Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices

Elliott S Fisher; Stephen M Shortell; A James O'Malley; Taressa K Fraze; Andrew Wood; Marisha Palm; Carrie H Colla; Meredith B Rosenthal; Hector P Rodriguez; Valerie A Lewis; Steven Woloshin; Nilay Shah; Ellen Meara

doi:10.1377/hlthaff.2019.01813

Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices

Health Aff (Millwood). 2020 Aug;39(8):1302-1311. doi: 10.1377/hlthaff.2019.01813.

Authors

Affiliations

¹ Elliott S. Fisher (Elliott.S.Fisher@dartmouth.edu) is a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire.
² Stephen M. Shortell is the Blue Cross of California Distinguished Professor of Health Policy and Management Emeritus and Professor of the Graduate School, codirector of the Center for Healthcare Organizational and Innovation Research, and dean emeritus at the School of Public Health, all at the University of California Berkeley, in Berkeley, California.
³ A. James O'Malley is a professor of biostatistics at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
⁴ Taressa K. Fraze is an assistant professor in the Department of Community and Family Medicine at the University of California San Francisco, in San Francisco, California.
⁵ Andrew Wood is a research associate at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
⁶ Marisha Palm is a research associate in the Department of Medicine, Tufts Medical Center, in Boston, Massachusetts.
⁷ Carrie H. Colla is a professor at the Dartmouth Institute for Health Policy and Clinical Practice in the Geisel School of Medicine at Dartmouth.
⁸ Meredith B. Rosenthal is the C. Boyden Gray Professor of Health Economics and Policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
⁹ Hector P. Rodriguez is the Henry J. Kaiser Professor of Health Policy and Management, director of the California Initiative for Health Equity and Action, and codirector of the Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California Berkeley.
¹⁰ Valerie A. Lewis is an associate professor of health policy and management at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina.
¹¹ Steven Woloshin is a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
¹² Nilay Shah is a professor at the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, in Rochester, Minnesota.
¹³ Ellen Meara is a professor of health economics and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health; an adjunct professor of health policy and clinical practice at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth; and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts.

Abstract

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.

Keywords: Financial Integration; Government programs and policies; Hospital quality; Hospitals; Integrated Delivery Systems; Medical research; Organization of care; Payment; Physician practices; Primary care; Quality of care; Systems of care; consolidation; health policy; quality improvement.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Delivery of Health Care*
Hospitals*
Humans
Ownership
Physicians*
Quality of Health Care
United States

Abstract

Publication types

MeSH terms

Grants and funding