Intolerable risk, irreparable harm: the legacy of physician-owned specialty hospitals.

Issues of physician ownership and referral could cause major shifts in the structure of medical care and make the financing of U.S. hospital services problematic. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 mandated research on this matter and applied an eighteen-month moratorium against self-referral to allow policymakers to consider the issue. Research findings thus far confirm that physicians' ownership and referral present conflicts of interest through medical and economic patient selection and potentially excessive utilization. The policy response must prevent these results and preserve fair competition among hospitals.