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8 Medicare Patient Outcomes and Hospital Organizational Mission
Pages 354-374

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From page 354... ... The measures we analyze include ~ Post-operative mortality for Medicare elective surgical admissions measured over the stay and within 180 days of admission ~ 90-day post-discharge readmission rates for Medicare elective surgery admissions � Stabs regarding acccredita~on by Me Joint Commission on Accreditation of Hospitals UCAH) � Two measures of Medicare case mix. Read the entire page →
From page 355... ... Z Bet .~ so O ~ Go, Ct i== C; Pa O Cal - ~ CO 00 '$4 can ~ ~ C.D 0 _ Cal oo Cal CO O _ ~ ~ _ _ - CD Cal Cal O O ~ US Cal ~ ~ Cal Cal ~ Cal ~ {D Cal CC) Read the entire page →
From page 356... ... bAmerican Hospital Association data for 1981-1982 were used to assign this ownership status indicating membership in a multibospital system. CJoint Commission on Accreditation of Hospitals. Read the entire page →
From page 357... ... . Proprietary Proprietary Nonprofita Nonprofit Chain Independent Chain Independent All eight elective procedures 1975 0.049 0.045 0.050 0.013 1977 0.063 0.057 0.058 0.012 1979 0.062 0.070 0.054 0.011 1981 0.055 0.041 0.056 0.054 1981 by procedure Hemorrhoidectomy 0.020 0.000 0.029 0.025 Cholecystectomy 0.059 0.067 0.083 0.076 Inguinal hernia 0.027 0 043 0.029 0.026 Open prostatectomy 0.051 0.032 0.055 0.040 Transurethral resection of prostate 0.077 0.041 0.063 0.064 Hysterectomy 0.000 0.026 0.019 0.019 Excision of bladder lesion 0.095 0.039 0.083 0.095 Mastectomy 0.033 0.037 0.047 0.037 aAmencan Hospital Association data for 1981-1982 were used to assign this ownership status indicating membership in a muldhospital system. Read the entire page →
From page 358... ... The descriptive data suggest that it may not be meaningful to statistically examine many of the specific procedures separately due to the combined consequences of rare outcomes and small samples of cases for particular ownership TABLE 5 Unadjustec! 90-Day Readmission Rates by Hospital Type Proprietary Proprietary NonprofitQ Nonprofit Chain Independent Chain Independent All eight elective procedures 1975 0.067 0.083 0.084 0.081 1977 0.104 0.101 0.103 0.094 1979 0.088 0.093 0.084 0.083 1981 0.111 0.089 0.093 0.089 1981 by procedure Hemorrhoidectomy 0.140 0.056 0.079 0.073 Cholecystectomy 0.083 0.072 0.092 0.087 Inguinal hernia 0.077 0.075 0.058 0.052 Open prostatectomy 0.098 0.081 0.110 0.081 Transurethral resection of prostate 0.136 0.129 0.115 0.113 Hysterectomy 0.063 0.013 0.057 0.064 Excision of bladder lesion 0.190 0.099 0.114 0.139 Mastectomy 0.076 0.063 0.076 0.047 America Hospital Association data for 1981-1982 were used to assign this ownership status indicating membership in a multihospital system. Read the entire page →
From page 359... ... The pattern for proprietary chains is similar; for readmission rates, proprietary chains have higher rates than voluntary chains, except for hernia repair. But unlike the independent proprietaries, the investor-owned chain hospitals have lower lengths of stay than the voluntary chain hospitals. Read the entire page →
From page 360... ... .9- Not .9 1.1 1.1 + For M ED ICAR E CASEM IX Profit For Profit ~1 Chn Ind Chn Ind Propr Volun ORGANIZATION Read the entire page →
From page 361... ... ~ 75- 200- .9- Not For Chn Ind Chn Ind <75 200 400 400+ .9 1.1 1.1+ For Profit Propr Volun Profit SIZE (beds) MEDICARE ORGANIZATION CASEM iX FIGURE 2 Cholecystectomy outcomes, 1981 data. Read the entire page →
From page 362... ... 75- 200- 9- Not For Chn Ind Chn Ind <~75 200400 400+ .9 1.1 1.1t For Profit Propr Volun Profit SIZE (beds) MEDICARE ORGANIZATION CASEM IX FIGURE 3 Inguinal hernia repair, 1981 data. Read the entire page →
From page 363... ... 75- 200- .9- Not For Chn Ind 200~400 400+ .9 1.1 1.1+ For Profit Propr Profit Chn Ind Volun ORGAN IZATION Read the entire page →
