Becker's Clinical Quality & Infection Control

48 QUALITY IMPROVEMENT & MEASUREMENT Hospital-employed physicians more likely to order unneeded MRIs, Massachusetts study finds By Kelly Gooch P atients of physicians employed by hospitals are more likely to receive inappropriate referrals for diagnostic imaging, according to a study published May 3 in Health Affairs. e study — led by researchers from Boston-based Northeastern University, Stonehill College in Easton, Mass., and Boston University — is based on com- mercial health insurance claims from the Massachusetts All Payer Claims Database, as well as Medicare claims data and data from health plans. Data was collected for MRI referrals for three conditions — un- complicated lower back pain, nontraumatic knee pain without joint effusion, and nontraumatic shoulder pain without joint effusion — for 2009 through 2016. For the study, researchers compared a study cohort of 583 primary care physicians who became employed by a hospital in Massa- chusetts from 2009 through 2016 with 3,102 Massachusetts physicians who were not em- ployed by a hospital during the study period. e study found an association between hos- pital employment of physicians and patients' likelihood of receiving MRI referrals generally. For the study cohort, researchers also found that patients' likelihood of receiving inappro- priate MRI referrals climbed by 26 percent related to hospital employment of physicians. Additionally, researchers said physicians were more likely to refer patients for MRIs once they were employed by a hospital than before that employment began. "Our findings are in line with previous studies that have reported an association between hospital-physician integration and higher costs for patient care," the study's authors concluded. "However, our findings offer evidence that such higher costs are not largely a matter of better service access for patients. Rather, hospital-physician integration appears to be a potential driver of low-value care." n Hospitals with more privately insured patients have better care quality, Northwestern study finds By Lauren Jensik R esearchers at Evanston, Ill.-based Northwestern University's Kellogg School of Management found that hospitals with higher rates of privately insured patients consistently provided better-quality care than those with more publicly insured patients, according to an article published May 10 on the school's website. The researchers estimated that the mortality rate increased by 1.5 percent with every standard-deviation increase in a hospital's non-private patient share, the article said. Researchers posited that hospitals with more high-paying privately insured patients made more investments in quality initiatives to dif- ferentiate themselves from the competition and demonstrate their worth in private insurance networks. "Consistently what we see is that places that have more opportunity to earn money from quality make costly investments in quality," said Craig Garthwaite, PhD, who co-authored a report on the findings. Dr. Garthwaite, along with Amanda Starc, PhD, and Christopher Ody, PhD, analyzed data related to ZIP code demographics near hospitals as well as data involving hospital quality measures to draw their conclusions. "I don't think that our paper says that we shouldn't have 'Medicare for all,'" Dr. Garthwaite said. "But it does suggest that as part of the conversation about regulated prices, we should be talking about this quality trade-off more than I think is currently happening in the policy debate." n Joint Commission to launch maternal health verification program By Mackenzie Bean T he Joint Commission and American College of Obstetricians and Gynecolo- gists will offer a Maternal Levels of Care Verification program for hospitals starting Jan. 1, 2022, the organizations said June 23. The college and the Society for Maternal-Fetal Medicine developed the Levels of Maternal Care Obstetric Care Consensus in 2015, which defines the minimum capabilities needed to qualify for one of four levels of care. The verification process will involve an on-site review of maternal services by the Joint Com- mission, which will then determine the hospi- tal's level of maternal care. The organizations said they are also consid- ering a certification in obstetric care for hos- pitals that meet advanced criteria beyond the four level requirements. The goal of the program is to reduce ma- ternal morbidity and mortality rates in the U.S., they said. n

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