The Impact of Vertical Integration on Physician Behavior and Healthcare Delivery: Evidence from Gastroenterology Practices

Song, Luyan; Saghafian, Soroush; Newhouse, Joseph P.; Landrum, Mary Beth; Hsu, John

doi:10.2139/ssrn.3704941

Cited by 8 publications

(10 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did not assess the validity of SK&A's vertical integration indicator data field often used in academic research. An alternative to a survey-based approach to measuring vertical integration-such as SK&A's office-based physician database-is a claimsbased approach to infer providers' integration status from billing patterns (Ho et al, 2020;Song et al, 2020). Future research should compare survey and claims-based approaches for measuring hospital-physician integration and demonstrate the discrepancies and consequences of the different approaches.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Quality of SK&A’s Office-Based Physician Database for Identifying Oncologists

Valdez

Jacobson

2021

Med Care Res Rev

View full text Add to dashboard Cite

Health services research increasingly uses commercial databases that capture provider practice characteristics. Little is known about how these data sets compare along other dimensions with publicly available data. We assess the quality of one of the most commonly used commercial databases, SK&A’s office-based physician database, for capturing oncologists who bill the Medicare fee-for-service program. Using 2017 data, we find that nearly 74% of the oncologists in Medicare claims can be found in the SK&A data. Weighted by patients, service volume, or spending, match rates increase to 77%, 96%, and 92%, respectively. Matched oncologists have a high concordance (above 95%) on subspecialty as well as contact information other than street address. Oncologists who appear only in Medicare tend to have low service volumes and spending relative to those who are matched while over half of oncologists who appear only in SK&A have a pediatric subspecialty.

show abstract

Section: Discussionmentioning

confidence: 99%

Assessing the Quality of SK&A’s Office-Based Physician Database for Identifying Oncologists

Valdez

Jacobson

2021

Med Care Res Rev

View full text Add to dashboard Cite

show abstract

“…CPC+ was a practice site level intervention, necessitating data specific to individual practices sites used by PCPs. Prior studies have also applied different HOPD billing thresholds to define vertical integration, ranging from 100% of claims billed, 14 to 90% 18 to thresholds as low as >50% 29 . Since we know some of the observed PCPs in CPC+ practice sites also served other locations, we used the >50% threshold to maximize the chance of identifying a practice site as an HOPD.…”

Section: Methodsmentioning

confidence: 99%

“…Numerous studies have used this site‐of‐service differential in billing to measure physician‐integration for outpatient care, 15,26 cardiology, 27 gastroenterology, 18 post‐acute care, 28 and oncology 29,30 . It is important to note that while HOPD billing can be a strong indicator of integration, if a practice site is more than 35 miles away from the main campus of a hospital, the site cannot bill as an HOPD.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Furthermore, close monitoring of market competition can also mitigate the adverse effects of hospital closure on the rest of the delivery system. This is especially important in light of recent increases in vertical integration [11] and other similar activities that might negatively impact the healthcare sector. Importantly, however, policymakers should be aware of the complex nature of these policies, and note that enacting them may also result in unintended consequences such as hospitals being incentivized to reduce the system capacity.…”

Section: Key Insightsmentioning

confidence: 99%

Towards a more efficient healthcare system: Opportunities and challenges caused by hospital closures amid the COVID-19 pandemic

Saghafian

Song

Raja

2022

Health Care Manag Sci

Self Cite

View full text Add to dashboard Cite

A substantial number of United States (U.S.) hospitals have closed in recent years. The trend of closures has accelerated during the COVID-19 pandemic, as hospitals have experienced financial hardship from reduced patient volume and elective surgery cases, as well as the thin financial margins for treating patients with COVID-19. This trend of hospital closures is concerning for patients, healthcare providers, and policymakers. In this current opinion piece, we first describe the challenges caused by hospital closures and discuss what policymakers should know based on the existing research. We then discuss unique opportunities for researchers to inform policymakers by conducting careful studies that can shed light on different implications, trade-offs, and consequences of various strategies that can be followed.

show abstract

The Impact of Vertical Integration on Physician Behavior and Healthcare Delivery: Evidence from Gastroenterology Practices

Cited by 8 publications

References 61 publications

Assessing the Quality of SK&A’s Office-Based Physician Database for Identifying Oncologists

Assessing the Quality of SK&A’s Office-Based Physician Database for Identifying Oncologists

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

Towards a more efficient healthcare system: Opportunities and challenges caused by hospital closures amid the COVID-19 pandemic

Contact Info

Product

Resources

About