Access, quality, and costs of care at physician owned hospitals in the United States: observational study.
Ontology highlight
ABSTRACT: Objective
To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments.Design
Observational study.Setting
Acute care hospitals in 95 hospital referral regions in the United States, 2010.Participants
2186 US acute care hospitals (219 POHs and 1967 non-POHs).Main outcome measures
Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share.Results
The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia.Conclusion
Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care.
SUBMITTER: Blumenthal DM
PROVIDER: S-EPMC4558297 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundRecent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data.ObjectiveTo measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information.DesignRetrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics.PatientsPatients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims.Main outcomes and measuresAnnual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50-64.ResultsEstimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices.Conclusions and relevanceWe find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.
| S-EPMC7080686 | biostudies-literature
Project description:There is a growing interest in the quality and cost of care provided at Critical Access Hospitals (CAHs), a predominant source of care for many rural populations in the United States.To evaluate utilization, outcomes, and costs of inpatient surgery performed at CAHs.A retrospective cohort study of patients undergoing inpatient surgery from 2005 through 2009 at CAHs or non-CAHs was performed using data from the Nationwide Inpatient Sample and American Hospital Association.The CAH status of the admitting hospital.In-hospital mortality, prolonged length of stay, and total hospital costs.Among the 1283 CAHs and 3612 non-CAHs reporting to the American Hospital Association, 34.8% and 36.4%, respectively, had at least 1 year of data in the Nationwide Inpatient Sample. General surgical, gynecologic, and orthopedic procedures composed 95.8% of inpatient cases at CAHs vs 77.3% at non-CAHs (P?<?.001). For 8 common procedures examined (appendectomy, cholecystectomy, colorectal cancer resection, cesarean delivery, hysterectomy, knee replacement, hip replacement, and hip fracture repair), mortality was equivalent between CAHs and non-CAHs (P?>?.05 for all), with the exception that Medicare beneficiaries undergoing hip fracture repair in CAHs had a higher risk of in-hospital death (adjusted odds ratio?=?1.37; 95% CI, 1.01-1.87). However, despite shorter hospital stays (P???.001 for 4 procedures), costs at CAHs were 9.9% to 30.1% higher (P?<?.001 for all 8 procedures).In-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs. Although our findings suggest the potential for cost savings, changes in payment policy for CAHs could diminish access to essential surgical care for rural populations.
| S-EPMC3918670 | biostudies-literature
Project description:ImportanceState decisions not to expand Medicaid under the Patient Protection and Affordable Care Act could reduce emergency access to acute care hospitals.ObjectiveTo determine the relationship between state Medicaid expansion and emergency access to acute care hospitals in the United States.Design, setting, and participantsThis cross-sectional study linked hospital-level data from the Centers for Medicare & Medicaid Services from 2007 to 2017 to US Census data for all 50 US states and the District of Columbia. Geospatial analyses and difference-in-differences regression models were used to compare temporal changes in the size of the population without 30-minute access to acute care hospitals between 32 states that expanded Medicaid with the population without access in 19 that did not, before and after expansion. Analyses focused on the total population and those with low incomes; secondary analyses examined emergency access to safety-net hospitals.ExposuresState-level Medicaid expansion.Main outcomes and measuresPopulation without emergency access to an acute care hospital, defined as living outside a 30-minute drive of any hospital.ResultsStates that did not expand Medicaid experienced an increase in the population without access to hospitals overall (without expansion: 6.76% to 6.79% [0.03%]; vs with expansion: 5.65% to 5.35% [-0.30%]; difference-in-differences, 0.33%; 95% CI, 0.33%-0.34%; P < .001) and for low-income persons (without expansion: 7.43% to 7.39% [-0.04%]; vs with expansion: 6.25% to 6.15% [-0.10%]; difference-in-differences, 0.06%; 95% CI, 0.05%-0.07%; P < .001). If access changes in nonexpansion states were the same as expansion states, an estimated 421 000 more persons overall and 48 000 more low-income persons would have retained access. States that did not expand Medicaid experienced an increase in the population without access to safety-net hospitals overall (46.91% to 47.70% [0.79%] vs 33.94% to 33.07% [-0.87%]; difference-in-differences, 1.66%; 95% CI, 1.64%-1.66%; P < .001) and for low-income persons (45.28% to 46.14% [0.86%] vs 33.00% to 32.23% [-0.77%]; difference-in-differences, 1.63%; 95% CI, 1.63%-1.67%; P < .001). If access changes in nonexpansion states were the same as expansion states, an estimated 2 242 000 more persons overall and 364 000 more low-income persons would have retained access.Conclusions and relevanceStates that did not expand Medicaid under the Patient Protection and Affordable Care Act were associated with worse emergency access to acute care hospitals compared with states that expanded Medicaid.
