Study Misses the Mark in Suggesting Physician Employment Has No Effect on Hospital Quality Improvement
By Ira S. Nash, MD, FACC, FAHA, FACP, Senior Vice President, Northwell Health
As our country struggles to move our health care system toward the Triple Aim of lower costs, higher quality and a better patient experience, it is important to remember that physicians play an integral role in this transition.
Improving quality at every stage of the care continuum requires the collaboration and engagement of physicians. That is why a study published in January in the Annals of Internal Medicine needs to be more closely analyzed. In “Changes in Hospital–Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care,” the authors conclude that physician employment does not improve hospital care. While this conclusion may be technically correct, it does not have the broad policy implications that the authors suggest.
The definitions used in the study for physicians with an “employment affiliation” are so broad, they almost become meaningless. For instance, a hospital with a small number of employed physicians in a single clinical area such as radiology or emergency medicine was categorized as engaging in physician employment. This very low threshold on the definition of “employed physician” demonstrates a lack of understanding of HOW quality improvement is actually achieved.
It makes little sense to lump a hospital like that with one with a fully employed medical staff who are closely aligned with institutional initiatives around quality improvement.
From the Council of Accountable Physician Practices’ (CAPP’s) perspective, “employment” frames the issue in too narrow a fashion. It is the organization of physicians that is key to providing high-quality care. Specifically, our members have found that an integrated, physician-led care coordinated medical group does indeed equate to higher quality. Nothing in this paper speaks to what CAPP is putting forward as the model for what high-quality health care could be.
If the study authors had defined employment in a different way, or provided a measure of the extent of physician employment and organization, the results may well have been different. As CAPP continues to advocate for the longitudinal care of populations, organizing MDs into integrated physician-led medical groups will continue to be a point of advocacy for us. The issue of technical employment is secondary to how physicians are organized in clinical practice. Using such a broad brush to conclude that the employment of MDs isn’t driving the quality agenda is a disservice to us all.