Specialty cardiac hospitals: how special are they?

Specialty hospitals, owned and operated by physicians with an expertise in a particular medical condition, offer the opportunity to design a utopian care environment for optimal delivery of care. In fact, the concept of specialty heart hospitals dates back to the mid-19th century in England, with the opening in 1857 of London’s National Hospital for Diseases of the Heart and Paralysis. The institution of specialty hospitals in the United States underwent acceleration by the mid-1990’s.1 Many confluent factors explain the development of specialty cardiac hospitals in the United States, including significant advances in cardiovascular technology, dramatic increases in the cost (and profitability) of cardiovascular care, and, most important, the perceived financial constraints on both hospitals and practicing physicians from health plans and payers, which results in a perception of reduced practice autonomy by physicians and hospitals.2,3 Presently, 100 specialty hospitals exist in the United States, with many focusing on cardiac care. Although specialty hospitals have the potential to improve care by focusing considerable clinical expertise and resources for the care of a limited spectrum of disease, empirical evidence that demonstrates improved outcomes is minimal or potentially biased because of challenges of adequate risk adjustment for the somewhat debated presence of lower-risk patients treated by specialty hospitals compared with their general hospital counterparts.4–6