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The Case for Specialization

How important is the choice of specialty services, cardiac care for example? Today some 1.2 million Americans are diagnosed with coronary heart disease, and another 700,000 will suffer a stroke. In all, coronary heart disease and stroke were responsible for 602,000 deaths in 2004. That's 25 percent of all deaths in the U.S. that year. Heart disease kills more Americans annually than all cancer's combined. Treating coronary heart disease costs $156.4 billion annually, and for a stroke the estimated annual treatment cost is $65.5 billion. Those numbers are set to grow, parallel to our aging population.

Specialty hospitals focused on cardiac care are critically important now, and will only become more vital as our nation ages. Why would we want to limit the availability of these crucial facilities? Remember, HealthGrades ranked three specialty hospitals in their top ten cardiac programs in the nation.

And why would we want to impede the growth in specialty orthopedic facilities? The numbers regarding this specialty are staggering, and growing exponentially into the future. A July 2007 Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Statistical Brief (#34) noted hospital stays connected with musculoskeletal procedures (including knee arthroplasty, hip replacement, and spinal fusion) numbered 3.4 million in 2005. The three procedures listed accounted for 1.2 million of those hospital stays. According to the report, patients hospitalized for musculoskeletal procedures were about 13 years older than the typical hospitalized patient (mean patient age of 60 years old versus 47 years old).

The University of Iowa studied tens of thousands of Medicare patients and found that complication rates were 40 percent lower for hip and knee surgeries at facilities specializing in orthopedics than for community hospitals. Also, a Medicare study showed that patients of all types are four times more likely to die in a full-service hospital after orthopedic surgery as they would at a specialty hospital. Those are startling statistics.

Competition: A Life or Death Decision

Choosing the correct hospital can be a life or death decision. While some hospitals are good, some clearly are not. If the hospital industry continues to do all it can to thwart competition in the form of physician-owned specialty hospitals, many patients and communities will be denied their choice of quality care. Some facts to consider when making the choice are:

• One in 200 patients who spend a night or more in the hospital will die from a medical error
• One in 16 will pick up an infection
• Deaths from preventable hospital infections each year exceed 100,000 (more than those from AIDS, breast cancer, and auto accidents combined)
• While the political health care reform debate often centers around covering the uninsured, according to the Committee to Reduce Infection Deaths, you are five times more likely to die from visiting a hospital than being uninsured.

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