The effect of hospital/physician integration on hospital choice

Baker, Laurence C.; Bundorf, M. Kate; Kessler, Daniel P.

doi:10.1016/j.jhealeco.2016.08.006

Cited by 98 publications

(71 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Physicians influence patient spending within their practice, as well as what hospitals or other facilities that patients may be referred to outside of their practice. 16 Thus, annual spending for each patient represents all services used by patients, not just the services directly provided by the attributed physician organization. Patients with > $100,000 in costs in a calendar year were excluded from the sample, in order to exclude the effect of small numbers of very sick patients on average expenditures per patient.…”

Section: Data On Healthcare Expendituresmentioning

confidence: 99%

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study

Metcalfe²,

Vu³

et al. 2019

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND: Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physicianhospital integration, or lacked patient-level data. OBJECTIVE: To measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physicianhospital contracting information. DESIGN: Retrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics. PATIENTS: Patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims. MAIN OUTCOMES AND MEASURES: Annual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50-64. RESULTS: Estimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices. CONCLUSIONS AND RELEVANCE: We find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.

show abstract

Section: Data On Healthcare Expendituresmentioning

confidence: 99%

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study

Metcalfe²,

Vu³

et al. 2019

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…Previous literature on practice ownership has addressed differences in overall cost of care, [14][15][16] rates of preventable hospital admissions, 17 hospital choice, 18 structures needed for quality improvement work, 19,20 and quality measures. 21,22 Our study extends this literature, comparing independent and hospital system practices on both personal and environmental psychological factors that can potentially support quality improvement efforts.…”

Section: Introductionmentioning

confidence: 99%

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout

et al. 2018

View full text Add to dashboard Cite

PURPOSE Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout.METHODS Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. RESULTSParticipating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospitalowned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff.CONCLUSIONS Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work.

show abstract

“…Since hospitals are expected to be responsive to patient demands, increasing the importance of distance will lessen the importance of other aspect of the demand function. The current literature on the determinants of patient choices shows that quality of care, the distance to the hospital, waiting times, and other hospital amenities are the main factors taken into account by patients when making this choice (Baker, Bundorf, & Kessler, 2016;Beckert & Kelly, 2017;Gaynor, Propper, & Seiler, 2016;Gravelle, Santos, Siciliani, & Goudie, 2012;Victoor, Delnoij, Friele, & Rademakers, 2012). Thus, the decrease in options available to patients could lessen the providers' incentives to provide high quality care and to limit waiting times.…”

Section: Policy Implications For the Organization Of Carementioning

confidence: 99%

What Underlies the Observed Hospital Volume-Outcome Relationship?

et al. 2018

View full text Add to dashboard Cite

Abstract:Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies. Keywords:Volume outcome relationship, France, Epithelial Ovarian Cancer, Instrumental variable, Organization of care, Care pathway, Learning effect, Centralization of care. for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

show abstract

The effect of hospital/physician integration on hospital choice

Cited by 98 publications

References 22 publications

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout

What Underlies the Observed Hospital Volume-Outcome Relationship?

Contact Info

Product

Resources

About