Physician employment and hospital readmission and mortality outcomes: an organizational perspective

PURPOSE: To assess if hospitals with high physician employment differ in risk-standardized mortality and readmission rates. DESIGN/METHODOLOGY/APPROACH: A cross-sectional evaluation of data from the 2021 Hospital Readmission Reduction program, Hospital Value-Based Purchasing Program, American Hospital Association and Area Health Resource Files was utilized. A binary variable was created to identify hospitals with ≤ 50% or >50% employed physicians. Dependent variables included 30-day mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia (PN), and chronic obstructive pulmonary disease (COPD) hospitalizations. Propensity score matching was utilized to compare hospitals. The final matched cohort compared 200 hospitals in each group ( ≤ 50% physicians and > 50% physicians). FINDINGS: After matching, hospitals with > 50% physician employment were associated with improved mortality scores for AMI (-0.36, 95% CI: -0.58, -0.14), COPD (-0.38, 95% CI: -0.63, -0.14), and PN (-0.71, 95% CI: -1.15, -0.27). No significant differences were noted for CHF mortality or readmission rates. ORIGINALITY/VALUE: There has been a growth in hospitals employing physician in the United States. This work demonstrates that hospitals with higher physician employment levels are associated with lower mortality scores. This likely reflects a broader organizational phenotype characterized by alignment, scale and clinical integration rather than physician employment as an isolated strategy. Further research should examine organizational features to better disentangle the structure and combination of organizational characteristics underlying these associations.