From page 364... ... indicates that chain-~liated hospitals have inhospital mortality rates for all elective procedures combined that are ll.9 percent higher than for nonchain hospitals, ret par. The dominant conclusion Tom these tests is that hospital ownership may not be a strong or consistent imBuence on postoperative mortality rates; significant results are not propagated across all procedures categories. Read the entire page →
From page 365... ... There is also some evidence that proprietary chains have higher readmission rates than other proprietary hospitals. Accreditation Rates Table 8 shows the statistical results for accreditation rates. Read the entire page →
From page 366... ... Switch from proprietary independent to proprietary chain 366 FOR-PROFIT ENTERPRISE IN HEALTH CARE TABLE 7 Statistical Results on Patient Outcomes: Percentage Differences in Adverse Outcome Ratea (p value in parentheses) Test Statistic All Eight Electives Cholecystectomy Inguinal Hernia Repair Transurethral Resection of Prostate .119 (.033) Read the entire page →
From page 367... ... The findings on readmission rates admit to no pattern whatsoever again providing no support for the view that investor-owned hospitals have poorer patient outcomes. In sum, the patient outcome findings do not show any persisting pattern that would support a conclusion that proprietary hospitals are providing poorer quality of care. Read the entire page →
From page 368... ... FOR-PROFIT ENTERPRISE IN HEALTH CARE lbe figure to detect persistent patterns may, in part, derive from these statistical power considerations. We can conclude, however, that no apparent pattern of large ownership differences exist for serious patient outcomes following elective surgery. Read the entire page →
From page 369... ... , and Prochain (= 1 if proprietary chain, O otherwise) The coefficients on the organization measures in the Model 1 specification tests for differences between chain and nonchain hospitals and between proprietary and nonproprietary hospitals. Read the entire page →
From page 370... ... First, we are concerned that measurement errors in the MEDPAR file may elevate the standard errors in the morlel, causing significant differences to be overlooked if tolerance levels are too stringent. Second, we believe that the policy applications of this work require that we allow less than the usual chance of committing false negative (type II) Read the entire page →
From page 371... ... Reading, Mass.: Addison Wesley. TABLE B-1 Statistical Results on Post-Operative Mortality Rates: Percentage Difference in Mortality Rate During the Staya Surgical Category Model All Elective Inguinal Surgery Cholecystectomy Hernia Repair Transurethral Resection of Prostate Model 1 Chainb Proprietary Model 2 Chain Proprietary Prochaind Model 3 DChaine Prochain Proprietary Model 4 DProprietaryf Proprietary Chain O Read the entire page →
From page 372... ... 0.382 (0.000) + aDependent variable is natural log of ratio of actual to expected rate. Read the entire page →
From page 373... ... + Proprietary + + Chain - + + -0.081 (0.002) a Dependent variable is natural log of ratio of acutal to expected rate. Read the entire page →
From page 374... ... - + Model 3 Proprietary DChain DProchain Model 4 D Proprietary Proprietary Chain - O Read the entire page →

From page 354...

... The measures we analyze include ~ Post-operative mortality for Medicare elective surgical admissions measured over the stay and within 180 days of admission ~ 90-day post-discharge readmission rates for Medicare elective surgery admissions � Stabs regarding acccredita~on by Me Joint Commission on Accreditation of Hospitals UCAH) � Two measures of Medicare case mix.

8 Medicare Patient Outcomes and Hospital Organizational Mission Pages 354-374

8 Medicare Patient Outcomes and Hospital Organizational Mission
Pages 354-374