Hospital-employed physicians don't necessarily improve quality of care

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Quality of care in hospitals doesn't improve simply by employing physicians.

Hospitals that hire physicians don't necessarily see a direct correlation to improved quality of care.

While more hospitals switch to employment-based affiliations with physicians, an analysis published online this week in the Annals of Internal Medicine found no association between converting to that model and changes in mortality rates, 30-day readmissions, length of stay or patient satisfaction rates.

“Although some of these improvements certainly are taking place as hospitals increasingly employ physicians, on the basis of the hospital performance metrics we examined, we found no national-level evidence that these changes have translated into better patient care,” the study authors said in an announcement.

The researchers compared 803 acute care hospitals in the U.S. that switched to an employee relationship with their physicians with 2,085 hospitals with unaffiliated or contractual relationships with their doctors to determine whether quality of care improved.

The study found that the proportion of hospitals that reported having employment arrangements with physicians increased from 29% in 2003 to 42% in 2012. Starting in 2009, employment has been the most common hospital-physician affiliation model, the study said. In fact, one in four medical practices was hospital-owned as of mid-2015 and 38% of U.S. physicians were employed by hospitals and health systems, according to a 2016 study.

Researchers for the latest study said the rationale behind increased hospital employment is that the new relationships will lead to greater care coordination, more closely aligned incentives and better patient care. However, up to two years after converting to an employment model, there was no improvement in the four quality metrics. Researchers said it could be that beneficial effects may take longer to appear. The only exception was that hospitals that switched to employed physicians had lower rates of readmissions for pneumonia.

But the study’s findings suggest that physician employment alone probably is not sufficient to improve hospital care, the researchers concluded. They recommended hospitals focus on ways to boost clinical integration and improve patient care instead of hoping those goals will be accomplished solely by employing more physicians. Hospitals that switched to an employment model were more likely to be larger and teaching hospitals.

The number of independent physician practices has declined and one study predicts only one in three will remain in private practice. Hospital ownership of physician practices has increased in both urban and rural areas of the country, but those in rural areas are being acquired at a dramatic rate.