Hospital-physician relations: Two tracks and the decline of the voluntary medical staff model

Health Affairs

Volumn 27, Issue 5, 2008, Pages 1305-1314

  Casalino, Lawrence P ^a,b   November, Elizabeth A ^c   Berenson, Robert A ^c   Pham, Hoangmai H ^c  

^a UNIVERSITY OF CHICAGO   (United States)

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

^c HSC ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EMERGENCY WARD; EMPLOYMENT; HEALTH CARE POLICY; HEALTH SERVICE; HOSPITAL; HOSPITAL PHYSICIAN; MEDICAL PRACTICE; MEDICAL SOCIETY; MEDICAL STAFF; PRIMARY MEDICAL CARE; UNITED STATES;

EMPLOYMENT; HEALTH CARE SURVEYS; HOSPITAL VOLUNTEERS; HOSPITAL-PHYSICIAN JOINT VENTURES; HOSPITALISTS; PHYSICIANS, PRIMARY CARE; SPECIALIZATION; UNITED STATES; URBAN HEALTH SERVICES;

EID: 54349112599     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.5.1305     Document Type: Article

References (31)

1. J.C. Robinson, "Physician-Hospital Integration and the Economic Theory of the Firm," Medical Care Research and Review 54, no. 1 (1997): 3-24.
2. In theory, many states ban the "corporate practice ofmedicine." However, in general (and in the CTS markets), these regulations permit hospitals to employ physicians through a variety of mediating legal and organizational arrangements.
3. L. Casalino and J.C. Robinson, "Alternative Models of Hospital-Physician Affiliation as the U.S. Moves Away from Tight Managed Care," Milbank Quarterly 81, no. 2 (2003): 331-351.
4. T. Lake et al., "Something Old, Something New: Recent Developments in Hospital-Physician Relationships," Health Services Research 38, no. 1, Part 2 (2003): 471-488.
5. R.A. Berenson, P.B. Ginsburg, and J.H. May, "Hospital-Physician Relations: Cooperation, Competition, or Separation?" Health Affairs 26, no. 1 (2007): w31-w43 (published online 5 December 2006; 10.1377/hlthaff.26.1.w31).
6. We excluded employed hospitalists and academic faculty physicians when discussing physician employment.
7. R.A. Berenson, T. Bodenheimer, and H.H. Pham, "Specialty-Service Lines: Salvos in the New Medical Arms Race," Health Affairs 25 (2006): w337-w343 (published online 25 July 2006; 10.1377/hlthaff.25.w337).
8. Reliable national data do not exist, but a recent study in Oregon found that 48 percent of hospitals have lost the ability to provide continuous coverage in at least one specialty. K.J. McConnell et al., "The On-Call Crisis: A Statewide Assessment of the Costs of Providing On-Call Specialist Coverage," Annals of Emergency Medicine 49, no. 6 (2007): 727-733.
9. See also A.S. O'Malley, D.A. Draper, and L.E. Felland, "Hospital Emergency On-Call Coverage: Is There a Doctor in the House?" (Washington: Center for Studying Health System Change, 2007).
10. A.E. Cuellar and P.J. Gertler, "Strategic Integration of Hospitals and Physicians," Journal of Health Economics 25, no. 1 (2006): 1-28.
11. See C.C. Ragin, The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies (Berkeley: University of California Press, 1987). The values in this table were assigned by the lead author, then reviewed and revised in consultation with the other authors.
12. J.K. Iglehart, "The New Era of Medical Imaging - Progress and Pitfalls," New England Journal of Medicine 354, no. 26 (2006): 2822-2828;
13. Medicare Payment Advisory Commission, Report to the Congress: Physician-Owned Specialty Hospitals Revisited (Washington: MedPAC, 2006);
14. and U.S. Government Accountability Office, Payment for Ambulatory Surgical Centers Should Be Based on the Hospital Outpatient System (Washington: GAO, 2006).
15. Centers for Medicare and Medicaid Services, Data Compendium, 2007 Edition (Baltimore: CMS, 2007);
16. MedPAC, Report to the Congress: Medicare Payment Policy (Washington: MedPAC, March 2004);
17. and MedPAC, Healthcare Spending and the Medicare Program: A Data Book (Washington: MedPAC, June 2007).
18. J.R. Gabel et al., "Where Do I Send Thee? Does Physician-Ownership Affect Referral Patterns to Ambulatory Surgery Centers?" Health Affairs 27, no. 3 (2008): w165-w174 (published online 18 March 2008; 10.1377/hlthaff.27.3.w165);
19. and J. Hadley and S. Zuckerman, "Physician-Owned Specialty Hospitals: A Market Signal for Medicare Payment Revisions," Health Affairs 24 (2005): w491-w493 (published online 25 October 2005; 10.1377/hlthaff.w5.491).
20. L.P. Casalino, K.J. Devers, and L.R. Brewster, "Focused Factories? Physician-Owned Specialty Facilities," Health Affairs 22, no. 6 (2003): 56-67;
21. and H.H. Pham et al., "Financial Pressures Spur Physician Entrepreneurialism," Health Affairs 23, no. 2 (2004): 70-81.
22. H.H. Pham et al., "Hospitalists and Care Transitions: The Divorce of Inpatient and Outpatient Care," Health Affairs 27, no. 5 (2008): 1315-1327.
23. L.P. Casalino, H. Pham, and G. Bazzoli, "The Growth of Single-Specialty Medical Groups," Health Affairs 23, no. 2 (2004): 82-90.
24. These PHOs claim sufficient "clinical integration" to engage physicians in joint contracting with health plans for contracts that do not involve the assumption of significant financial risk. L.P. Casalino, "The Federal Trade Commission, Clinical Integration, and the Organization of Physician Practice," Journal of Health Politics, Policy and Law 31, no. 3 (2006): 569-585.
25. MedPAC, Report to the Congress: Physician-Owned Specialty Hospitals Revisited;
26. and A.S. Chukmaitov et al., "A Comparative Study of Quality Outcomes in Freestanding Ambulatory Surgery Centers and Hospital-Based Outpatient Departments: 1997-2004," Health Services Research, 26 November 2007, http://dx.doi.org/10.1111/j.1475-6773.2007.00809.x (accessed 10 July 2008).
27. E.S. Fisher et al., "Creating Accountable Care Organizations: The Extended Hospital Medical Staff," Health Affairs 26, no. 1 (2007): w44-w57 (published online 5 December 2006; 10.1377/hlthaff.26.1.w44).
28. L.R. Burns, D.B. Nash, and D.R. Wholey, "The Evolving Role of Third Parties in the Hospital Physician Relationship," American Journal of Medical Quality 22,no. 6 (2007): 402-409;
29. and T.G. Rundall, S.M. Shortell, and J.A. Alexander, "A Theory of Physician-Hospital Integration: Contending Institutional and Market Logics in the Health Care Field," Journal of Health and Social Behavior 45 Supp. (2004): 102-117.
30. J. Goldsmith, "Hospitals and Physicians: Not a Pretty Picture," Health Affairs 26, no. 1 (2007): w72-w75 (published online 5 December 2006; 10.1377/hlthaff.26.1.w72);
31. and K. Smithson and S. Baker, "Medical Staff Organizations: A Persistent Anomaly," Health Affairs 26, no. 1 (2007): w76-w79 (published online 5 December 2006; 10.1377/hlthaff.26.1.w76).