For-Profit Enterprise in Health Care (1986) / Chapter Skim
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12 Medical Staff Size, Hospital Privileges, and Compensation Arrangements: A Comparison of System Hospitals
12 Medical Staff Size, Hospital Privileges, and Compensation Arrangements: A Comparison of System Hospitals
Pages 422-457
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From page 422... ...
Medical Staff Size, Hospital Pn~rileges, and Compensation Arrangements: A Companson of System Hospitals Michael A Momsey, Jeffrey A
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Equations emphasizing continuous dependent variables are estimated using ordinary least squares regression techniques; dichotomous dependent variables are analyzed using logit regression. Means and standard deviations of all variables are found in Appendix Tables A-1, A-2, A-3, and Am.
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Only voluntary sec FOR-PROFIT ENTERPRISE IN HEALTH CARE ular system hospitals have more active and associate medical staff members per 100 hospital beds. As Appendix Table A-7 reports, however, while the relationship across hospital types continues to hold when other factors are introduced, it is only the public system, freestanding, and contract-managed hospitals that exhibit statistically significant differences from IO system hospitals.
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Finally, Table 6 reports the percentage of the top five admitting physicians who are board certified. With the exception of contract-managed hospitals, which had a smaller percentage of board-certified heavy admitters, there was no statistically significant difference between hospitals in IO chains and other types of hospitals.
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TABLE 6 Comparison of Investor-Owned System Hospitals with Other Types of Hospitals: What Percentage of Top Five Admitting Physicians Are Board Certified? Investor Owned Religious Nonprofit Public Contract Systems Freestanding Systems Systems Systems Managed Mean Mean Mean Mean Mean Mean N(S.D.)
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On average, public system hospitals employ over 80 physicians. Freestanding hospitals employ approximately seven physicians.
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In this regard Hey are most like religious system hospitals and least like freestanding hospitals anal public system hospitals. These differences persist when other factors are controlled (Appendix Tables A-22, A-23, and A-24.
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DISCUSSION After controlling for system size, hospital size, teaching activity, region of the country, and SMSA size, IO system hospitals tend to differ from other times of ha~r~ital~ in the fill lowing ways: , ~_ ~ ~ ., 1. They accept a somewhat higher percentage of medical staffapplications than other types of hospitals.
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Privilege Criteria and Review This study indicates that at least as many IO system hospitals require board certification as a requirement of medical staff membership as do other hospitals. Combined with the other data indicating that IO system hospitals have a percentage of physicians who are board certified similar to that of nonproprietary hospitals, this suggests that IOs exhibit as much TABLE IS Comparison of Investor-Owned System Hospitals with Other Types of Hospitals: Do Your Radiologists Bill Patients Directly?
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· Carefully designed outcome studies that control for differences in case mix and other relevant variables are also needed to identify the degree to which there may be differences in the quality of care provided by different types of hospitals. Compensation Arrangements The fact that IO hospitals are less likely to have salaried relationships with their hospitalbased specialists and more likely to have their physicians bill directly for their services suggests looser financial relationships between IO hospitals and these specialists.
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Health Care Management Review 9~3~:1120. Relman, A
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b General and family practice8.978.1144,258 Pediatrics2.937.3114,482 General internal medicine5.518.6327,182 Other medical specialty4.207.8520,713 General surgery4.074.8220,074 Proportion of active and associate medical staff that is board certified0.610.332,724 aSize of standard metropolitan statistical area (SMSA)
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STAFF SIZE, PRIVILEGES, AND COMPENSATION TABLE A-2 Descriptive Statistics for Hospitals in the Analysis of Privilege Awarding and of Concentration of Admissions (N= 1,811) Variables Standard Mean Deviation Sum Independent Variables Freestanding hospital0.710.451,283 System characteristics System control Religious nonprofit0.120.33223 Secular nonprofit0.030.1859 Investor-owned0.060.25117 Public0.000.066 Contract-managed0.070.25123 System size21.1572.3638,295 Hospital characteristics Number of beds192.87171.98349,295 Regional location Northeast0.230.42422 South0.260.44470 Norm Central0.320.47573 West0.190.39346 SMSA sizea Non-SMSA0.440.50791 Under 10O,0000.020.1228 100,000-250,0000.090.29166 250,000 500,0000.090.28160 500,000 1 million0.080.28150 1 million-2.5 million0.150.35264 Over 2.5 million0.140.35252 House staff9.7942.3517,728 Dependent; Variables Number who applied for active stay privileges14.4722.5426,198 Percent who were accepted82.2334.17148,913 Usual number of months of provisional appointment9.015.1616,324 Board certification is required0.300.46536 Percent of admissions by top five admitting physicians45.6333.2282,641 Percent of top five admitting physicians who are board certified61.0736.07107,363 aSize of standard metropolitan statistical area (SMSA)
