Health system integration with physician specialties varies across markets and system types

Machta, Rachel; Reschovsky, James D.; Jones, David J.; Kimmey, Laura; Furukawa, Michael F.; Rich, Eugene C.

doi:10.1111/1475-6773.13584

Cited by 13 publications

(25 citation statements)

References 24 publications

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“…Many of the largest systems are private nonprofit and academic, but there are large for-profit systems as well. These descriptive findings on health systems are broadly consistent with and modestly extend what is known from recent studies …”

Section: Discussionsupporting

confidence: 89%

Organization and Performance of US Health Systems

Beaulieu

Chernew

McWilliams

et al. 2023

JAMA

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ImportanceHealth systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance.ObjectiveTo (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems.Evidence ReviewHealth systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare &amp; Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area.FindingsA total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with &gt;100 beds), as were system physician practices (74% vs 12% with &gt;100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large.Conclusions and RelevanceIn 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.

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Section: Discussionsupporting

confidence: 89%

Organization and Performance of US Health Systems

Beaulieu

Chernew

McWilliams

et al. 2023

JAMA

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“…The survey utilized a stratified-cluster sampling design, built off of the IQVIA OneKey database, surveying practices with three or more primary care physicians. The IQVIA data is often used as a sampling frame for health care organization surveys, and has been used extensively in research to examine health care organizations and ownership 29–33. The survey was fielded June 2017 through August 2018.…”

Section: Methodsmentioning

confidence: 99%

“…The IQVIA data is often used as a sampling frame for health care organization surveys, and has been used extensively in research to examine health care organizations and ownership. [29][30][31][32][33] The survey was fielded June 2017 through August 2018. Of the total 4976 physician practices, 2333 responses were received, resulting in a 48.6% response rate.…”

Section: Datamentioning

confidence: 99%

Survey of Information Exchange and Advanced Use of Other Health Information Technology in Primary Care Settings

Cross

Stevens

Spivack³

et al. 2021

Medical Care

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“…Note, vertical integration in this context does not necessarily reflect effective “clinical integration” of care delivery 8 . Rates of physician practice integration with health systems appear to vary substantially by specialty 9 . One study estimated that from 2007–2017, there was a 4%–34% increase in the number of physicians practices owned by health systems depending on specialty, 10 with adult primary care physicians (PCPs) in the middle of this range.…”

Section: Introductionmentioning

confidence: 99%

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

Chatrath,

Rich,

O'Malley

et al. 2024

Health Services Research

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ObjectiveTo test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims.Data Sources and Study SettingMedicare fee‐for‐service claims, IQVIA, and CPC+ practice surveys for this study.Study DesignWe compare measures of integration from Medicare claims to self‐reported indicators of integration from IQVIA and a survey of CPC+ participating practice sites.Data Collection/Extraction MethodsWe measure integration by using site‐of‐service billing in the 100% sample of Medicare Carrier claims from 2017–2020. In the IQVIA SK&A (2017–2018), OneKey (2019–2020), and practice survey data (2017–2019), we use self‐reported responses to measure integration.Principal FindingsWe find that currently most PCP practices sites that report themselves as being integrated with a health system do not bill as an HOPD. In 2017, 11% of CPC+ practices were identified as being vertically integrated in claims, while the equivalent numbers in SK&A and surveys were 52% and 54% integration, respectively. A t‐test found that both datasets significantly differed from claims (Survey: 41.3%–45.1%; SK&A: 45.3%–51.1%); this gap persists in 2018–2019.ConclusionMeasuring physician‐hospital vertical integration accurately is integral to determining consolidation. The overwhelming majority of PCP practice sites not billing as an HOPD may reflect Medicare regulatory changes that have reduced the financial incentives for doing so. These findings have implications for researchers that study the growth in PCP‐hospital integration in health care markets.

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Health system integration with physician specialties varies across markets and system types

Cited by 13 publications

References 24 publications

Organization and Performance of US Health Systems

Organization and Performance of US Health Systems

Survey of Information Exchange and Advanced Use of Other Health Information Technology in Primary Care Settings

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

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