Trends In Hospital Consolidation: The Formation Of Local Systems

Cuellar, Alison Evans; Gertler, Paul

doi:10.1377/hlthaff.22.6.77

Cited by 114 publications

(92 citation statements)

References 29 publications

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“…9,32,33). 4 We also measure LMSs' vertical integration breadth as the number of services stemming from acute care hospitals' referral sources (i.e., "upstream") and extending to their placement channels (i.e., "downstream") [28]. "Upstream" vertical integration breadth is the percentage of services provided by a LMS's facilities out of a possible 90 service variables categorized before general, acute inpatient care in the care continuum.…”

Section: Variable Measurementsmentioning

confidence: 99%

“…Studies have seldom explicitly examined LMSs as an organizational form, but of the exceptions, researchers point to the potential for LMSs to improve care coordination and service rationalization given their proximate spatial arrangements [4][5][6][7]. At the same time, these scholars have challenged LMSs' progress in realizing such potential, leading us to ask, to what degree do today's LMSs integrate and coordinate the delivery of care across their services and locations?…”

Section: Introductionmentioning

confidence: 99%

“…This distinction permits the comparison of forms observed between different LMSs even within a single multihospital chain, recognizing that health care remains primarily local in nature [4,11]. In contrast to previous research, this study also examines spatial differentiation when classifying hospital systems and accounts for LMSs' hospital-and non-hospital-based service locations, reflecting local systems' "geographic expansion race" to develop and disperse new hospital facilities and freestanding non-hospital-based sites throughout local markets [12].…”

Section: Introductionmentioning

confidence: 99%

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Clustered and distinct: a taxonomy of local multihospital systems

Shay

Mick

2016

Health Care Manag Sci

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Despite their prevalence and power in markets throughout the United States, local multihospital systems (LMSs) -also referred to as hospital-based "clusters" -remain an understudied organizational form, with studies instead primarily focusing either upon individual hospitals or viewing hospital systems collectively without distinguishing the local "sub-systems" that comprise larger regional or national hospital chains. To better understand these organizational forms, we develop a taxonomy specifically devote to LMSs, applying taxonomic analysis methods to a sample of LMSs in six U.S. states while accounting for LMSs' geographic arrangements and nonhospital-based service locations. Our analysis identifies five distinct LMS categories, with forms clearly distinguished according to their varying degrees of differentiation and integration. The study's results accentuate the importance of accounting for hospital systems' activities and arrangements in local markets -including their non-hospital-based sites -and highlight differences in systems' achievement of integration and coordination across services and locations, providing considerations in light of U.S. health system reform as well as international patterns of regional system formation.

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Section: Variable Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clustered and distinct: a taxonomy of local multihospital systems

Shay

Mick

2016

Health Care Manag Sci

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“…He defines local clusters in a manner consistent with Cuellar and Gertler (2003), namely cases in which two or more hospitals from the same system are present in a given market. Luke acknowledges that these concepts are not mutually exclusive, namely that some health systems will have local clusters of hospitals in more than one market.…”

Section: Bias In Taxonomy Because Of Multimarket Versus Single-marketmentioning

confidence: 99%

“…Luke acknowledges that these concepts are not mutually exclusive, namely that some health systems will have local clusters of hospitals in more than one market. 1 In fact, a careful examination of the 2000 data reported in Cuellar and Gertler (2003) indicates that most system hospitals (75 percent) belong to local clusters in that they are in a market where at least one other system partner is present. 2 Thus, many health systems, even if they have geographically dispersed hospital holdings, have ample opportunities to implement the sharing of services and physician/insurance arrangements among affiliated hospitals located in the same market.…”

Section: Bias In Taxonomy Because Of Multimarket Versus Single-marketmentioning

confidence: 99%

Rejoinder to Taxonomy of Health Networks and Systems: A Reassessment

Bazzoli¹,

Shortell²,

Dubbs³

2006

Health Services Research

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In his commentary on the taxonomy of health systems and networks that we originally developed in Bazzoli et al. (1999) and updated through Dubbs et al. (2004), Luke raises various concerns about the underlying concepts, measures, and approaches we used to develop our classification scheme. His primary concerns are: (1) a bias in system assignment occurs because the taxonomy categories capture multimarket configurations of systems rather than centralization per se; (2) hospital service configuration data do not provide relevant information about the locus of health system/network decision making; (3) the conceptual framework used may not be relevant for health networks; and (4) measurement error exists in certain variables. We address each of these issues in this rejoinder.Before commenting on these points, we note that our primary purpose for developing the taxonomy in the late 1990s was to examine the structure and strategy of health networks and systems as the American Hospital Association (AHA) and others defined them. The AHA had a long history of tracking these organizations, collecting information on multihospital systems starting in the mid-1970s and on health networks beginning in 1993. Over time, the objectives and structure of these organizations changed in response to changing market imperatives. Most notable was the movement in the mid1990s to develop organized delivery systems in anticipation of the Clinton administration's Health Security Act of 1994 and in response to the growing belief that capitated contracting between providers and health plans would become common. There was widespread acknowledgement among researchers and the industry that the organizations tracked by the AHA were growing more heterogeneous, and this led to concern that health services research that attempted to measure a system or network effect on hospital behavior would provide misleading information given the diversity of these organizations.

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Assessment of variation in 30‐day mortality following cancer surgeries among older adults across US hospitals

Lipitz‐Snyderman

Lavery

et al. 2020

Cancer Medicine

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Background While public reporting of surgical outcomes for noncancer conditions is common, cancer surgeries have generally been excluded. This is true despite numerous studies showing outcomes to differ between hospitals based on their characteristics. Our objective was to assess whether three prerequisites for quality assessment and reporting are present for 30‐day mortality after cancer surgery: low burden for timely reporting, hospital variation, and potential for public health gains. Study Design We used Fee‐for‐Service (FFS) Medicare claims to examine the extent of variation in 30‐day cancer surgical mortality between 3860 US hospitals. We included 340 489 surgeries for 12 cancer types for FFS Medicare beneficiaries aged ≥66 years, 2011‐2013. Hierarchical mixed‐effects logistic regression models adjusted for patient and hospital characteristics and with a random hospital effect were fit to obtain hospital‐specific risk‐standardized mortality rates (RSMRs) and 99% confidence intervals (CI). We calculated a hospital odds ratio to describe the difference in mortality risk for a hospital above vs below average quality and estimated the potential mortality reduction. Results The median number of cancer surgeries per hospital was 34. The median RSMR overall was 2.41% (99% CI 2.28%, 2.66%). In aggregate and for most cancers, variation between hospitals exceeded that due to differences in patient and hospital characteristics. For individual cancers, relative differences exceeded 20% in mortality risk between patients undergoing surgery at a hospital below vs above average quality, with the potential for an estimated 500 deaths prevented annually given hypothetical improvements. Conclusion Quality measurement and reporting of 30‐day mortality for cancer surgery is worthy of consideration.

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Trends In Hospital Consolidation: The Formation Of Local Systems

Cited by 114 publications

References 29 publications

Clustered and distinct: a taxonomy of local multihospital systems

Clustered and distinct: a taxonomy of local multihospital systems

Rejoinder to Taxonomy of Health Networks and Systems: A Reassessment

Assessment of variation in 30‐day mortality following cancer surgeries among older adults across US hospitals

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