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Lawrence P. Casalino, Kelly J. Devers, and Linda R. Brewster Focused Factories? Physician-Owned Specialty Facilities Health Affairs, November/December 2003; 22(6): 56-67. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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The Downside of Specialty Facilities

Mitchell T. Rabkin, M.D.   ( 13 November 2003 )

Factories or Boutiques

John A. Grima   ( 1 December 2003 )

Re: The Downside of Specialty Facilities

Robert M Narvaez, MD, MBA   ( 29 December 2003 )

The Downside of Specialty Facilities 13 November 2003
Mitchell T. Rabkin, M.D., Professor of Medicine Harvard Medical School Send comment to journal: Re: The Downside of Specialty Facilities mrabkin{at}bidmc.harvard.edu Mitchell T. Rabkin, M.D.	The considerations put forth in "Focused Factories: Physician-Owned Specialty Facilities" (Nov/Dec 2003) overlook a critical issue. Specialty hospitals and ambulatory surgery clinics focus exclusively on the episodic treatment of narrowly defined conditions. And while these providers seek patients otherwise healthy, should they encounter other disorders, they may have neither resources nor interest to deal with those problems. Essentially a production line, they are uninterested in the whole patient. The best approach to both health and cost control requires continuity of care with the intent to promote overall health and prevent illness of the patient over the months and years ahead. This is unlikely to be found in "focused factories." The immediate savings thus envisioned engender discontinuity with the prospect of longer-term problems of both health and cost.
Factories or Boutiques 1 December 2003
John A. Grima, Director of Regional Planning McKay-Dee Hospital Send comment to journal: Re: Factories or Boutiques mkjgrima{at}ihc.com John A. Grima	One way to perhaps test the extent to which ASCs and specialty hospitals are likely to become true focused factories is to measure the extent to which they employ focused factory technology. Do they standardize procedures and inputs? To what extent? Across the whole medical staff? Do they alter the patient experience so as to improve outcomes or increase productivity? Do they use nonphysician providers in ways that increase throughput? How do they manage for quality? Proactively through design, or restrospectively through review? If they are not doing these things, then they may be alternate care locations, but they are not likely to produce the productivity and quality revolution that is needed in American health care.
Re: The Downside of Specialty Facilities 29 December 2003
Robert M Narvaez, MD, MBA, Physician, Private Practice Send comment to journal: Re: Re: The Downside of Specialty Facilities gastrodr{at}drnarvaez.com Robert M Narvaez, MD, MBA	Of course, specialty hospitals are designed to treat narrow conditions patients may have. That description is obvious by its name. What is not appreciated is that these patients are easily referred to other specialties for whatever conditions remain to be addressed. Most if not all of these patients have a primary care physician who coordinates all of their health issues and does not allow them to "fall through the cracks" as we see in some large institutions. These specialty hospitals are both economically competitive with hospitals and more service-oriented than most hospitals. As a result, most patients prefer the services of a specialty hospital over general hospitals, which typically consider "customer service" an abstract proposition for purposes of public relations. As to whether specialty hospitals will usher in a new wave of improved health care, considering that market forces are the reason these hospitals exist in the first place, I suspect that as long as they treat their customers well and remain competitive, they will continue to exist. However, if one is truly looking for a revolution in health care, we should delineate those factors that motivate patients to seek preventive care. We haven't been very successful yet!