After a 13-month delay, the Florida Agency for Health Care Administration is expected to release in early February its much-awaited report on the impact of self-referrals on joint ventures among providers.
Data problems and staff turnover contributed to the delay, said agency spokesmen. The state Legislature in 1993 ordered the report to be completed by Dec. 31, 1994.
The report will compare facilities that operate joint ventures with physicians to nonventure facilities based on 1994 patient utilization and financial data. It also will compare the number of physician joint ventures in 1994 with the number of similar facilities in 1989.
"Because of prohibitions, we expect divestitures of (physician) joint-venture activities," said Alan Pearman, senior management analyst for the State Center for Health Statistics, the division of the state agency that conducted the study.
In 1992, the state Legislature banned physician ownership in five types of outpatient facilities. They include clinical labs and physician therapy, rehabilitation, diagnostic imaging and radiation therapy centers. Physician investors in those facilities were given until the end of 1995 to divest.
The Legislature, however, exempted hospitals, group practices, outpatient surgery centers and nursing homes from the self-referral ban because a 1991 state-sponsored study didn't indicate abuses. The study found that physician investors were more likely to overtest and that the overutilization related to joint ventures wasted more than $500 million annually.
But in 1993, the state agency conducted a study on the impact of joint physician ownership of hospitals. In that report, the state said data on Medicare patients at Columbia/HCA Healthcare Corp.-owned Victoria Hospital in Miami indicated "the possibility of cream skimming." Victoria Hospital has since closed.
The 1993 report found that patients referred to Victoria Hospital by Columbia physician investors had an average length of stay of 8.48 days. Those same doctors referred patients to other hospitals with an average stay of 13.5 days, the report said. The implication of the figures was that physician investors were steering more patients who might lose money under the prospective payment system to other facilities.
Columbia, which called the state study flawed, hired Healthcare Management Decisions of St. Petersburg, Fla., to conduct its own study. That study indicated Columbia physician investors admitted a higher proportion of charity-care patients to Columbia hospitals than physicians without a stake in the hospitals, said Scott Hopes, HMD's president.
Pearman said the state's new self-referral study wasn't designed as a follow-up to the agency's 1993 Columbia study. He said the purpose of the new study, which will be conducted annually, is to create a database to assess the impact of self-referral arrangements on a variety of healthcare facilities.
The study will compare payer mix, length of stays, case mix, staff hours per patient day, revenues, expenses and profits between facilities with physician investors and those without, Pearman said.