Hospital‐physician integration and risk‐coding intensity

Post, Brady; Norton, Edward C.; Hollenbeck, Brent K.; Ryan, Andrew M.

doi:10.1002/hec.4516

Cited by 7 publications

(6 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our physician‐level analysis was not designed to test patient‐level access associated with integration; it is possible that the reduction in integrated physicians' Medicare clinical volume was fully offset by non‐integrated physicians or other clinicians absorbing the difference. However, prior work found initial evidence that the integration of a patient's PCP was associated with a per‐patient decline in office visits 30 . Since hospital‐physician integration is rapidly becoming the dominant organizational form in health care delivery, we think it is important to further explore whether this increasingly consolidated landscape exerts contractionary effects on the supply of primary care.…”

Section: Discussionmentioning

confidence: 99%

“…Following the precedent of other strong study designs in this literature, we evaluated the effect of integration using an event study with integration as the event. 28 , 29 , 30 We centered each physician's integration start dates around t = 0, where t < 0 corresponded to the pre‐integration period. Physicians integrated as early as 2011 and as late as 2016.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Hospital‐physician integration and clinical volume in traditional Medicare

Post

Hollenbeck

Norton

et al. 2023

Health Services Research

Self Cite

View full text Add to dashboard Cite

ObjectiveTo test the effect of hospital‐physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare.Data Sources and Study SettingNationwide retrospective longitudinal study using Medicare claims and other data sources from 2010 to 2016.Study DesignWe identified 70,000 PCPs, some of whom remained non‐integrated and some who became hospital‐integrated during this study period. We used an event study design to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work‐relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated.Principal FindingsPer‐physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non‐integrated, work RVUs fell by 7% (95% confidence interval [CI]: −8.6% to −5.5%); the number of patients treated fell by 4% (95% CI: −5.8% to −2.6%); and claims volume among PCPs who became hospital‐integrated fell by over 15% (95% CI: −16.8% to −13.5%). Though professional revenue declined by $29,165 (95% CI: −$32,286 to −$26,044), this loss was almost entirely offset by increased facility fee revenue of $28,556 (95% CI: 26,909 to 30,203).ConclusionsHospital‐physician integration may affect the quantity of clinical services delivered by PCPs to traditional Medicare beneficiaries. Reductions in clinical volume associated with integration may have long‐term consequences for the supply of physician services and patient access to primary care. Future research on physician time use and patient access following hospital integration would further add to the evidence base.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Hospital‐physician integration and clinical volume in traditional Medicare

Post

Hollenbeck

Norton

et al. 2023

Health Services Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…We used Medicare Data on Provider Practice and Specialty to determine a physician’s hospital integration status. Following previous research, we identified providers as hospital-integrated if their TIN legal name referred to a hospital or a health system or if 75% or more of their office and outpatient procedures were billed with hospital outpatient department place of service codes 8–10 …”

Section: Methodsmentioning

confidence: 99%

“…Following previous research, we identified providers as hospital-integrated if their TIN legal name referred to a hospital or a health system or if 75% or more of their office and outpatient procedures were billed with hospital outpatient department place of service codes. [8][9][10] To identify hospital-integrated practices, we only considered physicians who held a Doctor of Medicine or Doctor of Osteopathic Medicine title to mitigate potential measurement error resulting from including mid-level practitioners who may have less reliable billing patterns. A practice's hospital integration status was ascertained based on the share of hospital-integrated physicians within the practice.…”

