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References for "More Doctors Controlled by Hospitals". March. 1st, 2012
(1) Cheung KM. Physicians leaving practices for healthsystem employment. FierceHealthcare. June 13, 2011. http://www.fiercehealthcare.com/story/physicians-leaving-practices-health-system-employment/2011-06-13
“By2013, less than a third of physicians will be in private practice, electing instead for employment with larger health systems, according to a new report released today by management consulting company Accenture Health.”
(2) Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of Participation. Federal Register. Vol76(205) Oct. 24, 2011. Page 65893. CMS-2011-0160-0001
http://www.regulations.gov/#!documentDetail;D=CMS-2011-0160-0001 http://www.healthwatchusa.org/publications/2012-Documents/CMS-2011-0160-0001.pdf
Governing Body (§ 482.12): “Based on our experience with hospitals and the input provided by stakeholders through anecdotal evidence, we believe that hospitals in a multi-hospital system(defined here as those having more than one CMS Certification Number (CCN)) can be effectively governed by a single governing body. Thus, we propose to revise and clarify the governing body requirement to reflect current hospital organizational structure whereby multihospital systems have integrated their governing body functions to oversee care in a more efficient and effective manner. Specifically, we propose to revise § 482.12 to state that ‘‘There must be an effective governing body that is legally responsible for the conduct of the hospital.’’
(3) Letter to Honorable Dave Camp. January 23, 2012.
http://www.ama-assn.org/resources/doc/washington/medicare-sgr-sign-on-letter-23jan2012.pdf
(4) O'Malley AS, Bond, AM, Berenson RA. Rising Hospital Employment of Physicians: Better Quality, Higher Costs? Center for Studying Health System Change. Issue Brief No. 136, Aug. 2011. http://www.medscape.com/viewarticle/74838
http://www.hschange.com/CONTENT/1230/
“The trend of hospital-employed physicians also may increase costs through higher hospital and physician commercial insurance payment rates and hospital pressure on employed physicians to order more expensive care.”
(5) Stensland J, Lisk C. and Zabinski D. Assessing Payment Adequacy: Hospital inpatient and outpatient services. Jan 12, 2012. MedPAC Presentation – Slide 8.
http://www.healthwatchusa.org/publications/2012-Documents/20120112-MedPAC-OPPS-Visit.JPG
http://www.medpac.gov/transcripts/Hospital%20January%20FINAL.pdf http://www.medpac.gov/meeting_search.cfm?SelectedDate=2012-01-12%2000:00:00.0
“Problem: OPPS rates typically much higher than physician fee schedule (PFS) rates; mid-level E&M visit 80% higher in OPD.”
(6) Kavanagh KT. Healthcare Integration. Will physicians lose their voice: Bulletin of the American College of Surgeons. Vol 96(6) June 1, 2011. http://www.facs.org/fellows_info/bulletin/2011/kavanagh0611.pdf
“The recent acquisition of Massachusetts-based Caritas Christi Healthcare (including six acute care hospitals) by Steward Healthcare, LLC, an affiliate of Cerberus Capital Partners and of Detroit Medical Center (including ten acute care hospitals) ten Detroit area hospitals by Blackstone-backed Vanguard Health System have drawn attention to the possibility of a new wave of acquisitions of charitable hospitals by private-equity firms. ic region or within a group of academic medical centers.”
(7) Nelson L. Lessons from Medicare’s Demonstration Projectson Disease Management, Care Coordination, and Value-Based Payment. Congressional Budget Office. Issue Brief. January 2012. http://www.cbo.gov/ftpdocs/126xx/doc12663/01-18-12-MedicareDemoBrief.pdf
“Bundled payments reduced Medicare’s expenditures for heart bypass surgeries by about 10 percent, and there were no apparent adverse effects on patients’ outcomes. By contrast, the PGP demonstration had little or no net effect on Medicare spending, after accounting for the bonuses paid, and the Premier demonstration had no net effect on Medicare spending.”
(8) Coakley, M. Examination of Health Care CostTrends and Cost Drivers. Massachusetts Attorney General. March 16, 2010. http://www.healthwatchusa.org/publications/201101-Documents/20100316-Mass-Hosp-Charges.pdf
“Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers.”
(9) Weiner, SM and Niewenhous, MD. Private Equity's Interest in Non-Profit Hospitals: What's Next? HealthLeadersMedia. Jan. 23, 2012. http://www.healthleadersmedia.com/content/FIN-262582/Private-Equitys-Interest-in-NonProfit-Hospitals-Whats-Next
“The recent acquisition of Massachusetts-based Caritas Christi Healthcare (including six acute care hospitals) by Steward Healthcare, LLC, an affiliate of Cerberus Capital Partners and of Detroit Medical Center (including ten acute care hospitals) ten Detroit area hospitals by Blackstone-backed Vanguard Health System have drawn attention to the possibility of a new wave of acquisitions of charitable hospitals by private-equity firms. ic region or within a group of academic medical centers.”
(10) Cloud DS. Defense budget plan would cut spending by half a trillion. Los Angeles Times. Jan 16th, 2012 http://articles.latimes.com/2012/jan/26/nation/la-na-defense-spending-cuts-20120127
(11) Medicare Spending and Financing Fact Sheet. Kaiser Family Foundation Sept 2011 http://www.kff.org/medicare/7305.cfm
