Spending Per Medicare Beneficiary Is Higher in Hospital-Owned Small- and Medium-Sized Physician Practices

Overview

Journal Health Serv Res

Specialty Health Services

Date 2017 Sep 24

PMID 28940537

Citations 8

Authors

Michael F Pesko

Andrew M Ryan

Stephen M Shortell

Kennon R Copeland

Patricia P Ramsay

Xuming Sun

Jayme L Mendelsohn

Diane R Rittenhouse

Lawrence P Casalino

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relationship of physician versus hospital ownership of small- and medium-sized practices with spending and utilization of care.

Data Source/study Setting/data Collection: Survey data for 1,045 primary care-based practices of 1-19 physicians linked to Medicare claims data for 2008 for 282,372 beneficiaries attributed to the 3,010 physicians in these practices.

Study Design: We used generalized linear models to estimate the associations between practice characteristics and outcomes (emergency department visits, index admissions, readmissions, and spending).

Principal Findings: Beneficiaries linked to hospital-owned practices had 7.3 percent more emergency department visits and 6.4 percent higher total spending compared to beneficiaries linked to physician-owned practices.

Conclusions: Physician practices are increasingly being purchased by hospitals. This may result in higher total spending on care.

Citing Articles

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Ambulatory Care Fragmentation and Total Health Care Costs.

Kern L, Ringel J, Rajan M, Casalino L, Pesko M, Pinheiro L Med Care. 2024; 62(4):277-284.

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Association of Clinician Practice Ownership With Ability of Primary Care Practices to Improve Quality Without Increasing Burnout.

Rotenstein L, Cohen D, Marino M, Bates D, Edwards S JAMA Health Forum. 2023; 4(3):e230299.

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Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex.

Casalino L, Li J, Peterson L, Rittenhouse D, Zhang M, ODonnell E Health Aff (Millwood). 2022; 41(4):549-556.

PMID: 35377764 PMC: 9934398. DOI: 10.1377/hlthaff.2021.00440.

References

Robinson J, Miller K . Total expenditures per patient in hospital-owned and physician-owned physician organizations in California. JAMA. 2014; 312(16):1663-9. DOI: 10.1001/jama.2014.14072. View

Rittenhouse D, Casalino L, Shortell S, McClellan S, Gillies R, Alexander J . Small and medium-size physician practices use few patient-centered medical home processes. Health Aff (Millwood). 2011; 30(8):1575-84. DOI: 10.1377/hlthaff.2010.1210. View

Casalino L . Accountable care organizations--the risk of failure and the risks of success. N Engl J Med. 2014; 371(18):1750-1. DOI: 10.1056/NEJMe1410660. View

Carlin C, Dowd B, Feldman R . Changes in Quality of Health Care Delivery after Vertical Integration. Health Serv Res. 2014; 50(4):1043-68. PMC: 4545346. DOI: 10.1111/1475-6773.12274. View

Weeks W, Gottlieb D, Nyweide D, Sutherland J, Bynum J, Casalino L . Higher health care quality and bigger savings found at large multispecialty medical groups. Health Aff (Millwood). 2010; 29(5):991-7. DOI: 10.1377/hlthaff.2009.0388. View

Neprash H, Chernew M, Hicks A, Gibson T, McWilliams J . Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices. JAMA Intern Med. 2015; 175(12):1932-9. DOI: 10.1001/jamainternmed.2015.4610. View

Kralewski J, Dowd B, Knutson D, Tong J, Savage M . The relationships of physician practice characteristics to quality of care and costs. Health Serv Res. 2014; 50(3):710-29. PMC: 4450926. DOI: 10.1111/1475-6773.12242. View

Casalino L, Pesko M, Ryan A, Mendelsohn J, Copeland K, Ramsay P . Small primary care physician practices have low rates of preventable hospital admissions. Health Aff (Millwood). 2014; 33(9):1680-8. DOI: 10.1377/hlthaff.2014.0434. View

Casalino L, Gillies R, Shortell S, Schmittdiel J, Bodenheimer T, Robinson J . External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003; 289(4):434-41. DOI: 10.1001/jama.289.4.434. View

10.

Casalino L . Which type of medical group provides higher-quality care?. Ann Intern Med. 2006; 145(11):860-1. DOI: 10.7326/0003-4819-145-11-200612050-00012. View

11.

Berenson R, Ginsburg P, Christianson J, Yee T . The growing power of some providers to win steep payment increases from insurers suggests policy remedies may be needed. Health Aff (Millwood). 2012; 31(5):973-81. DOI: 10.1377/hlthaff.2011.0920. View

12.

Casalino L, Chen M, Staub C, Press M, Mendelsohn J, Lynch J . Large Independent Primary Care Medical Groups. Ann Fam Med. 2016; 14(1):16-25. PMC: 4709151. DOI: 10.1370/afm.1890. View

13.

Buntin M, Zaslavsky A . Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ. 2004; 23(3):525-42. DOI: 10.1016/j.jhealeco.2003.10.005. View

14.

Casalino L . The Medicare Access And CHIP Reauthorization Act And The Corporate Transformation Of American Medicine. Health Aff (Millwood). 2017; 36(5):865-869. DOI: 10.1377/hlthaff.2016.1536. View

15.

Casalino L, Wu F, Ryan A, Copeland K, Rittenhouse D, Ramsay P . Independent practice associations and physician-hospital organizations can improve care management for smaller practices. Health Aff (Millwood). 2013; 32(8):1376-82. DOI: 10.1377/hlthaff.2013.0205. View

16.

McWilliams J, Chernew M, Zaslavsky A, Hamed P, Landon B . Delivery system integration and health care spending and quality for Medicare beneficiaries. JAMA Intern Med. 2013; 173(15):1447-56. PMC: 3800215. DOI: 10.1001/jamainternmed.2013.6886. View

17.

Friedberg M, Coltin K, Pearson S, Kleinman K, Zheng J, Singer J . Does affiliation of physician groups with one another produce higher quality primary care?. J Gen Intern Med. 2007; 22(10):1385-92. PMC: 2305845. DOI: 10.1007/s11606-007-0234-0. View

18.

Capps C, Dranove D, Ody C . The effect of hospital acquisitions of physician practices on prices and spending. J Health Econ. 2018; 59:139-152. DOI: 10.1016/j.jhealeco.2018.04.001. View

19.

D Reschovsky J, Rich E . Hospital Acquisition of Physician Groups: On the Road to Value-Based or Higher-Priced Care?. JAMA Intern Med. 2015; 175(12):1939-41. DOI: 10.1001/jamainternmed.2015.6183. View

20.

Muhlestein D, Smith N . Physician Consolidation: Rapid Movement From Small To Large Group Practices, 2013-15. Health Aff (Millwood). 2016; 35(9):1638-42. DOI: 10.1377/hlthaff.2016.0130. View