It’s been a while since I posted because of interview and exams, but while I was waiting for my flight yesterday I noticed an issue of Forbes that I thought would be perfect for a post. I am a fan of specialty hospitals as I believe that specialization allows process improvement and eventually leads to learning and the creation of best processes that can be adopted industry-wide (like at Shouldice Hospital with hernia repairs). While it is true that statistics on specialty hospitals get skewed by the specialty hospitals skimming the healthiest patients, I believe the advantages of what these hospitals can offer outweigh the negatives. Obviously, Stark rules and a conflict of interest with physician self-referrals is a major issue, which I think is more an issue of shades of grey rather than black-and-white. The other major argument is that these hospitals take away the cost-shifting ability of traditional hospitals to use the higher margin procedures to subsidize treatments with low or even negative margins. This is a significant issue, but I believe it is one that should be addressed between hospitals and insurers to make sure that no treatment has a negative margin. This can done either by increased reimbursement or process improvement to cut down on the cost of treatment.
Bad Medicine- This cover story asserts that big hospitals are the source of numerous preventable infections and patients receive better treatment at specialty hospitals that focus on a specific type of treatment. Forbes also reports that the big hospitals have attempted to drive specialty hospitals out of business or prevent them from evening forming. A related story about The Heartland Spine & Specialty Hospital sounds a lot like collusion by the hospitals trying to exert near-monopoly powers to keep a specialty hospital out of business. It shouldn’t come as much of a surprise that two Senators in charge of the committee that oversees the finances of government health organizations that denounced this story.
Hospitals’ Nightmare- I believe this was featured as a sidebar to the cover story. It briefly touches on the fight to get insurers not to pay or even stop working with hospitals that do not meet certain infection standards.
Congress Mounts New Attack On Specialty Hospitals- Dan Whelan, the author of the cover story, reports that Congress is poised to repeal the change in regulations from 2006 that allowed the opening of specialty hospitals. As is typical for Congress, they are trying to ban specialty hospitals by adding on a few words onto a much larger piece of legislation.