Horizontal and Vertical Integration of Physicians: A Tale of Two Tails

Burns, Lawton R.; Goldsmith, Jeff; Sen, Aditi P.

doi:10.1108/s1474-8231(2013)0000015009

Cited by 93 publications

(113 citation statements)

References 94 publications

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“…This can occur through the exercise of managerial control under an employment contract or financial rewards such as call pay, directorships, and ancillary service agreements (Burns et al, 2013). Optimists about integration think that this reduces agency problems.…”

Section: Introductionmentioning

confidence: 98%

The effect of hospital/physician integration on hospital choice

Baker

Bundorf

Kessler

2016

Journal of Health Economics

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In this paper, we estimate how hospital ownership of physicians' practices affects their patients' hospital choices. We match data on the hospital admissions of Medicare beneficiaries, including the identity of their physician, with data on the identity of the owner of their physician's practice. We find that a hospital's ownership of a physician dramatically increases the probability that the physician's patients will choose the owning hospital. We also find that patients are more likely to choose a high-cost, low-quality hospital when their physician is owned by that hospital.

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Section: Introductionmentioning

confidence: 98%

The effect of hospital/physician integration on hospital choice

Baker

Bundorf

Kessler

2016

Journal of Health Economics

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“…These various arrangements could provide physician organizations with greater resources, which need not necessarily enhance clinical decisions, as they could support higher physician incomes rather than support patients' ongoing care. 41 Formal employment of physicians by hospitals and other entities, however, could reduce physician autonomy and affect evidence based-decisions at the point of care either positively or negatively, depending, for instance, on whether the employer's focus tilts toward quality improvement or revenue maximization.…”

Section: Network and Affiliationsmentioning

confidence: 99%

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

2015

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There is ample evidence that many clinical decisions made by physicians are inconsistent with current and generally accepted evidence. This leads to the underuse of some efficacious diagnostic, preventive or therapeutic services, and the overuse of others of marginal or no value to the patient. Evolving new payment and delivery models place greater emphasis on the provision of evidence-based services at the point of care. However, changing physician clinical behaviors is likely to be difficult and slow. Policy makers therefore need to design interventions that are most effective in promoting greater evidence-based care. To help identify modifiable factors that can influence clinical decisions at the point of care, we present a conceptual model and literature review of physician decision making. We describe the multitude of factors-drawn from different disciplines-that have been shown to influence physician point-of-care decisions. We present a conceptual framework for organizing these factors, dividing them into patient, physician, practice site, physician organization, network, market, and public policy influences. In doing so, we review some of the literature that speak to these factors. We then identify areas where additional research is especially needed, and discuss the challenges and opportunities for health services and policy researchers to gain a better understanding of these factors, particularly those that are potentially modifiable by policymakers and organizational leaders. 5 Many studies have observed large variations in clinical practice, across geographic areas and within local areas or even specific physician organizations. 6 We are undergoing rapid change in healthcare organization and delivery. Physicians are increasingly practicing in larger organizations and systems of care, in part prompted by widespread initiatives by federal, state, and private payers to improve care quality and lower costs. These reform efforts, such as patient-centered medical homes and accountable care organizations, along with significant federal funding of comparative effectiveness research, incentives for adoption of health information technology that includes decision support, and feedback on clinical quality performance raise the hope and expectation that clinical decision making will improve, with greater adherence to accepted evidence.Within this context, research and requisite data collection on key factors affecting physician decision making is necessary to design interventions and refine current ones. In this article, we present a conceptual framework for understanding factors contributing to physician clinical decision making, specifically those related to physicians' use of evidence at the point of care. With this framework, we conclude with directions for future research and the data needs necessary to conduct this research.We frame our discussion in the context of physician decision making as part of a broader inquiry into collecting data on physicians and their practice organizations. Of course, evidence...

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“…3 In a recent review of literature on scale and scope economies in physician practice organizations, Burns and colleagues noted there has been rapid growth in very large physician practices, but that most physicians continue to practice in smaller and single-specialty practices. 4 Further, Burns et al found the Bevidence of scale economies, scope economies, and quality performance advantages [for larger groups] has been strikingly thin, in some cases for decades.^Given ongoing physician payment reforms, and concerns these can motivate opportunistic integration of physicians into larger organizational entities of uncertain value to patients, 5-7 the impact of practice consolidation on the economics of physician practice remains an important policy research question.…”

Section: Introductionmentioning

confidence: 99%

“…Utilizing the recent review by Burns et al, 4 as well as supplemental searches of EBSCOhost, PubMed and MEDLINE, and Google Scholar for articles published since 1980, we review practice inputs and outputs as typically described in the literature on the economics of medical practice, as well as new considerations relevant to the evolving nature of physician work. We identify the conceptual challenges for defining these Binputs^and Boutputs^in a complex and evolving health care system.…”

Section: Introductionmentioning

confidence: 99%