Hospital Ownership and Managerial Influence over Treatment Decisions: The Case of Admissions from the Emergency Department

30 Pages Posted: 9 Dec 2021 Last revised: 15 Dec 2021

See all articles by David H. Howard

David H. Howard

Emory University - Department of Health Policy and Management

Guy David

The Wharton School, University of Pennsylvania - Health Care Management

Date Written: November 16, 2021

Abstract

A number of False Claims Act lawsuits have alleged that managers at for-profit
hospitals pressured physicians, using feedback and manipulation of defaults, to admit patients
unnecessarily from the emergency department. Using 100% hospital records from Florida for
2015-2017, we estimate that admission rates were 7 percentage points (20%) higher at for-profit
hospitals. We additionally describe admission rate trends from 2007-2017 at two hospital
systems that paid large penalties to the Department of Justice for unnecessary admissions. The
timing of pre- and post-investigation changes in admission rates and our cross-sectional
estimates are consistent with allegations that administrators influenced physicians’ admission
decisions.

Note:
Funding Information: None to declare.

Declaration of Interests: None to declare.

Ethics Approval Statement: The study was approved by Emory's Institutional Review Board.

Keywords: Hospital ownership, emergency room, hospital admission, reimbursement, physician induced demand

JEL Classification: I11, I18, L33

Suggested Citation

Howard, David H. and David, Guy, Hospital Ownership and Managerial Influence over Treatment Decisions: The Case of Admissions from the Emergency Department (November 16, 2021). Available at SSRN: https://ssrn.com/abstract=3964725 or http://dx.doi.org/10.2139/ssrn.3964725

David H. Howard (Contact Author)

Emory University - Department of Health Policy and Management ( email )

1518 Clifton Road NE
Atlanta, GA 30322
United States

Guy David

The Wharton School, University of Pennsylvania - Health Care Management ( email )

3641 Locust Walk
Colonial Penn Center
Philadelphia, PA 19104-6358
United States

HOME PAGE: http://www.wharton.upenn.edu/faculty/david.html

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