Specialty Hospitals: Can General Hospitals Compete?

The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of “fair” competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals provided information to help assess their potential effect on health care delivery. This issue brief discusses the research on specialty hospitals, including their payments under Medicare’s hospital inpatient payment system, the quality and cost of care they deliver, their effect on general hospitals and on overall health care delivery, and the regulatory and legal environment in which they have proliferated. It concludes with open issues concerning physician self-referral and the role of general hospitals in providing a range of health care services

Referrals to Mental Health Treatment Facilities

This paper is organized into three main sections. The first is a review of the literature which serves as a theoretical background for this research. Social context is examined with its implications for defining problems in terms of mental or emotional concerns. Certain personal limitations on seeking help are discussed. The literature dealing with specific referral sources to mental health treatment are examined. The second section contains impressions gained from interviews with mental health professionals about the importance of the referral source on their evaluations of a client. They responded to questions about what people come to them, what information a person\u27s referral source gives to them and the implications of this information. The third section of this paper deals with information gathered from a community mental health center. These data concern referral sources and how it may be a reflection of a client\u27s social contacts and previous experience using mental health facilities

Medicare Physician Payments and Spending

The Medicare program’s physician payment method is intended to control spending while ensuring beneficiary access to physician services, but there are signs that it may not be working. The physician’s role in the health care delivery system as the primary source of information and treatment options, together with growing demand for services and the imperfect state of knowledge about appropriate service use, challenge Medicare’s ability to achieve these two goals. This issue brief describes the history of physician spending and the contribution of escalating service use and intensity of services to the rise in Medicare outlays, setting the stage for further discussion about the use of the Medicare payment system to control spending and ensure access

Updating Medicare\u27s Physician Fees: The Sustainable Growth Rate Methodology

Medicare’s method to annually update the fees it pays physicians has been under fire for some time—specifically, since the method determined that physician fees should be reduced rather than increased. The update method, called the sustainable growth rate (SGR), was implemented to control the growth in Medicare physician spending. Yet Congress, in response to physician concerns about beneficiary access to care, has acted to avert physician fee cuts since 2003. Although this signals dissatisfaction with the SGR methodology, there is yet to be a widely accepted physician fee update proposal that balances federal budgetary realities with the need to ensure beneficiary access. And the cost of changing the update method continues to mount, adding to the difficulties of developing a solution that meets the needs of all stakeholders. This issue brief describes the SGR methodology, the reasons why projected physician fee updates are negative, and some options that have been proposed to remedy the current situation

Competition and Collaboration, Chicago-Style

The National Health Policy Forum sponsored a site visit to Chicago, Illinois, March 16-18, 2008 to consider how competition and collaboration have shaped Chicago?s health care market. Chicago is a study of contrasts between wealth and poverty and between large, internationally known facilities and struggling community hospitals. The stressed state of the county health system concerned all of the stakeholders and may be an impetus for increased cooperation among the haves and the have nots. No longer waiting for state health reform efforts, key players were working to shore up needed providers and develop a more equitable distribution of resources, although the need for a rational planning framework appeared overwhelming. Site visit participants toured the best the city had to offer and met with those vying to deliver what was needed in their communities. They met with community, insurance, hospital, clinic, and government leaders to discuss the political, economic, and cultural forces that affected the health care market and various competitive and collaborative activities

Heath Care Spending: Why Is Miami an Outlier?

The National Health Policy Forum’s site visit to Miami focused on the complex factors that drive health care spending and is the latest in a series on the dynamics of health care markets. Miami has long been recognized as having among the highest Medicare per capita spending in the country, along with high rates of uninsured, strong managed care presence, and a history of health care fraud. This colorful health care market brings into stark relief many of the reasons for high and growing health care spending across the country. It also highlights several issues involved in building and maintaining adequate capacity to care for the newly insured as health care reform is implemented. Site visit participants toured the sprawling public health system, a state-of-the art Medicare Advantage clinic that caters to the Cuban community, and neighborhoods known for housing high-billing pharmacies and home health agencies that provide few, if any, legitimate services. These and other opportunities to interact with local providers and health care stakeholders gave participants insights into the complexities and unique features of health care markets

Primary Care Physician Supply, Physician Compensation, and Medicare Fees: What Is the Connection?

Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a primary care physician crisis? Why does compensation across physician specialties vary so widely? Can Medicare physician fee changes affect access to primary care? These questions defy simple answers. This issue brief lays out the latest information on physician workforce, compensation differences across physician specialties, and Medicare’s physician fee-setting process. The paper builds on data presented by David N. Gans, vice president, practice management resources, Medical Group Management Association, at a May 2, 2008, Forum session on physician income and medical practice differences across specialties

Redesigning Practice to Improve Care Delivery (Boston)

This site visit focused on how the practice of medicine is changing or can be changed to improve care delivery across the spectrum of patient populations. Regarded as a “medical Mecca,” Boston is home to the academic health centers and teaching hospitals where many of the nation’s physicians are trained. As a center of innovation, Boston prides itself on its high bar with respect to standards of care. Panels addressed the used of clinical information technology (IT) in the physician’s office, in the hospital, and community-wide. Participants observed how IT is being used to further the mission of community health centers. Physician-managers described initiatives in their practices to design workflows and develop incentives that would encourage physicians to achieve quality and resource-use goals. Communication among physicians, other providers, and patients was examined, with emphasis on health literacy and cultural sensitivity