Changes in Hospital-Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care.

Scott KW1, Orav EJ1, Cutler DM1, Jha AK1.

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Abstract

BACKGROUND:

Growing evidence shows that hospitals are increasingly employing physicians.

OBJECTIVE:

To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model.

DESIGN:

Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012.

SETTING:

U.S. nonfederal acute care hospitals.

PARTICIPANTS:

803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region.

INTERVENTION:

Hospitals' conversion to an employment relationship with any of their privileged physicians.

MEASUREMENTS:

Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.

RESULTS:

In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.

LIMITATIONS:

The measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear.

CONCLUSION:

During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.