Should you care whether a hospital employs its doctors?

A recent Kaiser Health News article notes that doctors who once practiced on their own are increasingly working for hospitals. The idea, at its best, is that doctors who practice in a group setting, like a hospital, can better coordinate care and improve quality of services for patients. At its worst, the hospital sees the doctors as a means to generate more revenue. Should you care whether a hospital employs its doctors?

In September, Broward Health, a non-profit hospital system based in Florida that employs its doctors, paid $70 million to settle charges that it was improperly kicking back money to doctors for making patient referrals to the hospital. For decades, policymakers have tried to prevent such arrangements on the theory that they can encourage doctors to deliver more care than necessary, driving up costs and potentially harming patients.

The question remains whether promoting good care has anything to do with how doctors are paid? Or, is it about the goals of the people directing and providing care. Broward’s goals appear to have been revenue-based. But, not all hospitals who hire their doctors share those goals.

The Veterans Administration (VA) doctors are employees. Based on many studies comparing patient safety and health care quality under different payment systems, the VA offers “the best care anywhere.”  The VA has been lauded for giving systematic attention to appropriate treatment in ways other hospitals do not. It encourages a team-based coordinated care approach to care.

That said, not only is there huge quality and safety variations among hospitals, but there can be large variations within a hospital or a hospital system. The Wall Street Journal reports that patient care varies widely at VA hospitals.

So, how is a person to choose among health care providers? For good reason, the public is not focused on health plan quality.  And the various hospital ratings will at best tell you a piece of the hospital quality story. A lot of data is still not available. But, make sure you look at hospital infection rates.  Moreover, keep in mind that the quality of care delivered turns in significant part on the doctors who are providing care. For more information about the different provider ratings available through Medicare and elsewhere, visit the Informed Patient Institute.