Hospital-Physician Affiliations and Patient Treatments, Expenditures, and Outcomes (original) (raw)
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Health Services Research, 2017
Objective. To examine the relationship of physician versus hospital ownership of small-and medium-sized practices with spending and utilization of care. Data Source/Study Setting/Data Collection. Survey data for 1,045 primary carebased practices of 1-19 physicians linked to Medicare claims data for 2008 for 282,372 beneficiaries attributed to the 3,010 physicians in these practices. Study Design. We used generalized linear models to estimate the associations between practice characteristics and outcomes (emergency department visits, index admissions, readmissions, and spending). Principal Findings. Beneficiaries linked to hospital-owned practices had 7.3 percent more emergency department visits and 6.4 percent higher total spending compared to beneficiaries linked to physician-owned practices. Conclusions. Physician practices are increasingly being purchased by hospitals. This may result in higher total spending on care. Key Words. Ambulatory/outpatient care, health care organizations and systems, ownership/governance Health care reform appears to be accelerating two decades-old trends: physician practices are increasingly owned by hospitals, and physicians in small practices are moving into medium-sized and large practices (Burns, Goldsmith, and Sen 2013; Casalino 2014). Between 2013 and 2015, the percentage of physicians in practices with 1-24 physicians (i.e., small-and medium-sized practices) decreased from approximately 48 percent to approximately 42 percent; the percentages were similar for primary care physicians (Muhlestein and Smith 2016). Estimates of the percentage of physicians employed by hospitals vary (Burns, Goldsmith, and Sen 2013; Kane 2015); a recent study
Physician-Owned Specialty Hospitals: A Market Signal For Medicare Payment Revisions
Health Affairs, 2005
Jean Mitchell's findings show that physician-entrepreneurs respond to financial incentives and take advantage of variations in profitability within Medicare's hospital payment system. The growth of physician-owned specialty hospitals can be seen as the reflection of parallel growth in profit opportunities. As Medicare plans to do, payments should be revised to squeeze out excess profits. Prohibiting physicians' use of hospitals they own might be unnecessary and could make it harder to identify future distortions in Medicare prices. If squeezing out excess profits threatens general hospitals' social missions, then new and explicit ways of identifying and funding social missions must be found.
Health Services Research, 2007
Objective. To develop a method for assigning Medicare enrollees and the physicians who serve them to individual hospitals with adequate validity to allow population-based assessments of provider specific costs and quality of care. Data Sources/Study Setting. The study populations consist of a 20 percent sample of Medicare fee-for-service enrollees and all physicians submitting claims for Medicare services from 1998 to 2000. Data were obtained from Medicare claims and enrollment files, Medicare's MPIER file, and from the American Hospital Association Annual Survey. Study Design. Cross-sectional analysis of the characteristics of hospitals, their extended medical staffs (EMSs) and the utilization patterns of their assigned Medicare enrollees. Data Collection Methods. Medicare enrollees were assigned to their predominant ambulatory physician and then to the hospital where that physician provided inpatient services or where a plurality of that physician's patient panel had medical admissions. Each beneficiary was linked to a physician and a hospital regardless of whether the patient was hospitalized creating Ambulatory Provider Specific Cohorts (APSCs). Principal Findings. Ninety-six percent of eligible Medicare enrollees who had an index physician visit in 1998 were assigned to a specific provider. Two-thirds of the medical admissions during a 2-year period occurred at the assigned hospital and twothirds of evaluation and management services were billed by the assigned hospital's EMS. The empirically derived EMS for hospitals had reasonable face and discriminant validity in terms of number and type of physicians practicing at different sized and type hospitals. Estimates of risk-adjusted costs across physician groups in year one are highly predictive of costs in a subsequent year (r 5 0.87, po.0001 and weighted k 5 0.65, po.0001). Conclusions. Medicare claims data can be used to assign virtually all Medicare enrollees to empirically defined care systems comprised of hospitals and the physicians who practice at these hospitals. Studies of patterns of practice, costs and outcomes of r Health Research and Educational Trust care experienced by these APSCs could complement other methods of monitoring provider performance.
Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care
Health services research, 2016
To assess the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. Inpatient discharges from 3,957 community hospitals in 44 states and American Hospital Association Annual Survey data from 2010 to 2012. We conducted a retrospective longitudinal regression analysis using hierarchical modeling of discharges clustered within hospitals. Detailed discharge data including costs, length of stay, and patient characteristics from the Healthcare Cost and Utilization Project State Inpatient Databases were merged with hospital survey data from the American Hospital Association. Hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge and better quality of care compared with other independent hos...
Milbank Quarterly, 2008
Context: Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). Methods: This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. Findings: The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Conclusions: Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.
Journal of the American College of Cardiology, 2007
We sought to determine whether for-profit status influenced hospitals' care or outcomes among non-STsegment elevation myocardial infarction (NSTEMI) patients. Background While for-profit hospitals potentially have financial incentives to selectively care for younger, healthier patients, perform highly reimbursed procedures, reduce costs by limiting access to expensive medications, and encourage shorter in-patient length of stay, there are limited data available to investigate these issues objectively. Methods Using data from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines) Initiative, we investigated whether for-profit status influenced hospitals' patient case mix, care, or outcomes among 145,357 patients with NSTEMI treated between January 1, 2001, and December 31, 2005, at 532 U.S. hospitals. Impact of for-profit status on care and outcomes was analyzed overall and after adjustment for clinical and facility factors using regression modeling. Results Patients (n ϭ 11,658) treated at 58 for-profit hospitals were of similar age and gender, but were more likely to be nonwhite (black, Asian, Hispanic, and other) and have health maintenance organization/private insurance, diabetes mellitus, congestive heart failure, hypertension, and renal insufficiency compared with 133,699 patients treated at 474 nonprofit hospitals. For-profit hospitals were less likely to use discharge beta-blockers, but all other treatments were similar including the use of interventional procedures (cardiac catheterization and revascularization procedures) compared with nonprofit centers. In-hospital length of stay and mortality were also similar by hospital type. Conclusions We found no evidence that for-profit hospitals selectively treat less sick patients, provide less evidence-based care, limit in-hospital stays, or have patients with worse acute outcomes than nonprofit centers.
Does the Ownership of the Admitting Hospital Make a Difference?
Medical Care, 2003
OBJECTIVE. To determine differences in mortality after admission for acute myocardial infarction (AMI) and in the use of low-and high-tech services for AMI among for-profit, public, and private nonprofit hospitals. STUDY DESIGN, SETTING, AND PATIENTS. Cooperative Cardiovascular Project data for 129,092 Medicare patients admitted for AMI from 1994 to 1995.
Health Services Research and Managerial Epidemiology, 2019
Objective: This study explores the price implications of hospital systems by analyzing the association of system characteristics with selected cardiac surgery pricing. Data Source: Using a large private insurance claim database, the authors identified 11 282 coronary artery bypass graft (CABG) cases and 49 866 percutaneous coronary intervention (PCI) cases from 2002 to 2007. Study Design: We conducted a retrospective observational study using generalized linear models. Principal Findings: We found that the CABG and PCI prices in centralized health and physician insurance systems were significantly lower than the prices in stand-alone hospitals by 4.4% and 6.4%, respectively. In addition, the CABG and PCI prices in independent health systems were significantly lower than in stand-alone hospitals, by 15.4% and 14.5%, respectively. Conclusion: The current antitrust guidelines tend to focus on the market share of merging parties and pay less attention to the characteristics of merging p...