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We used data from the 2005-06 Community Tracking Study site visits to examine the impact of quality reporting on hospitals' data collection and review processes, feedback and accountability mechanisms, quality improvement activities, and resource allocation. Individual hospitals participate in multiple, varied reporting programs with distinct effects on hospital operations. Reporting programs play complementary roles in encouraging quality improvement but are poorly coordinated and command sizable resources, in large part because of inadequate information technology. Policy should be directed at encouraging formal assessments of how individual and combinations of programs affect quality outcomes, and the development of adaptable information systems. [ABSTRACT FROM AUTHOR]

The Institute of Medicine's report To Err Is Human described the alarming prevalence of medical errors and recommended a range of activities to improve patient safety. Three general mechanisms for stimulating hospitals to reduce medical errors are professionalism, regulation, and market forces. Although some believe that market forces are becoming more important, we found that a quasi-regulatory organization (the Joint Commission on Accreditation of Healthcare Organizations) has been the primary driver of hospitals' patient-safety initiatives. Professional and market initiatives have also facilitated improvement, but hospitals report that these have had less impact to date. [ABSTRACT FROM AUTHOR]

We examine how an integrated delivery system responded to threatened exclusion from an insurer's high-performance network by attempting to reduce costs through fundamental redesign of care processes. Some factors facilitating this transformation, such as its structure as a large salaried medical group exclusively affiliated with a hospital, might be specific to the organization and its market. Other essential elements could be replicated. But in a fee-for-service payment system, cost reduction from reducing the number of services or changing their mix can reduce profitability. Making the business case for sustaining desirable provider behavior may require that purchasers and plans make equally fundamental changes in payment policy. [ABSTRACT FROM AUTHOR]

Data from the Community Tracking Study provide a valuable perspective from which to observe how economic disparities--largely a function of different sources of coverage--influence access to medical care in the United States. Many recent investments and initiatives are focused on affluent communities and are accessible mainly to people with employer-based or Medicare coverage. For people with Medicaid or no coverage at all, access to basic care is worsening, as a result of stalled coverage expansions and service cutbacks. An improving economy could forestall further cuts and permit reversal of earlier ones, but progress in closing this rift does not appear imminent. [ABSTRACT FROM AUTHOR]

Hospitals and physicians are developing and marketing discrete and profitable specialty-service lines. Although closely affiliated specialist physicians are central to hospitals' service-line products, other physicians compete directly with hospitals via physician-owned specialty facilities. Specialty-service lines may be provided in a variety of settings, both inside and outside traditional hospital walls. Thus far, the escalating battle between hospitals and physicians for control over specialty services has not affected hospital profitability. However, as the scope of care that can be safely performed in the outpatient arena expands, physician competition for control over specialty services may threaten hospitals' financial health. [ABSTRACT FROM AUTHOR]

Data from the most recent Community Tracking Study (CTS) interviews in twelve nationally representative metropolitan areas indicate that hospitals are increasingly employing physicians, particularly specialists. Nonemployed physicians are separating from hospitals passively by refusing to serve on medical staff committees or take emergency department call, and actively by creating specialized facilities, such as ambulatory surgery centers (ASCs), to compete for hospitals' most profitable services. Employment is more common and physician-owned ASCs are less common in consolidated hospital markets. The interviews also suggest other factors motivating physician employment by, or separation from, hospitals, and likely consequences of these trends. [ABSTRACT FROM AUTHOR]