Hospital-physician relations: Cooperation, competition, or separation?

Health Affairs

Volumn 26, Issue 1, 2007, Pages

  Berenson, Robert A ^a,b   Ginsburg, Paul B ^c   May, Jessica H ^c  

^a URBAN INSTITUTE   (United States)

^b CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^c HSC ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COOPERATION; ECONOMIC ASPECT; EMERGENCY HEALTH SERVICE; HUMAN; MEDICAL STAFF; ORGANIZATION AND MANAGEMENT; OUTPATIENT DEPARTMENT; PUBLIC RELATIONS; WORKLOAD;

AMBULATORY CARE FACILITIES; COOPERATIVE BEHAVIOR; ECONOMIC COMPETITION; EMERGENCY SERVICE, HOSPITAL; HOSPITAL-PHYSICIAN RELATIONS; HOSPITALISTS; HUMANS; MEDICAL STAFF, HOSPITAL; WORKLOAD;

EID: 33846668740     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.1.w31     Document Type: Article

References (30)

1. M.V. Pauly and M. Redisch, "The Not-for-Profit Hospital as a Physicians' Cooperative," American Economic Review 63, no. 1 (1973): 87-99;
2. P. Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982);
3. and R. Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989).
4. L. Casalino and J.C. Robinson, "Alternative Models of Hospital-Physician Affiliation as the United States Moves Away from Tight Managed Care," Milbank Quarterly 81, no. 2 (2003): 331-351.
5. Ibid.
6. R.A. Berenson, T. Bodenheimer, and H.H. Pham, "Specialty-Service Lines: Salvos in the Medical Arms Race," Health Affairs 25 (2006): w337-w343 (published online 25 July 2006; 10.1377/hlthaff.25.w337).
7. For more information on the Community Tracking Study, see P. Kemper et al., "The Design of the Community Tracking Study: A Longitudinal Study of Health System Change and Its Effects on People," Inquiry 33, no. 2 (1996): 195-206. The twelve communities studied in depth as part of the CTS are Boston; Cleveland; Greenville, SC; Indianapolis; Lansing; Little Rock; Miami; northern New Jersey; Orange County, CA; Phoenix; Seattle; and Syracuse.
8. In Round Three, responses on hospital pressures were obtained from forty-seven hospital executives, including thirty-seven CEOs; in Round Five, responses were obtained from twenty-eight hospital executives, including twenty-two CEOs..
9. Berenson et al., "Specialty-Service Lines."
10. Ibid.
11. Similar programs targeted to physicians were not as well developed and do not require physicians to engage hospitals in the same way that hospitals must engage physicians in quality and safety activities. T. Bodenheimer et al., "Can Money Buy Quality? Physician Responses to Pay for Performance," Issue Brief no. 102 (Washington: Center for Studying Health System Change, December 2005).
12. H.H. Pham, J. Coughlan, and A.S. O'Malley, "The Impact of Quality-Reporting Programs on Hospital Operations," Health Affairs 25, no. 5 (2006): 1412-1422;
13. and Centers for Medicare and Medicaid Services, "Hospital Quality Initiatives: Overview," December 2005, http://www.cms.hhs.gov/ HospitalQualityInits (accessed 14 November 2006).
14. Pham et al., "The Impact of Quality-Reporting Programs."
15. U.S. Government Accountability Office, Medicare Physician Payments: Medical Settings and Safety of Endoscopic Procedures, Pub. no. GAO-03-179 (Washington: GAO, October 2002).
16. Under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), all Medicare-participating hospitals with EDs must provide a medical screening exam, followed by stabilization and further care or transfer as needed, regardless of the patient's ability to pay. EMTALA also requires hospitals to maintain a list of on-call physicians in a manner that best meets the needs of the hospital's patients in accordance with the resources available to the hospital. EMTALA obligations, including ensuring adequate on-call physician coverage, fall predominantly on hospitals, not physicians. In addition, hospitals have a natural interest in offering a wide range of specialty coverage to attract insured patients and to meet community expectations.
17. A.S. O'Malley et al., "Rising Pressure: Hospital Emergency Departments as Barometers of the Health Care System," Issue Brief no. 101 (Washington: HSC, November 2005).
18. H.H. Pham et al., "Health Care Market Trends and the Evolution of Hospitalist Use and Roles," Journal of General Internal Medicine 20, no. 2 (2005): 101-107.
19. E.A. Weeks, "The New Economic Credentialing: Protecting Hospitals from Competition by Medical Staff Members," Journal of Health Law 36, no. 2 (2003): 247-300.
20. B. Baskin, "No Firings, Justices Tell Hospital," Arkansas Democrat Gazette, 3 February 2006.
21. J.V. Hetzel and W.C. Tomey, "Hospital Physician Joint Venture: Some Barriers Come Down while Others Go Up," http://citease.netspacetoday.com/ kmjmlaw/publications/article.nhtml?uid=10015 (accessed 13 March 2006).
22. U.S. Department of Health and Human Services Office of Inspector General, "Fact Sheet: Federal Anti-Kickback Law and Regulatory Safe Harbors," November 1999, http://oig.hhs.gov/fraud/docs/safeharborregulations/safefs.htm (accessed 13 March 2006).
23. Berenson et al., "Specialty-Service Lines."
24. Hospitalists are sometimes employees of hospitals and sometimes employees of health plans or capitated medical groups.
25. Berenson et al., "Specialty-Service Lines."
26. E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Parts 1 and 2," Annals of Internal Medicine 138, no. 4 (2003): 273-298.
27. Federal Register 71, no. 160 (2006): 47870-48351.
28. Medicare Payment Advisory Commission, Report to the Congress: Physician-Owned Specialty Hospitals, March 2005, http://www.medpac.gov/ publications_congressional_reports_Mar05_SpecHospitals.pdf (accessed 13 November 2006).
29. See generally, Federal Register 66, no. 23 (2001): 8771;
30. and S. Choudhry, N.K. Choudhry, and T.A. Brennan, "Specialty versus Community Hospitals: What Role for the Law?" Health Affairs 24 (2005): w361-w372 (published online 9 August 2005; 10.1377/hlthaff.w5.361).