The researchers found that overall, rates of change for total revascularization were higher in HRRs after cardiac hospitals opened when compared with HRRs where new cardiac programs opened at general hospitals and HRRs with no new programs. "Four years after their opening, the relative increase in adjusted rates was more than 2-fold higher in HRRs where cardiac hospitals opened (19.2 percent) when compared with HRRs where new cardiac programs opened at general hospitals (6.5 percent) and HRRs with no new programs (7.4 percent)."

"Although we are unable to comment directly on the appropriateness of these procedures, these findings raise the concern that the opening of cardiac hospitals may lead to greater procedural utilization beyond the simple addition of capacity to a market. This is particularly worrisome since cardiac hospitals may not substantially improve clinical outcomes when compared with general hospitals with similar procedural volumes," the researchers write.

" our findings may have important policy implications. The Centers for Medicare & Medicaid Services recently issued their final report to Congress implementing a strategic plan for specialty hospitals. Their plan primarily involves revisions to the inpatient prospective payment systems to 'level the playing field' between specialty and general hospitals and limit financial incentives for investing in certain services simply due to profitability. It also proposes new 'gainsharing' and value-based payment approaches to better align physician and hospital incentives toward improving care at general hospitals. Reforms directly related to physician ownership include enhanced transparency of financial relationships. More stringent measures, such as limiting investments by physician owners, were not included. The extent to which additional measures are needed will require further data on appropriateness of care at specialty hospitals as well as the impact o
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Contact: Bonnie Johnson
734-761-7910
JAMA and Archives Journals
6-Mar-2007