Dr. Timothy Robison earnestly speaks of taking better care of patients. A spokeswoman for the American Heart Association warns of inevitable conflicts of interest.

Robison said that while working in an old operating room at Muskogee Regional Medical Center, he “wanted new equipment and more for my patients.” That’s when he came up with the idea of Muskogee Community Hospital.

“First, the other physicians heard about it by word of mouth, then we had a meeting in 2000 or 2001,” he said. “The majority of the founders showed up and committed to it that night.”

Community hospitals are not as responsive to the physician’s viewpoint, Robison said.

“At other hospitals, they don’t care what we say,” he said. “If there’s someone not competent in their job, or the walls were dirty, the hospital doesn’t have to respond to the physician’s observation or request.”

Robison said he thinks all the MCH founding members feel that they need to have an environment which is open for the practice of medicine instead of restrictive to the practice of medicine.

“We want a better environment for our patients, we want a much better environment for our employees, and we think the resulting environment will be better for the physicians.”

Robison said physician-owned hospitals deliver better results.

“No matter what you look at statistically, physician-owned hospitals, specialty hospitals, the quality of care is better, the surgical and medical outcomes are better, there is no parameter you can measure it against where its timeliness of delivery and patient outcomes are not better,” he said. “That is the bottom line.”

Robison said opposition from the AHA is an attempt to block a free market.

Ellen Pryga, director of policy for the AHA, said the issue is not whether the hospital is specialty or an acute care, but physician ownership.

“One problem is that they tend to focus their services on the more lucrative services,” she said. “They tend to focus only on insured patients. And then they have a tendency to do more procedures per person, which is generally viewed as being suspicious in terms of whether or not all that utilization was needed.”

Pryga said most physicians have admitting privileges to their own hospital as well as the community hospital and what happens is a certain amount of sorting.

“That always seems to end up with the community hospital getting the majority of the Medicaid patients and those who are not well insured or the majority of patients who need services that are undercompensated,” she said.

Pryga said that because physicians are able to do the majority of their surgery and related services at their own institution, they refuse to serve on-call at the local community hospital. She added that, if a patient at a physician-owned hospital develops complications, they are usually sent to the community hospital.

“It tends to affect the ability to generate enough paying patients to cover non-paying patients and to not enough utilization of the more lucrative services to balance out the less lucrative services so you can maintain their availability in the community,” she said. “In Oklahoma, there have been some real issues in terms of access to trauma care due to the increase in physician-owned hospitals.”