Hospital‐physician integration and Medicare’s site‐based outpatient payments

Post, Brady; Norton, Edward C.; Hollenbeck, Brent K.; Buchmueller, Thomas C.; Ryan, Andrew M.

doi:10.1111/1475-6773.13613

Cited by 25 publications

(37 citation statements)

References 34 publications

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“…We defined integration using a claims-based algorithm developed by Neprash and colleagues 23 and used in other peer-reviewed work [24][25][26] that makes use of the place of service information submitted on every Medicare claim (Appendix 2 of Supporting information); we supplemented this with a keyword search of the employer name (Appendix 5 of Supporting information). We defined early career physicians as those who completed their training within the last 5 years; established physicians were those who completed training six or more years ago.…”

Section: Methodsmentioning

confidence: 99%

Hospital‐cardiologist integration often occurs without a practice acquisition

Post

Nallamothu

Hollenbeck

2022

Health Services Research

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Objective To describe how much of the recent increase in hospital‐cardiologist integration has come from acquisitions of physician practices compared to individual employment decisions. While the role of physician practice acquisitions has received considerable attention in the news, integration may also be driven by individual physicians accepting employment at hospital‐based practices. Data Sources American Medical Association Physician Masterfile and Medicare data. Study Design Analysis of changes in hospital‐cardiologist integration from 2011 to 2018. We measured increases in integration and changes in the number of independent and hospital‐owned practices. Data Collection/Extraction Methods Not applicable. Principal Findings In 2011, 18% of cardiologists were integrated, rising to 25% in 2016. Of this rise, 48% occurred with no acquisitions. Physicians who had completed residencies in the past 5 years (early career physicians) had higher rates of integration that also increased over time: the percentage of early career physicians joining hospital systems rose from 25% to 32%, indicating rapid growth in the number of physicians who began their careers working in hospital‐based sites. Conclusions A large and growing portion of hospital‐cardiologist integration came from hospital employment at the individual physician level. Future policies focused on preserving competition and affordability may benefit from better understanding this form of consolidation.

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Section: Methodsmentioning

confidence: 99%

Hospital‐cardiologist integration often occurs without a practice acquisition

Post

Nallamothu

Hollenbeck

2022

Health Services Research

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“…In their paper, "Hospital-Physician Integration and Medicare's Site-Based Outpatient Payments" Post et al 1 These payment rules create an arbitrage opportunity. Hospitalbased billing increases total payments, and the additional payments can be allocated, explicitly or implicitly, between hospitals and physicians.…”

Section: Disparities In Payment Across Sites Encourage Consolidationmentioning

confidence: 99%

“…In their paper, “Hospital‐Physician Integration and Medicare's Site‐Based Outpatient Payments” Post et al 1 ask whether the gap in payment that arises when a service is billed by a hospital outpatient department versus when it is billed as a physician office‐based service encourages hospitals to buy physician practices. This gap in payment arises because, in Medicare, payment is tied to fee schedules and fee schedules are tied to the site of care.…”

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confidence: 99%

Disparities in payment across sites encourage consolidation

Chernew

2021

Health Services Research

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“…First, integration could change the coded severity of a physician's patients by changing the “back office” coding system, for example, using technology that standardizes and maximizes coding, which we have discussed. Second, vertically integrated physicians might prescribe more health care for their patients, whether as part of a quality‐improvement initiative – for example, integration has been associated with greater use of care management protocols – or simply because they enjoy higher levels of outpatient reimbursement (Bishop et al., 2016; Post et al., 2021). Coding of patient chronic conditions could increase if patients see their physician more often.…”

Section: Introductionmentioning

confidence: 99%

Hospital‐physician integration and risk‐coding intensity

et al. 2022

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and policymakers have voiced concerns that hospital-physician integration has increased prices and spending without an offsetting increase in quality (Lin et al., 2021; Young et al., 2021).Simultaneously, a growing body of research has discovered that hospitals are quite agile in responding to incentives to maximize reimbursement by strategically coding patient symptoms into diagnosis codes reported on claims to insurers (Bastani et al., 2019;Meyers et al., 2020). Such coding practices, while enabling hospitals to achieve better scores in risk-adjusted payment settings, have increased public spending on health care by billions of dollars(Geruso & Layton, 2020

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Hospital‐physician integration and Medicare’s site‐based outpatient payments

Abstract: Objective: To determine the relationship between Medicare's site-based outpatient billing policy and hospital-physician integration.

Cited by 25 publications

References 34 publications

Hospital‐cardiologist integration often occurs without a practice acquisition

Hospital‐cardiologist integration often occurs without a practice acquisition

Disparities in payment across sites encourage consolidation

Hospital‐physician integration and risk‐coding intensity

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