Hospital-Physician Consolidation Accelerated In The Past Decade In Cardiology, Oncology

Nikpay, Sayeh; Richards, Michael R.; Penson, David F.

doi:10.1377/hlthaff.2017.1520

Cited by 81 publications

(86 citation statements)

References 7 publications

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“…20 SK&A tracks physician and practice patterns, including hospital affiliations and ownerships and has been used by our group to evaluate trends in integration of medical and surgical practices. 1,11,21 We obtained practice information from 2007,2009,2011,2013,2015, and 2017 at the National Provider Identification (NPI) level and linked to the National Plan and Provider Enumeration System (NPPES) for further provider characteristics, as previously described. 1 To evaluate our primary outcome, vertical integration, we created a binary variable characterizing surgical practices as 1 if owned by hospital or health care system and 0 if not, based on SK&A self-report.…”

Section: Methodsmentioning

confidence: 99%

“…1,11,21 We obtained practice information from 2007,2009,2011,2013,2015, and 2017 at the National Provider Identification (NPI) level and linked to the National Plan and Provider Enumeration System (NPPES) for further provider characteristics, as previously described. 1 To evaluate our primary outcome, vertical integration, we created a binary variable characterizing surgical practices as 1 if owned by hospital or health care system and 0 if not, based on SK&A self-report. 1 We generated 3 groups of practices: those that remained independent and never vertically integrated during our observed time period (2007 to 2017), those that were integrated with a hospital in 2007 at the start of our observation period, and those that integrated over this decade of observation.…”

Section: Methodsmentioning

confidence: 99%

“…1 To evaluate our primary outcome, vertical integration, we created a binary variable characterizing surgical practices as 1 if owned by hospital or health care system and 0 if not, based on SK&A self-report. 1 We generated 3 groups of practices: those that remained independent and never vertically integrated during our observed time period (2007 to 2017), those that were integrated with a hospital in 2007 at the start of our observation period, and those that integrated over this decade of observation. We used practice self-reported Medicaid acceptance from SK&A as a binary variable to assess access to care for lowincome individuals over time.…”

Section: Methodsmentioning

confidence: 99%

“…An increasing number of surgical practices in the US are vertically integratingdassociating financially and administratively with hospitals or large physician groups rather than smaller, independent practice arrangements. [1][2][3][4][5] Multiple factors contribute to observed consolidation, including increasing administrative complexity of health care delivery and mounting financial pressures regarding changing reimbursement. [2][3][4]6 This increase in consolidation affects both patient access to care and health care costs.…”

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confidence: 99%

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

Haddad

Resnick

Nikpay

2020

Journal of the American College of Surgeons

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Haddad

Resnick

Nikpay

2020

Journal of the American College of Surgeons

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“…Twenty percent of physician practices were hospital owned in 2002 (Kocher & Sahni, 2011); more than half of physician practices were owned by a hospital or a system in 2016 (Kane, 2017). The growth of integration is observed across the board, but it has been salient in certain specialties, such as oncology and cardiology (Nikpay, Richards, & Penson, 2018). About 30% of oncology practices were owned by a hospital or a system in 2003, but the corresponding proportion in 2015 was 60% (Alpert, Hsi, & Jacobson, 2017).…”

Section: Introductionmentioning

confidence: 99%

The impact of integration on outpatient chemotherapy use and spending in Medicare

2019

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Hospital–physician integration has substantially grown in the United States for the past decade, particularly in certain medical specialties, such as oncology. Yet evidence is scarce on the relation between integration and outpatient specialty care use and spending. We analyzed the impact of oncologist integration on outpatient provider‐administered chemotherapy use and spending in Medicare, where prices do not depend on providers' integration status or negotiating power. We addressed oncologists' selective integration and patients' nonrandom choice of oncologists using an instrumental variables method. We found that integrated oncologists reduced the quantity of outpatient chemotherapy drugs but used more expensive treatments. This led to an increase in chemotherapy‐drug spending after integration. These findings suggest that changes in treatment patterns—treatment mix and quantity—may be an important mechanism by which integration increases spending. We also found that integration increased spending on chemotherapy administration (the act of injection). This is because integration shifted billing of chemotherapy to hospital outpatient departments, where Medicare payments for chemotherapy administration are higher than those in physician offices. As integration increases, efforts should continue to assess how integration influences patient care and explore policy options to ensure desirable outcomes from integration.

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Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System

Johnston

Wiemken

Hockenberry

et al. 2020

JAMA

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practices into health systems composed of hospitals and multispecialty practices is increasing in the era of value-based payment. It is unknown how clinicians who affiliate with such health systems perform under the new mandatory Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) relative to their peers. OBJECTIVE To assess the relationship between the health system affiliations of clinicians and their performance scores and value-based reimbursement under the 2019 MIPS. DESIGN, SETTING, AND PARTICIPANTS Publicly reported data on 636 552 clinicians working at outpatient clinics across the US were used to assess the association of the affiliation status of clinicians within the 609 health systems with their 2019 final MIPS performance score and value-based reimbursement (both based on clinician performance in 2017), adjusting for clinician, patient, and practice area characteristics. EXPOSURES Health system affiliation vs no affiliation. MAIN OUTCOMES AND MEASURESThe primary outcome was final MIPS performance score (range, 0-100; higher scores intended to represent better performance). The secondary outcome was MIPS payment adjustment, including negative (penalty) payment adjustment, positive payment adjustment, and bonus payment adjustment. RESULTSThe final sample included 636 552 clinicians (41% female, 83% physicians, 50% in primary care, 17% in rural areas), including 48.6% who were affiliated with a health system. Compared with unaffiliated clinicians, system-affiliated clinicians were significantly more likely to be female (46% vs 37%), primary care physicians (36% vs 30%), and classified as safety net clinicians (12% vs 10%) and significantly less likely to be specialists (44% vs 55%) (P < .001 for each). The mean final MIPS performance score for system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated clinicians (absolute mean difference, 18.7 [95% CI, 18.5 to 18.8]). The percentage receiving a negative (penalty) payment adjustment was 2.8% for system-affiliated clinicians vs 13.7% for unaffiliated clinicians (absolute difference, −10.9% [95% CI, −11.0% to −10.7%]), 97.1% vs 82.6%, respectively, for those receiving a positive payment adjustment (absolute difference, 14.5% [95% CI, 14.3% to 14.6%]), and 73.9% vs 55.1% for those receiving a bonus payment adjustment (absolute difference, 18.9% [95% CI, 18.6% to 19.1%]). CONCLUSIONS AND RELEVANCEClinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.

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Hospital-Physician Consolidation Accelerated In The Past Decade In Cardiology, Oncology

Cited by 81 publications

References 7 publications

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

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

The impact of integration on outpatient chemotherapy use and spending in Medicare

Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System

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