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

Abstract

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.

Overview of methods for characterization and visualization of a protein–protein interaction network in a multi-omics integration context

“…Horizontal integration is a solution to eliminate these false interactions and allows to find missing data, thus adjusting the resulting confidence score ( Everson et al, 2019 ; Gebreyesus et al, 2022 ). Horizontal integration methods have contributed to development of various types of databases based on organism-specific diseases, biological processes, and detection methods, such as the Integrated Interactions Database (IID) ( Kotlyar et al, 2019 ), IntAct ( Hermjakob et al, 2004a ), and StringDB ( Szklarczyk et al, 2019 ).…”

Vertical Integration and Physician Practice Labor Composition

“…Specifically, we consider a practice as vertically integrated when it reports ownership by a hospital or health system (i.e., hospital-physician integration) in a given year. The SK&A data have been the key source of integration information for recent studies in this area (e.g., Baker et al, 2016;Everson et al, 2019;Koch et al, 2017;Nikpay et al, 2018;Richards et al, 2016). These data have been found to be comprehensive and representative of greater than 90% of ambulatory practices in the United States (Rhodes et al, 2014).…”

“…1 But there is scant evidence for efficiency gains or improved care quality following these formal tie-ups (Burns et al, 2013;Carlin et al, 2015;Scott et al, 2017). Other downstream implications from vertical integration are largely unexplored, however-with the adoption and use of health information technology being one exception (Everson et al, 2019;Lammers, 2013;McCullough & Snir, 2010).…”

Hospital Characteristics Associated With Clinically Integrated Network Participation

“…4 However, organizational integration into health care systems has not necessarily generated improvements in clinical integration or patient outcomes. [5][6][7] Evidence indicates that system-owned practices may be more likely to implement care management practices, 8 use advanced health information technology, 9 and perform well on process measures, compared with independent practices. 10,11 But in many cases vertical integration is linked to higher utilization and spending 12,13 without any positive effect on health care quality and outcomes.…”