Section: Hospital Integrationmentioning

confidence: 99%

Hospital-physician Integration and Value-based Payment

Thai,

Post,

Young

2023

Medical Care

Self Cite

View full text Add to dashboard Cite

Background: Hospital-physician integration is often justified as a driver of clinical quality improvement due to joint resources covering a broad spectrum of care. Value-based programs, such as the Medicare Merit-Based Incentive Payment System (MIPS), are intended to tie financial incentives to clinical quality, which may confer an advantage on such integrated practices. Objectives: We assessed the relationship between hospital-physician integration and MIPS performance by comparing hospital-integrated practices and independent practices. Research Design: This was a cross-sectional study using data from the Quality Payment Program for the performance year 2020. Subjects: Physician practices with a valid MIPS composite score in performance year 2020. Measures: Hospital integration was based on whether at least 75% of a practice’s physicians either billed most of their services using hospital outpatient department codes or billed through a hospital tax identifier. The primary outcome was the MIPS quality category score, and the secondary outcomes were the specific quality measures reported by practice groups. Results: Of the 20 most frequently reported measures, 14 were common in both groups. No difference was observed in the quality category score between hospital-integrated practices and independent practices in either unadjusted comparisons or after adjusting for practice characteristics, including practice size, geography, specialty mix, and case mix. In the secondary outcome models for specific quality measures, hospital-integrated practices achieved higher scores on most overlap measures but not all. Conclusions: The findings on quality category score suggest that hospital integration does not confer much advantage in the context of MIPS quality performance.

show abstract

“…Empirically, it has been shown that under FFS vertically integrated healthcare systems can indeed exert their market power when negotiating hospital and physician prices with commercial insurers (Baker et al., 2014; Capps et al., 2018; Curto et al., 2022; Lin et al., 2021) while also inducing a higher utilization of diagnostic tests and procedures (Whaley et al., 2021). For Medicare, vertical integration may result in patient severity up‐coding under a risk‐adjustment reimbursement model (Post et al., 2022) and thus higher payments (Post et al., 2021). These negative effects of vertical integration and how they manifest in the ACO and external provider clinical integration decisions are not captured in our model.…”

Section: Introductionmentioning

confidence: 99%

Care coordination for healthcare referrals under a shared‐savings program

Bravo

Levi

Perakis

et al. 2023

Production and Operations Management

View full text Add to dashboard Cite

Accountable care organizations (ACOs) are responsible for the quality and cost of care of specified patient populations, including the cost of referrals. Motivated by this environment, we study care coordination for healthcare referrals. We consider an ACO that refers an uncertain number of patients from its attributed population to a preferred external provider for specialized health services. ACOs are typically paid under the Medicare Shared Savings Program (MSSP). Under the MSSP, the payer sets a spending benchmark for the beneficiary population during a fixed time period and shares any gains (losses) relative to it with the ACO. During the billing period, all services delivered to the attributed population by the ACO and external providers continue to be reimbursed under fee‐for‐service. Gains (losses) are determined at the end of the period by comparing the actual spending, which includes all care expenses (regular visits, referrals, and failed treatments) incurred by the payer in the period to the predefined benchmark. In this environment, the ACO and external providers—the latter not compensated under the MSSP—lack incentives to invest enough in care coordination initiatives. We study financial incentive mechanisms between the ACO and its preferred external provider to achieve integrated care coordination in referral markets under the MSSP. We show that traditional fee‐for‐service and capitation agreements do not provide sufficient incentives for care coordination in referral markets. However, a risk‐ and cost‐sharing mechanism can induce integrated care coordination efforts while satisfying the ACO and provider's participation constraints. We characterize a family of such mechanisms and numerically study the variability of the ACO and the external provider's profit. We demonstrate that this type of agreement can be used not only to induce integrated care coordination but can also result in a Pareto improvement in profit variability. We also illustrate the impact of the different MSSP risk tracks parameters on the performance of this care coordination mechanism, including their effect on the quality of care and the payer's mean spending.

show abstract

Hospital‐physician integration and risk‐coding intensity

Cited by 7 publications

References 50 publications

Hospital‐physician integration and clinical volume in traditional Medicare

Hospital‐physician integration and clinical volume in traditional Medicare

Hospital-physician Integration and Value-based Payment

Care coordination for healthcare referrals under a shared‐savings program

Contact Info

Product

Resources

About