By Mike Shields
KHI News Service
TOPEKA, Dec. 12
A new report on the state”s specialty hospitals drew mixed response Tuesday from members of the Kansas Health Policy Authority, which in March will recommend to the Legislature how the state should best deal with the controversial facilities.
The report by Kansas Health Institute senior policy analyst Sheldon Weisgrau was guarded it in its conclusions, saying much remains unknown about how the hospitals might be harming general hospitals.
“The jury is still out on the impact on general hospitals,” Weisgrau said, “and that”s really what the controversy is all about.”
But that didn”t stop some authority members from staking strong positions after Weisgrau presented a summary of his report, which was done in conjunction with the Kansas Department of Health and Environment.
“We don”t need anymore studies and we don”t let these people (specialty hospitals) in our (provider) network because we think it”s irresponsible,” said health policy board member E.J. “Ned” Holland, human resources vice president at EMBARQ Corp., formerly known as Sprint Nextel. “What has happened to health care costs since certificate of need was repealed in the 80s?”
Holland was the authority member most vocal in his criticism of the specialty hospitals, which he said are “clearly skimming” more profitable cases from general hospitals while leaving them saddled with costly obligations such as emergency room care and treatment of the poor and uninsured. He suggested Kansas might be better off returning to the long-abolished policy of requiring hospitals to meet “certificate of need” requirements, a set of regulatory hurdles eliminated in Kansas 20 years ago. More than half of U.S. states still have “certificate of need” licensing requirements, but champions of the specialty hospitals and at least one member of the health authority said that process had been proven ineffective because it was too political and bureaucratic.
“In most states it doesn”t work, it is just a bureaucracy,” said Paul Kerens, president of the Kansas Surgical Hospital Association and senior executive officer for Kansas City Orthopedic Institute, one of the studied specialty hospitals. “It becomes a political hoop. I don”t think certificate of need is the answer.”
But comments by other health policy board members suggested there might be enough support on the panel for recommending some sort of stepped up regulation.
“I would like to ask (the Legislature) to take a closer look at licensure,” to be sure specialty hospitals are not harming rural general hospitals, said board member Joe Tilghman of Overland Park, a retired federal Medicare and Medicaid administrator.
But board member Vernon Mills, a Leavenworth pediatrician, said the health authority shouldn”t overlook the innovative nature of the hospitals.
“This is not as simple as it sounds,” he said. “There were huge numbers of incentives for this to happen. We all live with the mess we made and this is the consequence.”
Mills said specialty hospitals grew from the frustration many doctors had with the bureaucracy surrounding large general hospitals and the slow response to new ideas and patient needs.
Specialty hospitals typically are owned wholly or in part by doctors. But in some instances they are partially owned by a nearby general hospital. That is the case for Salina Surgical Hospital, which is owned 50 percent by the city”s general hospital, said Jim Sergeant, the specialty hospital”s CEO.
“Please come visit a facility,” he told health authority members. “Talk to the people, nurses, patients. I think these animals can work. We”ve kind of got that giant mentality and this allows treating people on a smaller scale.”
The
KHI research
showed that specialty hospitals:
* Provide a limited range of services, treat fewer types of cases, and are more focused on surgical procedures than general hospitals.
* Treat a higher proportion of Medicare patients and lower proportions of Medicaid and uninsured patients than general hospitals.
* Have mixed impact on their general hospital competitors.
In the Kansas City area, the entry of specialty hospitals coincided with an increase in joint replacement and back and neck surgeries at both general and specialty hospitals, suggesting that a larger supply of providers drove an increase in service volume.
In the Wichita market, increases in the number of coronary bypass surgeries at specialty hospitals coincided with a sharp decline in the volume of those done at competing general hospitals.
In rural markets, increases in the number of hysterectomies at specialty hospitals coincided with a sharp decline in the number done at competing general hospitals.
For other services, no consistent patterns were evident regarding the impact of specialty hospitals on general hospitals and overall utilization.
The KHI report suggested Kansas policymakers consider these options:
* Collect information from the general hospitals about the changes they”ve made in response to competition from the specialty hospitals.
* Collect ownership and investor information from the specialty hospitals.
* Collect quality-of-care data from general and specialty hospitals.
* Consider the pros and cons of greater licensing requirements for specialty hospitals.
* Consider reintroducing the certificate-of-need regulations.
Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
mshields@khi.org
or at 785-233-5443, ext. 123.