The trend of hospitals nationwide employing physicians and buying medical practices does not benefit patients any more than other employment models, according to a recent study.
About 42% of hospitals in 2012 directly employed clinicians, up from 29% in 2003. The moves are primarily aimed at increasing productivity and leveraging the local market, but it's often touted as a way to coordinate care and improve quality.
Until now, research on the employment model's effect on patient care has been limited, said Kirstin Scott, who recently earned her doctorate in health policy from Harvard Medical School. Scott, along with a team of researchers, evaluated federal data to uncover how quality of care is linked to facilities where physicians are employed.
The findings, published Tuesday in the journal Annals of Internal Medicine, found quality of care was largely the same at hospitals that directly employ physicians compared to those who do not.
The study looked at 30-day mortality, readmissions and length of stay for Medicare beneficiaries with three medical conditions: acute myocardial infarction, congestive heart failure and pneumonia. By using data from the American Hospital Association, the authors compared the quality metrics at 803 hospitals that directly employed physicians versus 2,085 hospitals that don't.
Thirty-day mortality rates at both types of hospitals were almost the same. The mortality rate at hospitals that employed physicians for over two years was 10.8% compared to 10.9% at hospitals that didn't directly employ physicians.
The researchers found there was “no effect of switching to an employment model” on hospitals' readmission rates, length of stay or patient satisfaction metrics.
The hospital employer model is touted for its potential to improve quality outcomes because it can encourage “coordination efforts” and continuum of care services, Scott said.
But Scott said the data from the report suggests that simply creating the new employment relationship between a hospital and its physicians is not enough to improve quality of care. Hospital executives and physicians should also work to foster new collaborative relationships focused on quality outcomes in order to see further improvement.
Scott also notes that the study was only looking at the quality metrics two years after a hospital changed its employment model. The facilities may need more time to reap the full benefits of the new relationship, she said. “In a 10-year window we may see more improvement for the sake of patients.”
The report also found that not-for-profit hospitals and large academic institutions are more likely to directly employ physicians than for-profit hospitals. About 11.6% of large hospitals employ physicians compared to 8.8% of for-profit hospitals.
