Specialty Hospitals and Community Hospitals

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Specialty Hospitals and Community Hospitals The Medicare Prescription Drug, Improvement, and Moderation Act of 2003 enacted an 18-month moratorium to investigate whether specialty hospitals privately owned by physicians were unjustly profiting from self-referrals to their own hospital (McLauglin & McLauglin, 2008). Many critics of these specialty hospitals contend that they draw the most profitable patients to their facilities; therefore making it more difficult for community hospitals to generate funding for their less-profitable services such as the emergency room (Tynan, November, Lauer, Pham, and Cram, 2009). However, the defenders of specialty hospitals claim they provide better quality services and receive higher patient satisfaction ratings than community hospitals (Tyanan et al., 2009). This case study discusses new reforms for specialty physician-owned hospitals since the Medicare Payment Advisory Commission (MedPAC) moratorium was lifted in 2006, the implications of these reforms for both specialty physician-owned and community hospitals, why possible specialty physician-owned hospitals were opened during the 18-month moratorium period, and changes to Medicare diagnosis-related groups (DRGs) used for reimbursement. Reforms for Physician-Owned Specialty Hospitals There have been a few significant changes since 2006 that affect how physician owned specialty hospitals run their private businesses. In August 2006, the moratorium for specialty hospitals was ended with MedPAC proposing new reforms affecting private for profit specialty hospitals (McLauglin & McLauglin, 2008). The proposals stated that the Medicare DRG reimbursement hospital payments should be revised so they more closely matched actual costs and s... ... middle of paper ... ... procedures. Health Affairs, 31(4), 806-815. doi: 10.1377/hlthaff.2011.0624 McLauglin, C. & McLauglin, C. (2008). Health policy analysis: An interdisciplinary approach. Boston Jones and Bartlett Publishers. Rau, J. (2013, Apr. 12). Doctor-owned hospitals prosper under health law. Kasier Health News. Retrieved from http://www.kaiserhealthnews.org/stories/2013/april/12/ doctor-owned-hospitals-quality-bonuses.aspx Tyann, A., November, E.A., Lauer, J., Hoangmai, H.P., Cram, P. (2009, April). General hospitals, specialty hospitals and financially vulnerable patients. HSC Research Brief No. 11. Retrieved from http://www.hschange.com/CONTENT/1056/ Wilson, R. C. (2008). When entrepreneurship and ethics collide: The case of physician- owned specialty hospitals. Journal of Applied Management and Entrepreneurship, 13(2), 87-101.

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