TY - JOUR
T1 - Financial integration’s impact on care delivery and payment reforms
T2 - A survey of hospitals and physician practices
AU - Fisher, Elliott S.
AU - Shortell, Stephen M.
AU - O’malley, A. James
AU - Fraze, Taressa K.
AU - Wood, Andrew
AU - Palm, Marisha
AU - Colla, Carrie H.
AU - Rosenthal, Meredith B.
AU - Rodriguez, Hector P.
AU - Lewis, Valerie A.
AU - Woloshin, Steven
AU - Shah, Nilay
AU - Meara, Ellen
N1 - Funding Information:
The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from IQVIA information services (OneKey subscription information services 2010–17, IQVIA Inc., all rights reserved). The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Inc. or any of its affiliated or subsidiary entities. The American Medical Association (AMA) was the source for the raw physician data; statistics, tables, and tabulations were prepared by the authors using data from the AMA Physician Masterfile. All of the authors were supported by the Agency for Healthcare Research and Quality (Grant No. 1U19HS024075). Valerie Lewis also received support from the National Institute on Aging (Grant No. K01AG049914). The opinions are those of the authors alone. Elliott Fisher works as a consultant to Covered California and serves on the board of directors of the Institute for Healthcare Improvement and the Fannie E. Rippel Foundation. Stephen Shortell serves on the board of the Independent Healthcare Association (IHA) in California. Carrie Colla works as a consultant for Blue Cross Blue Shield of Massachusetts.
Publisher Copyright:
© 2020 Project HOPE— The People-to-People Health Foundation, Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Health systems continue to grow in size. Financial integration—the ownership of hospitals or physician practices—often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.
AB - Health systems continue to grow in size. Financial integration—the ownership of hospitals or physician practices—often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.
UR - http://www.scopus.com/inward/record.url?scp=85089057485&partnerID=8YFLogxK
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U2 - 10.1377/hlthaff.2019.01813
DO - 10.1377/hlthaff.2019.01813
M3 - Article
C2 - 32744948
AN - SCOPUS:85089057485
SN - 0278-2715
VL - 39
SP - 1302
EP - 1311
JO - Health Affairs
JF - Health Affairs
IS - 8
ER -