Consolidation of physician practices by hospitals, or vertical integration, increased across all practice types in 2007-17. Rates of growth were highest among medical and surgical specialty practices and lowest among primary care practices. There was substantial variation within the specialties, ranging from 4 percentage points in dermatology to 34 percentage points in cardiology and oncology.
The United States will eventually get through the acute coronavirus disease 2019 (COVID-19) crisis but not without fundamental changes to the medical care system. Since the epidemic began, payment policy has stretched to remedy the bias of the health care system for inperson treatment provided by physicians. In response to the need for social distancing, new policies include broader payment for telemedicine, expanded scope-ofpractice ability for nonphysician practitioners, and increased ability of physicians and nurses to practice across state lines. While these policy reforms address some of the immediate needs of this crisis, such as getting personnel to where they are most needed, they are not a complete solution to the COVID-19 crisis. How the aftermath of the current COVID-19 wave is handled will be just as important for the business of health care as what is happening now.Two issues about the medical system after the current wave are particularly important: What type of organizations will be available to treat patients a few months from now? And how will those patients be most effectively served?
In states that expanded Medicaid, uninsured hospital stays decreased sharply and Medicaid stays increased sharply in the first two quarters of 2014. There was no change in payer mix in states that did not expand Medicaid.
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