Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15

Muhlestein, David; Smith, Nathan J.

doi:10.1377/hlthaff.2016.0130

Cited by 105 publications

(79 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared with vertically integrated organizations, horizontally integrated organizations appeared to more selectively target physicians that had attested to MU. The data therefore do not indicate that horizontal integration provided the potential benefit of EHR adoption and MU attestation, and as others have remarked, horizontal integration can threaten the competitive landscape by consolidating physician market power . Given the selective integration patterns we observed, future efforts and subsidies aiming to accelerate health IT adoption and advancement may need to be better targeted.…”

Section: Discussioncontrasting

confidence: 55%

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

Everson

Richards

Buntin

2019

Health Services Research

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 55%

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

Everson

Richards

Buntin

2019

Health Services Research

View full text Add to dashboard Cite

show abstract

“…In 2015, more than two-thirds of primary care physicians were in groups of 11 clinicians or more. 11 Given that our participating practices represented independent and hospital system practices, as well as federally qualified health centers (FQHCs), we hypothesized that practices would differ by their ownership structure in the degree of clinician and nonclinician burnout, work environment, and psychological safety at baseline.…”

Section: Introductionmentioning

confidence: 99%

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout

et al. 2018

View full text Add to dashboard Cite

PURPOSE Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout.METHODS Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. RESULTSParticipating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospitalowned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff.CONCLUSIONS Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work.

show abstract

“…Medicare, Medicaid, and commercial payers are rapidly adopting ACO contracts. (4, 5) Inpatient spending is an essential focus for cost growth reduction throughout Medicare, and for Medicare ACOs in particular (the Pioneer ACO program, the Medicare Shared Savings Program, and Next Generation ACO Model). This is because inpatient hospital spending accounted for 32% of fee-for-service Medicare spending in 2013.…”

mentioning

confidence: 99%

“…Analysis of savings from the first two performance years of the Pioneer model (2012 and 2013) found that inclusion of a hospital had no effect on whether the ACO had savings or losses(19), but ACOs with hospitals performed better on ACO quality measures than ACOs that did not. (20) While theories about the importance of a hospital to the ACO model have been considered (21), this analysis is the first to assess the actual participation of hospitals in ACOs using a mixed-methods approach. In this paper, we analyze the types of hospitals participating in ACOs to determine whether they differ from those not participating, and analyze advantages and disadvantages to hospital inclusion from an ACO perspective.…”

mentioning

confidence: 99%

Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data

et al. 2016

Self Cite

View full text Add to dashboard Cite

Relationships between physicians and hospitals have changed considerably over the past decade as hospitals and physician groups integrate and new public and private payment policies create financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important because managing hospital care is a key part of improving quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2015, and hospitals that were in urban areas, non-profit, or had a smaller share of Medicare patients were more likely to participate in ACOs compared to other ACOs. Qualitative data identified several advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although ACOs that include hospitals (63 percent of ACOs) offered more comprehensive services compared to ACOs without hospitals, we found no differences among ACOs in their ability to manage hospital-related aspects of patient care.

show abstract

Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013–15

Abstract: In the past few decades there has been a trend of physicians moving from smaller to larger group practices. We found that this trend continued in the period 2013-15. Primary care physicians have made this change at a much faster pace than specialists have.

Cited by 105 publications

References 13 publications

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

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

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout

Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data

Contact Info

Product

Resources

About