Physician Hospital Privileges: Implications for a Medical Staff Policy

摘要

The paper examines physician affiliation patterns with hospital medical staffs.It follows research and development of alternative medical staff payment policies that could strengthen incentives for physicians to control their inpatient service volume and intensity under the Medicare Fee Schedule. One alternative would differentially withhold payment to physicians on medical staffs whose average casemix adjusted volume per admission is significantly above the national average. To provide some understanding of the potential for shifting admissions from a high to a lower cost medical staff, the paper explores how many hospitals with which a physician is affiliated, and the proportion of a physician's practice that occurs in a single hospital. Databases include, 100 percent claims from the 1991 National Claims History (NCH) files for seven states, and 100 percent of 1992 national Medicare Patient Analysis and Review (MedPAR) file. Findings include: (1) on average, attending physicians have 1.55 affiliations; (2) ninety percent of an attending physician's Medicare services are provided in a single hospital; and (3) in the typical hospital, 20 percent (13 physicians) of attending physicians account for 55 percent of the medical staff's total inpatient services. Findings are also presented by type of specialty and type of hospital.