Monitoring technology and firm boundaries: Physician–hospital integration and technology utilization

McCullough, Jeffrey S.; Snir, Eli M.

doi:10.1016/j.jhealeco.2010.03.003

Cited by 20 publications

(12 citation statements)

References 55 publications

(49 reference statements)

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“…Formal tie‐ups between hospitals and physician practices have been shown to strategically alter physicians’ referral patterns and choices over care delivery settings as well as drive higher medical care prices, spending, and treatment intensity—without clear evidence of quality improvements . At the same time, prior studies have also shown technology adoption links to vertical integration as well as increases in Medicaid acceptance following hospital take‐overs of physician practices leaving the net benefits of integration uncertain. Our data cannot inform us if the MU program causally spurred greater vertical integration activity, but they are consistent with the program contributing to the declining appeal of independent practice and therefore adding pressure toward formal integration.…”

Section: Discussionmentioning

confidence: 99%

Horizontal and vertical integration's role in meaningful use attestation over time

Everson

Richards

Buntin

2019

Health Services Research

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Objective To compare rates of attestation and attrition from the MU program by independent, horizontally integrated, and vertically integrated physicians and to assess whether MU created pressure for independent physicians to join integrated organizations. Data Source/Study Setting Secondary Data from SK&A and Medicare MU Files, 2011‐2016. Office‐based physicians in the 50 United States and District of Columbia. Study Design We compared attestation rates among physicians that remained independent or integrated throughout the study period. We then assessed the association between changing integration and MU attestation in multivariate regression models. Principal Findings Our sample included 291 234 physicians. Forty nine percent of physicians that remained independent throughout the period attested to MU at least once during the program, compared with 70 percent of physicians that remained horizontally or vertically integrated physicians. Only approximately 50 percent of independent physicians that attested between 2011 and 2013 attested in 2015, representing significantly more attrition than we observed among integrated physicians. In multivariate regression models, physicians that joined these organizations were more likely to have attested to MU prior to integrating and this difference increased following integration. Conclusions These findings point toward a growing digital divide between physicians who remain independent and integrated physicians that may have been exacerbated by the MU program. Targeted public policy, such as new regional extension centers, should be considered to address this disparity.

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Section: Discussionmentioning

confidence: 99%

Horizontal and vertical integration's role in meaningful use attestation over time

Everson

Richards

Buntin

2019

Health Services Research

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“…Economic evaluations published in health economic journals mostly focus on single elements of integrated care [8283848586]. There is need for that to change and health economists to understand the peculiarities of integrated care as intervention under evaluation.…”

Section: Discussion and Research Agendamentioning

confidence: 99%

Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven?

Tsiachristas¹,

Stein²,

Evers³

et al. 2016

Int J Integr Care

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Health economists are increasingly interested in integrated care in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integrated care is still in its early years, facing several difficulties. The aim of this paper is to describe the unique nature of integrated care as a topic for economic evaluation, explore the obstacles to perform economic evaluation, discuss methods and techniques that can be used to address them, and set the basis to develop a research agenda for health economics in integrated care. The paper joins the voices that call health economists to pay more attention to integrated care and argues that there should be no more time wasted for doing it.

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“…In our context, the quality of an agent's performance may be very difficult to determine and agent responsibilities may be shirked in favor of local (community) needs when leadership is decentralized. Whereas research has shown that vertical integration and IT adoption can be complementary when hospitals acquire physician practices (McCullough & Snir, 2010), no research, to our knowledge, has been conducted on how consolidation of IT decision rights and strategic alignment is correlated with IDS IT adoption, standardization, or innovation. Therefore, hospital system integration is a potential solution to the incentive alignment and moral hazard issues that arise with principalY agent problems in health care management (e.g., Robinson, 1997).…”

Section: Conceptual Frameworkmentioning

confidence: 94%

Corporate Governance and the Adoption of Health Information Technology Within Integrated Delivery Systems

Baird

Furukawa

Rahman

et al. 2014

Health Care Management Review

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Monitoring technology and firm boundaries: Physician–hospital integration and technology utilization

Cited by 20 publications

References 55 publications

Horizontal and vertical integration's role in meaningful use attestation over time

Horizontal and vertical integration's role in meaningful use attestation over time

Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven?

Corporate Governance and the Adoption of Health Information Technology Within Integrated Delivery Systems

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