A letter recently sent to presidential candidates about specialty hospitals is "all fiction, no facts," according to groups representing full-service community hospitals. Those groups, the Iowa Hospital Association (IHA) and the American Hospital Association (AHA), sent their own letter to the candidates to set the record straight about the real impact of limited-service facilities, which drive up the nation's health care costs and threaten to dismantle vital community resources for patients.

The joint IHA-AHA letter responds in detail to a misleading missive that a group of physicians backed by the trade association Physician Hospitals of America, recently sent to presidential candidates.

Physician-owned, limited-service hospitals typically provide the most profitable services to patients who are less sick -- essentially "cherry picking" the easiest, best-paying cases and serving few uninsured or Medicaid patients. They have physician-owners who self-refer to the hospital, enabling physician-owners to pay themselves for referring patients to the facilities they own. In contrast, full-service community hospitals provide a full array of services, from burn care and neonatal intensive care units to emergency departments - services communities depend upon in the middle of the night and in times of disaster.
Because limited-service hospitals are able to pick and choose patients, they divert well-paying patients to their facilities leaving the community hospital to care for more complicated and costly cases. Faced with an un-level playing field, some community hospitals may have had to cut back on essential but expensive health care services communities depend on, thereby shredding the health care safety net.

Concerns have surfaced about limited-service hospitals' ability to handle emergencies and complications after surgery. Recent deaths have occurred at limited-service hospitals due to physicians not being present "after hours." Facilities were forced to call 9-1-1-and rely on the full-service community hospital-to provide the necessary treatment.

Congress has weighed in many times about the conflict of interest self-referral poses. Current plans before Congress aim to restrain-not close-these facilities, which contribute to overuse of services and the increasing cost of health care.

Dear Presidential Candidates:

You recently received a misleading letter from a group of Iowa and South Dakota physicians that distorted the impact of physician-owned, limited-service hospitals on communities. As representatives of nearly 5,000 full-service community hospitals and 117 hospitals in Iowa, we believe these limited-service facilities pose an inherent conflict of interest for physicians involved and drive up health costs for everyone.

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