Selection of a cardiac surgery provider in the managed care era

Abstract

The observable determinants of cardiac surgery provider selection are related to hospital reputation, historical referral patterns, and patient proximity, not objective clinical or cost performance. The paradoxic behavior of commercial managed care probably results from unobserved choice factors that are not primarily based on objective provider performance.

Effects of report cards on referral patterns to cardiac surgeons

“…This is consistent with the Mukamel et al (2004Mukamel et al ( /2005 findings that report card ratings were associated with surgeon choice prior to publication in New York. It is also consistent with studies of the role of unpublished quality in hospital referral patterns (Luft et al, 1990;Chernew et al, 1998;Shahian et al, 2000), but not with Dranove and Sfekas's (2008) finding a low correlation between consumers' prior beliefs and hospitals' report card scores. It is also worth noting that the size of the report card effects in the pre-period were roughly equal (and not significantly different) between states, supporting the assumption that in the absence of report cards consumers in Florida and in Pennsylvania had equivalent levels of knowledge about their surgeons on average.…”

“…Mukamel et al (2004Mukamel et al ( /2005 found that, in choosing a cardiac surgeon, the information in the first New York report card partially substituted for other, implicit signals of surgeon quality. Other studies have shown that CABG patients in states without report cards were more likely to be treated at low-mortality hospitals (Luft et al, 1990;Chernew et al, 1998;Shahian et al, 2000), indicating that public report cards for cardiac surgery may offer redundant information. 7…”

“…Four hospitals in Pennsylvania and one in Florida began offering CABG surgery during the Pre period (after data for the report card were collected); observations from these hospitals and one in New York were coded with a separate indicator for being unrated. Lagged hospital market share was measured as the proportion of CABGs from a patient's HSA performed at each hospital in the HRR-specific choice set during 2000, before the start of the Pre period (Shahian et al, 2000).…”

“…Shahian et al (2000) andMukamel et al (2004Mukamel et al ( /2005 also follow this approach. 11 I assume that surgeons do not change their prices in response to report card publication and that the better-rated ones have slack capacity.…”

Are patients’ preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations

“…For example, a patient may go to the GP first, is then referred to a hospital for diagnostic purposes and, finally, is sent to another hospital department, or even another hospital, for treatment. While following this path, there may not be any clear opportunity to make a choice, particularly not independent of any previous care the patient has received [20-22]. …”