As some members of Congress propose to weaken Medicare’s prohibition on physician self-referral to new physician-owned hospitals and ease restrictions on their growth, new data from Dobson | DaVanzo show that POHs publicly report on fewer Medicare quality measures and perform worse on readmission penalties than full-service community hospitals. The study also reinforces previous findings that POHs generally treat a population that is younger, less medically complex and less likely to be enrolled in Medicare or Medicaid. 
 
“This new analysis adds to more than 15 years of research suggesting that POHs select their patients by avoiding less profitable Medicaid and uninsured patients, treat fewer medically complex patients, and provide fewer emergency services,” AHA and the Federation of American Hospitals note in a one-pager on the report. “Beyond validating findings by the Government Accountability Office, Health and Human Services Office of Inspector General, and the Medicare Payment Advisory Commission that POHs do not treat the same scope, complexity, or acuity of patients as non-POHs within the same market, this analysis also shows that POHs have higher average penalties for readmissions compared to full-service community hospitals. In short, by choosing the healthiest and wealthiest patients, POHs pose program integrity, access and health equity risks for the Medicare program.” 

Related News Articles

Perspective
Public
More than 34.1 million Americans were enrolled in a Medicare Advantage plan in 2025, accounting for 54% of all Medicare beneficiaries. We have seen enrollment…
Headline
A KFF analysis released Jan. 28 found that Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, an increase…
Headline
The Centers for Medicare & Medicaid Services Jan. 26 released proposed changes to Medicare Advantage plan capitation rates and Part D payment policies for…
Headline
The AHA Jan. 26 expressed support and provided its perspective on certain provisions within the Centers for Medicare & Medicaid Services’ proposed…
Headline
The AHA Jan. 20 made recommendations to Congress on modernizing the Medicare Access and CHIP Reauthorization Act. Among the proposals, the AHA recommended…
Headline
The comment period for the Centers for Medicare & Medicaid Services' proposed rule for policies governing the Medicare Advantage and Part D programs for…