Both sides in the heated debate over whether the federal government should muzzle growth of specialty hospitals say they find support for their positions in a newly released General Accounting Office study.
But the GAO study, released Thursday, delves into just two basic questions--on physician ownership and patient acuity--and takes a neutral tone, not offering any policy recommendations.
GAO officials say they will release a more extensive study with actual recommendations in the fall.
Meanwhile, House Ways and Means Committee Chairman William Thomas (R-Calif.) has reportedly dropped support of a bill muzzling specialty hospitals by changing physician-investment rules, introduced by Rep. Pete Stark (D-Calif.) and Rep. Jerry Kleczka (D-Wis.), according to representatives of the specialty hospital industry who recently met with Thomas.
But these industry representatives add that Thomas is planning to introduce his own bill that would impose limits on specialty hospitals.
At an investors' conference in Washington on Wednesday, Thomas suggested that specialty hospitals should be paid at a lower Medicare reimbursement rate than community hospitals, according to Randy Fenninger, a lobbyist for the American Surgical Hospital Association who was at the meeting.
But Fenninger says the new GAO report, ordered by Thomas and Kleczka, produces little evidence that there should be any crackdown.
"We welcome the study," Fenninger says, "because we think it supports what we do and undermines our critics," mainly acute care hospitals.
On the other hand, the Federation of American Hospitals says in a release that the new report "provides important guidance to lawmakers on the serious threat to community hospitals posed by physician-owned boutique hospitals."
The American Hospital Association adds: "AHA believes that change is needed at the federal level" by tightening rules on physician investments.
But the new study carefully takes a neutral tone.
Specifically, it finds that physicians usually have an ownership stake in specialty hospitals--which was no surprise to anyone--but adds that in almost half the cases individual physician ownership tends to be just 3% or less.
"I find it difficult to believe that a physician would refer to a hospital where he or she has so little invested," Fenninger says.
However, the study points out that "some physicians owned substantially larger shares," with individual physician ownership at greater than 15% in almost one-fifth of the cases.
The study also finds that specialty hospitals tend to treat a lower-acuity patient than general hospitals, seemingly supporting arguments that specialty hospitals take the better-paying cases away from acute care hospitals.
But Fenninger argues that the differences in acuity--ranging from 2% to 5%, depending on the type of specialty hospital--"does not support the assertion that specialty hospitals are skimming off the cream (from acute care hospitals)."
The study counted less than 100 specialty hospitals but notes there has been a boom in specialty hospitals in recent years. It also notes that specialty hospitals make up about 1% of Medicare reimbursements to hospitals, which Fenninger asserts is too small a share to worry about.
James Cosgrove, assistant director of healthcare economic and payment issues at the GAO, tells Modern Physician that his office intends to delve into more key issues on specialty hospitals and will produce a final report with recommendations in the fall.
Though the GAO waited one and a half years before starting the study, Cosgrove says the office did not have time between February and April of this year, when the study took place, to answer all the questions raised by the Ways and Means Committee when it ordered the study in July 2001.
Specifically, the committee asked about the financial impact of surgical hospitals on acute care hospitals, as well as their impact on patient utilization and on the supply of nurses. The committee also asked about the relation between physicians' ownership and utilization of specialty hospitals and whether specialty hospitals provide higher quality and more efficient care.
Finally, the committee wanted the GAO to recommend whether there should be federal prohibitions on physician self-referrals to surgical hospitals, which is proposed by the Stark-Kleczka bill.
Answers to these questions will be in the fall report, Cosgrove says.