In a recent opinion piece on Bloomberg, it is argued that bigger hospitals only mean higher prices, not better care. Hospitals that merge with other hospitals and buy up groups of doctors claim that size brings efficiency and the opportunity for more value-based care but the authors argue that there is no evidence to prove that bigger hospitals offer better care.
The Dartmouth Atlas of Health Care and other sources have proved numerous times that some of the biggest and most well-known hospitals subject their patients to “useless tests and marginal treatments.” In a 2010 analysis for the Massachusetts attorney general, there was no correlation between price and quality of care; a Health Affairs study had similar results for the rest of the country. In reality, the authors argue, bigger hospitals are the highest priced, not the best, and with specialists on a salary, a hospital can charge higher rates, which the parties then split.
Furthermore, the mergers are shifting power from physicians and other caregivers to administrators and corporations, “whose loyalty lies with the institutions or shareholders.” Alternately, the authors contend, the emphasis in healthcare should be placed on the formation of physician groups; specifically, multispecialty group practices, including nurses and other midlevel providers, that work together to coordinate care.
The best solution, the authors believe, is to build organizations such as Accountable Care Organizations controlled by primary-care physicians. One way to do this would be for Medicare to expand its “Advance Payment Model,” a program that provides capital to small and rural physician groups. Experiments with incentives for models like this could potentially accelerate the formation of multispecialty ACOs driven by primary care. In the end, we need to “give primary-care groups control over what happens to patients, large hospital systems, and specialist-dominated groups” so that those with the greatest access to capital do not keep raising prices.
Click here to read more