Physicians Practicing in Hospitals: Implications for a Medical Staff Policy

President Clinton's health reform package included a proposal that would limit Medicare payments to the medical staffs of hospitals whose inpatient physician service volume was systematically above national norms. Under this policy, it would be possible for a physician practicing in more than o...

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Bibliographic Details
Published in:Inquiry (Chicago) 1995-07, Vol.32 (2), p.204-210
Main Authors: Miller, Mark E., Welch, W. Pete, Englert, Ellen
Format: Article
Language:English
Subjects:
Health care delivery
Health care policy
Hospital admissions
Hospital-Physician Relations
Hospitals
Medical practice
Medical specialties
Medical Staff, Hospital
Medicare
Medicare - statistics & numerical data
Medication administration
Organizational Policy
Patient Admission - statistics & numerical data
Physicians
Policy Making
Professional Practice - statistics & numerical data
Proposals
Reforms
Research Notes and Data Trends
Statistical analysis
Studies
Surgical specialties
Teaching hospitals
United States
Vascular diseases
Viability
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Summary:President Clinton's health reform package included a proposal that would limit Medicare payments to the medical staffs of hospitals whose inpatient physician service volume was systematically above national norms. Under this policy, it would be possible for a physician practicing in more than one hospital to be penalized in one and not the other. Physicians might direct their admissions to certain hospitals to avoid penalties, and thereby would threaten the viability of some hospitals. However, to engage in large-scale admission shifting, physicians must practice in multiple hospitals. Using a national database, we find that, on average, physicians are affiliated with 1.56 hospitals and that 62% are affiliated with one hospital. On average, 90% of a physician's admissions are in a single hospital. We also find that, in the average hospital, a relatively small percentage of physicians (20%) admit a majority (60%) of Medicare patients. We discuss policy implications.
ISSN:0046-9580
1945-7243