Physician-owned hospitals: Are they the boogeyman?

Regarding self-referral by phsyicians, Sandoval is wrong:
1. Many hospitals employ physicians and incur sigificant losses doing so. The spinoff contribution margin is used to fund hospital operations and does not flow back into physicians pockets. The analogy does not hold.
2. Absent any standard for qualifies as "community benefit' some hopsitals claim capital expenses on building as community benefit. In sprit, community benefit is supposed to be charity care. How much true charity do these hopsitals provide?
3. Agile, perhaps. Better quality? Prove it. According to the Commonwealth Fund, the US is now dead last among industrialized nations for quality.
4. The realtionship between physician self-referral and utilization is not a "popular perception" it is an ironclad, irrefutable fact confirmed repeatedly in multiple studies over decades. Dr. Mitchell's most recent study (July, Medical Care) merely corroborates what has been proven ad nauseaum.

Physician onwership of ASC's, imaging centers and specialty hospitals, often in partnership with device manufacturers results in undeniable increases in utilization, much of it inappropriate and uneccessary. It is a totally transparent manifestation of physician greed and soils the noble heritage of our profession. It is ironic, that the most highly compensated among us, (orthopods, neurosurgeons and cardiovascular surgeons) who are already earning millions from their practices need even more. They are lining their pockets at taxpayer expense while pushing the nation ever deeper into debt. This too shall pass and one day our profession will be puged of those who have forgotten the Oath.

The "anonymous" post has no credibility at all because, unlike Ms. Sandvig, the writer is not willing to sign it and let you know his/her bias (I don't have any personal stake). There are quality issues in all types of hospitals, though specialty hospitals generally score higher. But only the big corporate hospitals are threatened by the growth of specialty hospitals that provide patient choice (and threaten their local monopolies). Their effort to deny physicians the right to own hospitals is un-American. If you have a college degree in that, you're not allowed to own a business? You can't own a business you are actually qualified to run? "Anonymous" must be someone connected to an existing hospital who feels threatened by the entry into the free market of competition. Any of your readers who do not understand that competition drives prices down and quality up should return to school for a quick refresher course in basic middle school economics.

All interesting comments but to me this issue is quite simple. Why do we allow physicians to self-refer to entities where they have a financial interest and will receive a personal financial gain by the referral? We do not allow attornies to do this nor do we allow accountants and other professionals. Look at the mess that Anderson had at Enron by auditing thier own subsidiary consulting advice. Would we allow our government officials to refer business/contracts (undisclosed I might add) to businesses in which they have an interest? The answer is simple. No! This self-referral is a horrible conflict of interest and should not be allowed, period!

One thing that is not touched upon when mentioning physician owned hospitals is patient and physician satisfaction. I am a general surgeon that invested in a physician owned hospital after 16 months of doing cases at this facility. The biggest plus to this facility is ease of scheduling cases, the ability to have control over what products and techniques go into the actual surgery (instead of a hospital executive that has no clue, nor cares, about surgical outcomes other than "the bottom line"), and the "old school" idea that the physician is treated with respect. If I find staff or situations that I consider unsafe, I can have a direct impact in change. In our local community hospital, my concerns are largely brushed aside by individuals that either have limited or no medical training. I have the ability to schedule more cases per day and still be home before dinner. This keeps my family happy. Patients are also happy since I am able to schedule their surgery with more flexibility and efficiency. Yesterday I did two cases at our community hospital. I took 2 hours between the cases for turnover time. I have patience, but come on... This happens routinely and nobody can answer why, nor do they care. So why do physicians like physician-owned facilities? Is it because they are "greedy" or is it because they feel greater satisfaction within their profession. In regards to self-referral I never push a patient to have surgery at any facility. I inform them of their options, disclose my relationship, and let them decide.