part of larger hospitals, such as the U-M CVC.

In fact, the state of Michigan does not have any standalone specialty heart hospitals, because of a strict "certificate of need" statute that gives the state government control over the opening of new hospitals or major clinical expansions.

Many other states, especially in the South and West of the United States, don't have such statutes. In such states, specialty heart hospitals owned and operated by physicians cropped up throughout the late 1990s and early 2000s.

But in 2003, the federal government took action that halted the opening of new ones, due to concerns over the potential for doctors who co-own specialty hospitals to be influenced by financial rather than medical reasons when referring patients for hospital care. Concern has also arisen about specialty hospitals' potential to "skim" the most lucrative patients from a region, leaving other hospitals with sicker and uninsured patients. Meanwhile, advocates for specialty hospitals say they increase quality and efficiency of care by focusing clinical expertise for these disease processes.

Last year the moratorium was lifted, and in August 2006 the Centers for Medicare & Medicaid Services (CMS) presented a strategic plan to address the long-term development of specialty hospitals. This plan recommended adjustments to Medicare payments to limit financial incentives as well as rule changes to require physicians to disclose their financial interests to patients. New specialty hospitals continue t

Contact: Kara Gavin
University of Michigan Health System

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