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Standard Mean Deviation Sum Freestanding hospital0.720.45888 System characteristics System control Religious nonprofit0 120.33151 Secular nonprofit0.030.1840 Investor-owned0.060.2479 Public0.010.087 Contract-managed0.060.2369 System size20.7672.0325,612 Hospital characteristics Number of beds218.62190.62269,779 Regional location Northeast0.260.44316 South0.260.44320 North Central0.290.46364 West0.190.39234 SMSA sizes Non-SMSA0.360.48940 Under 100,0000.020.1322 100,000-250,0000.100.30127 250,000-500,0000.100.30123 500,000 1 million0.090.29114 1 million-2.5 million0.170.37204 Over 2.5 million0.170.37204 House staff14.5053.8317,892 Dependent Variables Anesthesiologists are paid a percent of revenues or a fee for service0.890.311,103 Pathologists are paid a percent of revenues or a fee for service0.670.47821 Radiologists are paid a percent of revenues or a fee for service0.900.301,108 aSize of standard metropolitan statistical area (SMSA)
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STAFF SIZE, PRIVILEGES, AND COMPENSATION TABLE AL Descriptive Statistics for Hospitals in the Analysis of Physicians' Direct Patient Billing Decisions (N = 1,627) Variables Standard Mean Deviation Sum Freestanding hospital System characteristics System control Religious nonprofit Secular nonprofit Investor-owned Public Contract-managed System size Hospital characteristics Number of beds Regional location Northeast South North Central West Independent Variables 0.71 0.12 0.03 0.06 0.01 0.06 20.21 0.45 1,lS8 0.33 0.18 0.24 0.08 0.24 70.53 212.37183.63 0.25 0.26 0.30 0.19 202 0.43 0.44 0.46 0.39 408 427 480 312 SMSA sizea Non-SMSA 0.37 0.48605 Under 100,000 0.02 0.1328 100,000-250,000 0.09 0.29154 250,000-500,000 0.10 0.30160 500,000-1 million 0.09 0.291S4 1 million-2.5 million 0.17 0.37273 Over 2.5 million 0.16 0.36253 House staff 13.55 53.3622,053 Dependent Variables Anesthesiologists bill patients directly 0.71 0.45 1,160 Pathologists bill patients directly 0.22 0.41 351 Radiologists bill patients directly 0.59 0.49 968 aSize of standard metropolitan statistical area (SMSA)
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* Model statistics R2 0.38 0.38 N 1,811 1,811 aSize of standard metropolitan statistical area (SMSA)
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* Model statistics R2 0.06 0.06 N 1,811 1,811 aSize of standard metropolitan statistical area (SMSA)
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System Control Coefficients Relative to Investor-Owned Systems Variables Coefficient Standard Error Coefficient Standard Error _ Freestanding hospitals -8.54 2.72*
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* -3.05 0 33 SMSA sizea Under 100,000 100,000-250,000 250,000 500,000 500,000-1 million 1 million-2.5 million Over 2.5 million House staff Constant Model statistics R2 N 0.96 2.06 2.82 2.51 2.88 2.83 0.38 13.68 0.16 4,935 1.06 0.41*
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_ . System Control Coefficients Relative toFreestanding Hospitals Investor-Owned Systems VariablesCoefficient Standard ErrorCoefficient Standard Error Freestanding hospitals 0.63 0.47 System characteristics System control Religious nonprofit-0.18 0.330.45 0.55 Secular nonprofit1.11 0.48*
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System Control Coefficients Relative toFreestanding Hospitals Vanables Investor-Owned Systems Coefficient Standard Error Coefficient Standard Error Freestanding hospitals - 2.04 0.53*
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* Model statistics R2 0.20 0.20 N 4,935 4,935 aSize of standard statistical metropolitan area (SMSA)
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* Model statistics R2 0.13 0.13 N 4,935 4,935 aSize of standard statistical metropolitan area (SMSA)
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* Model statistics R2 0.57 0.57 N 1,811 1,811 aSize of standard statistical metropolitan area (SM~SA)
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* S8.67 4.51 Model statistics R2 0.067 0.067 N 1,758 1,758 aSize of standard statistical metropolitan area (SMSA)
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System Control Coefficients Relative to Freestanding Hospitals Variables Investor-Owned Systems Coellicient Standard Error Coefficient Standard Error Freestanding hospitals -0.08 0.28 System characteristics System control Religious nonprofit-0.33 0.18* - 0.41 0.31 Secular nonprofit0.20 0.300.12 0.39 Investorowned0.08 0.28 Public-0.50 0.90-0.58 0.93 Contract-managed-0.06 0.26-0.13 0.31 System size-0.00 0.00- 0.00 0.00 Hospital characteristics Number of beds0.10 0.04*
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* Model statistics 0-043 4,448 0.043 4,448 aSize of standard statistical metropolitan area (SMSA)
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* Model statistics R2 0.10 0.10 N 1,811 1,811 aSize of standard statistical metropolitan area (SMSA)
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- 3.43 1.81 Model statistics R2 0.32 0.32 N S,004 5,004 aSize of standard statistical metropolitan area (SMSA)
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* Model statistics Pseudo R 0.28 0.28 N 1,234 1,234 aSize of standard metropolitan statistical area (SMSA)
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* 3.76 0.89 Model statistics Pseudo R 0.41 0.41 N 1,234 1,234 aSize of standard metropolitan statistical area (SMSA)
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* 2.59 0.50 Model statistics Pseudo R 0.48 0.48 N 1,234 1,234 aSize of standard metropolitan statistical area (SMSA)
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* Constant-0.19 0.16- 0.58 0.36 Model statistics Pseudo R 0.38 0.38 N 1,627 1,627 aSize of standard metropolitan statistical area (SMSA)
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* 0.41 0.34 Model statistics Pseudo P 0.29 0.29 N 1,627 1,627 aSize of standard metropolitan statistical area (SMSA)
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* - 0.46 0.30 Model statistics Pseudo R 0.34 0.34 N 1,627 1,627 aSize of standard metropolitan statistical area (SMSA)
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