| S-EPMC7670316 | biostudies-literature
Project description:BackgroundMedical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care.MethodsPractice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims-computable measures of screening and monitoring, avoidable utilization, risk-adjusted per-beneficiary per-year (PBPY) costs, and the practice's net revenue.ResultsSeveral characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved screening and monitoring.ConclusionsPractice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization. However, these relationships are not the only pathways connecting practice characteristics to cost and those additional pathways contain substantial "noise" adding uncertainty to the estimated direct effects. Some of the attributes thought to be important characteristics of accountable care organizations and medical homes appear to be associated with lower quality and no improvement in cost.
| S-EPMC4450926 | biostudies-literature
Project description:Critical access hospitals (CAHs) play a crucial role in the US rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for individuals living in rural areas in the United States; however, little is known about the quality of care they provide or the outcomes their patients achieve.To examine the quality of care and patient outcomes at CAHs and to understand why patterns of care might differ for CAHs vs non-CAHs.A retrospective analysis in 4738 US hospitals of Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI) (10,703 for CAHs vs 469,695 for non-CAHs), congestive heart failure (CHF) (52,927 for CAHs vs 958,790 for non-CAHs), and pneumonia (86,359 for CAHs vs 773,227 for non-CAHs) who were discharged in 2008-2009.Clinical capabilities, performance on processes of care, and 30-day mortality rates, adjusted for age, sex, race, and medical comorbidities.Compared with other hospitals (n = 3470), 1268 CAHs (26.8%) were less likely to have intensive care units (380 [30.0%] vs 2581 [74.4%], P < .001), cardiac catheterization capabilities (6 [0.5%] vs 1654 [47.7%], P < .001), and at least basic electronic health records (80 [6.5%] vs 445 [13.9%], P < .001). The CAHs had lower performance on processes of care than non-CAHs for all 3 conditions examined (concordance with Hospital Quality Alliance process measures for AMI, 91.0% [95% CI, 89.7%-92.3%] vs 97.8% [95% CI, 97.7%-97.9%]; for CHF, 80.6% [95% CI, 79.2%-82.0%] vs 93.5% [95% CI, 93.3%-93.7%]; and for pneumonia, 89.3% [95% CI, 88.6%-90.0%] vs 93.7% [95% CI, 93.6%-93.9%]; P < .001 for each). Patients admitted to CAHs had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI: 23.5% vs 16.2%; adjusted odds ratio [OR], 1.70; 95% confidence interval [CI], 1.61-1.80; P < .001; for CHF: 13.4% vs 10.9%; adjusted OR, 1.28; 95% CI, 1.23-1.32; P < .001; and for pneumonia: 14.1% vs 12.1%; adjusted OR, 1.20; 95% CI, 1.16-1.24; P < .001).Compared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.
