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Too Much of a Good Thing?

Peter Cram, MD, MBA; Gary E. Rosenthal, MD

JAMA. 2007;297:998-999.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The emergence of specialty hospitals that focus on lucrative procedural aspects of medicine has generated a heated debate among policy makers^1-2 that largely involves 4 issues: patient selection (ie, "cherry-picking" of healthier and wealthier patients by specialty hospitals); quality of care in specialty and general hospitals; impact of specialty hospitals on the financial health of general hospitals; and influence of specialty hospitals on utilization and health care costs.

The debate intensified in 2003 with the passage of a temporary congressional moratorium (allowed to expire in 2005) on new specialty hospital construction. However, empirical data addressing the 4 issues remain limited. Consistent evidence suggests that specialty hospitals admit patients with lower acuity and fewer comorbidities than general hospitals.^3-4 Studies assessing quality have found that risk-adjusted rates of adverse outcomes in specialty hospitals are similar or somewhat lower (perhaps 10%-20%) compared with general hospitals.^5-6 . . . [Full Text of this Article]

Author Affiliations: Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, and Center for Research in the Implementation of Innovative Strategies for Practice (CRIISP), Iowa City Veterans Administration Medical Center, Iowa City, Iowa.

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