Does Vertical Integration Improve Access to Surgical Care for Medicaid Beneficiaries?

Abstract

BACKGROUND: Vertical integration is increasingly common among surgical specialties in the US; however, the effect of vertical integration on access to care for low-income populations remains poorly understood. We explored the characteristics of surgical practices associated with vertical integration and the effect of integration on surgical access for Medicaid populations. STUDY DESIGN: Using a survey of US office-based physician practices, we examined characteristics of 15 surgical subspecialties from 2007 to 2017, including provider sex and specialty, practice payer mix, surgical volume, and county socioeconomic status. Using multivariable logistic regression and time-series analysis, we evaluated practice and provider characteristics associated with vertical integrationdour primary outcomedand practice Medicaid acceptance ratesd our secondary outcome. RESULTS: Our analysis included 84,795 unique surgical practices (303,903 practice-years). The rate of vertical integration during the 10-year period was 18.0%, with 72.1% of surgical practices never integrating. Practices that integrated were more likely to accept Medicaid patients than practices that did not (81.0% vs 60.8%, p < 0.001). Accepting Medicaid increased the likelihood of vertical integration relative to practices that did not (odds ratio [OR] 4.20, 95% CI 3.93 to 4.49). Practices that integrated were more likely to accept Medicaid in the future (OR 2.61, 95% CI 2.40 to 2.83), even after adjusting for previous Medicaid acceptance and hospital and time fixed effects. CONCLUSIONS: Surgical practices caring for the underinsured are more likely to join larger health care systems, driven by market characteristics. Vertical integration is associated with future increased rates of Medicaid acceptance among practices, allowing for increased access to surgical care for vulnerable, low-income patients. The potential benefit of increased surgical access for low-income beneficiaries from vertical integration must be balanced with the potential for increased prices.

Vertical Integration in Healthcare and Patient Satisfaction: An Exploratory Analysis of Portuguese Reforms

“…These experiences have yielded positive outcomes that align with the results anticipated for the Portuguese reform. One illustrative study is the research conducted by Haddad et al [41], which determined that there is a correlation between the association of primary surgical and procedural practices with hospitals and an enhanced accessibility to surgical care for Medicaid patients, in comparison to traditional models. Similarly, a study conducted by Gillies et al [42] found that the integration of hospitals and physicians' practices yields superior outcomes in terms of the processes of care quality measures such as breast cancer screening, adolescent immunisation screening, and the management of high blood pressure when compared to non-integrated models.…”

The Portuguese NHS 2024 reform: transformation through vertical integration

“…Despite that, even in these circumstances vertical integration has shown some benefits. In a systematic review of vertical integration and quality of care in the US, 6 out of 10 studies found that vertical integration was associated with higher quality of care ( 22 ) and vertical integration was associated with increased access to surgical care for vulnerable, low-income patients ( 23 ).…”

Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties

“…Furthermore, research on vertical integration extends beyond its impact on staff satisfaction. A study examining access to surgical care for Medicaid beneficiaries found that vertical integration is associated with increased Medicaid acceptance rates among practices, allowing greater access to surgical care for vulnerable, low-income patients [ 49 ]. Similarly, other studies suggest that vertical integration has the potential to reduce hospital readmissions [ 50 51 ].…”