The American Medical Association plans to conduct its own comprehensive study of how physician-owned specialty hospitals affect the quality of care, patient-referral patterns and the economic viability of community hospitals.
The AMA's 550-member House of Delegates overwhelmingly approved a potentially controversial study that could alienate some members-including the cardiologists and orthopedic surgeons who have turned to specialty hospitals as a source of additional income. The study was among more than 200 reports and resolutions the AMA pored over during its annual meeting last week in Chicago.
"The AMA is going to have to look at this with a global view," said Michael Miller, a physician from Madison, Wis., who insisted that the report include how specialty facilities affect not-for-profit community and safety net hospitals. "We have to look at the entire (profession). Even if it has an impact one way or another on one specialty, or subspecialty, we need to study this with balance."
The AMA, which considers medical liability reform its top priority, also spent considerable time discussing malpractice, including a proposal to endorse the withholding of nonemergency services to plaintiffs' attorneys and their spouses. That suggestion was withdrawn amid considerable criticism. The organization also backed off a suggestion that the AMA underwrite a national Internet clearinghouse to publicly identify physicians who testify against fellow physicians in malpractice cases.
Despite the AMA's focus on malpractice, the growth of specialty hospitals over the past several years took center stage during part of the five-day meeting.
"This is the wave of the future-we have to face reality," said Franklin Zeplowitz, a general surgeon from Buffalo, N.Y. "We need to study the impact. It's going to become a major factor in healthcare. Will it require more stringent supervision? How about peer review? Are these hospitals undergoing proper scrutiny?"
The struggle between community hospitals and specialty facilities has spawned an ugly war in some areas, triggering lawsuits from doctors whose hospital privileges have been withdrawn because of their financial involvement in competing specialty facilities.
The AMA's study, expected to be completed in time for the association's interim meeting in Atlanta in early December, is already partly under way, according to board member Duane Cady, a surgeon from Lafayette, N.Y. It is at such a preliminary stage he was not even sure whether staffers or board members had started substantive work on the project.
"I think this is a very important issue; it's high on everyone's agenda," Cady said. "There are a number of stakeholders involved: physicians, hospitals, insurers, patients. And the physician touches on all of them."
He said it is vital that the AMA produce a comprehensive report regardless of whether it offends any of the constituencies represented by the 250,000-member organization.
The AMA is the latest group to study specialty hospitals in the wake of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which imposed an 18-month moratorium on new doctor-owned facilities. Critics say that specialty facilities will have a devastating impact on community hospitals, stripping them of the high-margin services they need to underwrite money-losing departments and charity care.
As part of the moratorium, which was prompted by complaints from the American Hospital Association and other industry heavyweights, the federal government is undergoing its own extensive review of specialty hospitals, which primarily focus on profitable services such as cardiology and orthopedic surgery. The AMA's report is expected to precede similar studies by the Medicare Payment Advisory Commission and HHS, which are required as part of the Medicare modernization act to submit reports by March 2005 on the efficiency, cost and outcomes of specialty hospitals.
Critics of specialty hospitals hope the reports will lead Congress to either extend the moratorium or impose a permanent ban.
Meanwhile, the AMA's House of Delegates decided against taking action on a proposal to create an Internet listing of doctors who testify against other doctors. Troy Tippett, a neurological surgeon in Florida, where the state medical association maintains such a listing, said, "It casts sunshine on something that is ... in the dark." He said a list of these names might compel "those who testify to realize that they must tell the truth."
Critics slammed the idea, suggesting that it would imply that physicians who testify in malpractice cases are doing something wrong.
"If a person is harmed by malpractice, that plaintiff deserves truthful testimony on either side," said Carol Rose, an anesthesiologist from Pittsburgh.
J. Chris Hawk, the South Carolina surgeon who gained national attention for his proposal that physicians decline to provide anything but emergency care to plaintiffs' lawyers and spouses, abruptly withdrew what he described as his "infamous resolution" before it was even considered (See Outliers, p. 36).
Hawk's provocative proposal was denounced by a parade of colleagues, including Francis Kittredge, a neurologist from Bangor, Maine, who also has a law degree. He called it "an insult to all the good professionals in the legal profession."