Health Systems—The Present and the Future

Casalino, Lawrence P.

doi:10.1001/jama.2022.24141

Cited by 6 publications

(6 citation statements)

References 16 publications

(29 reference statements)

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“…Since the early 2000s, US healthcare has undergone seismic shifts in the organization and delivery of care due to waves of mergers, acquisitions, and consolidation. Most physicians went from working independently in private practices a generation ago to the majority of physicians now being employed by large hospital systems and corporate entities (Casalino, 2023; Moses et al, 2013). From 1975 to 2010, the total number of physicians grew by 150% while the number of healthcare administrators grew by 3200%, with the ratio of physicians to administrators increasing from 1:1 to 1:10 during this period (Cantelupe, 2018).…”

Section: The Impact Of Larger Health Systems and Private Equity In He...mentioning

confidence: 99%

“Not what we signed up for”: Nurse shortages, physician scarcity, and time for collective bargaining?

Mayes

Muir

Pingali

2023

World Med & Health Policy

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The amount of distress and disengagement among many nurses and physicians has reached concerning levels in recent years. The result has been acute nurse shortages, significant increases in travel nursing, more physicians working fewer hours and retiring early, and urgent calls for change and reform. This analysis surveys many of the leading systemic contributors to nurse and physician demoralization. As the healthcare sector continues to experience more consolidation and increased investment by private equity and other corporate interests, physicians are increasingly becoming employees with similar forms of employment arrangements and pressures that nurses have had for decades. They are also becoming employees of the same larger health systems, hospitals, and corporate employers. These trends are leading to a convergence in the kind and intensity of pressures and problems that nurses and physicians face. As more medical residents and fellows increasingly turn to unionization and as growing numbers of nurses have gone on strike, both professions should consider the potential benefits of joining forces for the purposes of maintaining the autonomy they have left and to push for better conditions both for themselves and the patients for whom they care.

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Section: The Impact Of Larger Health Systems and Private Equity In He...mentioning

confidence: 99%

“Not what we signed up for”: Nurse shortages, physician scarcity, and time for collective bargaining?

Mayes

Muir

Pingali

2023

World Med & Health Policy

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“…Vertical integration is an increasingly common feature of American health care. [1][2][3][4] Most vertical integration involves hospitals acquiring, or otherwise establishing tight co-management of physician practices 5,6 with hospital systems incorporating physicians into their organizations to guide the flow of clinical resources. 7 Note, vertical integration in this context does not necessarily reflect effective "clinical integration" of care delivery.…”

Section: Introductionmentioning

confidence: 99%

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

Chatrath,

Rich,

O'Malley

et al. 2024

Health Services Research

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ObjectiveTo test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims.Data Sources and Study SettingMedicare fee‐for‐service claims, IQVIA, and CPC+ practice surveys for this study.Study DesignWe compare measures of integration from Medicare claims to self‐reported indicators of integration from IQVIA and a survey of CPC+ participating practice sites.Data Collection/Extraction MethodsWe measure integration by using site‐of‐service billing in the 100% sample of Medicare Carrier claims from 2017–2020. In the IQVIA SK&A (2017–2018), OneKey (2019–2020), and practice survey data (2017–2019), we use self‐reported responses to measure integration.Principal FindingsWe find that currently most PCP practices sites that report themselves as being integrated with a health system do not bill as an HOPD. In 2017, 11% of CPC+ practices were identified as being vertically integrated in claims, while the equivalent numbers in SK&A and surveys were 52% and 54% integration, respectively. A t‐test found that both datasets significantly differed from claims (Survey: 41.3%–45.1%; SK&A: 45.3%–51.1%); this gap persists in 2018–2019.ConclusionMeasuring physician‐hospital vertical integration accurately is integral to determining consolidation. The overwhelming majority of PCP practice sites not billing as an HOPD may reflect Medicare regulatory changes that have reduced the financial incentives for doing so. These findings have implications for researchers that study the growth in PCP‐hospital integration in health care markets.

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“…1,2 Skilled leaders will be vital in implementing organized processes, integrated care delivery, and efficiently using information technology to improve care and control costs. 1 The Institute of Medicine's Future of Nursing 2010 Report underscored the need for leadership development among 1244922WJ NXXX10.…”

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confidence: 99%

“…Current substantial and rapid changes in the US healthcare system will have significant cost and quality implications for many years to come. 1 Key trends include patient growth, technological advancements, increasing information, patient-driven care, novel delivery models, competition-fueled innovation, and persistent reform demands. 1,2 Skilled leaders will be vital in implementing organized processes, integrated ca-re delivery, and efficiently using information technology to improve care and control costs.…”

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confidence: 99%

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Growing the Next Generation of Nurse Leaders: A Report of the Process and Outcomes of the Midwest Nursing Research Society Leadership Academy

Adeola,

Fink,

Shen

et al. 2024

West J Nurs Res

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Background: Leadership development, career advancement, and collaboration among scholars are essential to nurturing nursing research excellence and sustainability. The Midwest Nursing Research Society (MNRS) has incorporated several strategies to advance nursing science and to increase the pool of future nurse leaders. In this article, we describe the process, activities, and outcomes of the Leadership Academy (LA), an innovative initiative from MNRS developed to identify, engage, and nurture future generations of leaders. Methods: For the LA 2022 to 2023 period, the MNRS leaders selected a cohort of 5 nurse scholars and engaged them in activities to develop, enhance, and advance their leadership skills. By following the LA purposes, the cohort participated in monthly meetings with MNRS leaders, received individual mentoring sessions, assessed strengths and areas for further development, attended seminars, participated in a book club, and implemented a cohort project that focused on the promotion and support of early career scholars. Results: Outcomes showed increased knowledge about organizational governance, direction, and resource development; leadership confidence culminating with leadership positions inside and outside MNRS; career development plans; engagement with board members, and enhanced networking. Moreover, the cohort members planned and executed a well-attended conference special session that engaged a large group of scholars to discuss challenges and opportunities for career development at the MNRS Annual Conference. Conclusion: The MNRS LA is a thriving organizational initiative that promotes engagement and leadership skills development thereby increasing the pool of candidates confidently prepared to lead the nursing profession.

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Health Systems—The Present and the Future

Cited by 6 publications

References 16 publications

“Not what we signed up for”: Nurse shortages, physician scarcity, and time for collective bargaining?

“Not what we signed up for”: Nurse shortages, physician scarcity, and time for collective bargaining?

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

Growing the Next Generation of Nurse Leaders: A Report of the Process and Outcomes of the Midwest Nursing Research Society Leadership Academy

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