Hospital ownership and admission rates from the emergency department, evidence from Florida

Objective: In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department. Data Sources: We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019. Study Design: We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument. Data Collection/Extraction Methods: Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults. Principal Findings: Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009. Conclusion: Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels. KEYWORDS fraud, hospital economics, hospital emergency service, medical overuse, ownership, patient admission
1 | INTRODUCTION Patients make almost 150 million visits to the emergency room annually (AHRQ 2021). At each visit, physicians must decide whether to admit the patient to the hospital [...]