| S-EPMC3337777 | biostudies-literature
Project description:ObjectiveTo describe social needs among low-income adults and estimate the relationship between level of unmet social needs and key indicators of health care access and quality.Data sourceNational survey data from 12 states from the 2017 Behavioral Risk Factor Surveillance System, which added a "Social Determinants of Health" Module in 2017.Study designWe examined differences in eight measures of health care access and quality (eg, check-up in last 12 months, inability to see doctor due to cost, receipt of eye examination for diabetics) for low-income adults with 0, 1, 2-3, and 4+ unmet social needs based on 7 social needs measures. We used adjusted logistic regression models to estimate the association between level of unmet need and each outcome.Principal findingsMost common unmet social needs included not having enough money for balanced meals (33 percent) or food (32 percent). After adjusting for observable characteristics, higher levels of unmet social need were associated with poorer access and quality. Compared to those with no reported unmet needs, having 4+ unmet needs was significantly associated with reduced probability of having a yearly check-up (65 percent vs 78 percent, adjusted difference = -7.1 percentage points (PP)), receiving a flu vaccine (33 percent vs 42 percent, adjusted difference = -5.4 PP), having a personal doctor (74 percent vs 80 percent, adjusted difference = -3.1 PP), and having a foot (63 percent vs 80 percent, adjusted difference = -12.8 PP) or eye examination (61 percent vs 73 percent, adjusted difference = -12.6 PP) for diabetic patients, and increased probability of being unable to see a doctor due to cost (44 percent vs 9 percent, adjusted difference = 27.9 PP) and having diabetes affect the eyes (22 percent vs 19 percent, adjusted difference = 8.0 PP) at α = 0.05.ConclusionsHigher levels of unmet social needs were associated with poorer access to and quality of care among low-income adults. Addressing social needs both inside and outside of health care settings may help mitigate these negative effects. Additional research on if and how to effectively do so is critical.
| S-EPMC7518813 | biostudies-literature
Project description:ObjectiveTo investigate whether the use of physician assistants (PAs) as providers for a substantive portion of a patient's office-based visits affects office visit resource use.Data sourceMedical Expenditure Panel Survey (MEPS) Household Component data from 1996 to 2004.Study designThis retrospective cohort study compares the number of office-based visits per year between adults for whom PAs provided >or=30 percent of visits and adults cared for by physicians only.Data collection/extraction methodsThe Agency for Healthcare Research and Quality collects MEPS data using methods designed to produce data representative of the U.S. noninstitutionalized civilian population. Negative binomial regression was used to compare the number of visits per year between persons with and without PA care, adjusted for demographic, geographic, and socioeconomic factors; insurance status; health status; and medical conditions.Principal findingsAfter case-mix adjustment, patients for whom PAs provided a substantive portion of care used about 16 percent fewer office-based visits per year than patients cared for by physicians only. This difference in the use of office-based visits was not offset by increased office visit resource use in other settings.ConclusionsResults indicate that the inclusion of PAs in the U.S. provider mix does not affect overall office visit resource use.
| S-EPMC2654167 | biostudies-literature
Project description:BACKGROUND:Millions of Americans live in the US territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized. METHODS:Among Fee-for-Service Medicare beneficiaries aged 65 years and older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states. RESULTS:Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all 3 conditions: in the most recent time period (2008-2012), the adjusted odds of 30-day mortality were 1.34 [95% confidence interval (CI), 1.21-1.48], 1.24 (95% CI, 1.12-1.37), and 1.85 (95% CI, 1.71-2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61% lower than states), $4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (P<0.001 for all). CONCLUSIONS AND RELEVANCE:Among Medicare Fee-for-Service beneficiaries, in 2008-2012 mortality rates were higher, or not significantly different, and hospital reimbursements were lower for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of health care and policies in the territories is critical to ensure health equity for all Americans.
| S-EPMC6482857 | biostudies-literature
Project description:Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States.
| S-EPMC5967237 | biostudies-literature
Project description:BackgroundNewborn care practices that best promote the health and well-being of mother-infant dyads after birth while minimizing transmission of COVID-19 were uncertain at the onset of the COVID-19 pandemic.ObjectiveExamine variation in COVID-19 newborn care practices among U.S. birth hospitals and by hospital characteristics (U.S. census region, highest level of neonatal level of care, and Baby-Friendly hospital status).Study designWe surveyed physicians via American Academy of Pediatrics email listservs and social media between 5/26/2020-6/8/2020. Physicians identified the birth hospital in which they provided newborn care and their hospital's approach to obstetrical and newborn care related to COVID-19. Chi-square tests were used to examine variation in hospital practices by U.S. census region, highest level of neonatal care, and Baby-Friendly hospital status.ResultsFour hundred thirty three physicians responded from 318 hospitals across 46 states. Variation in care of SARS-CoV-2 positive mother-infant dyads was greatest for approaches to location of newborn care (31% separation, 17% rooming-in, and 51% based on shared-decision making), early skin-to-skin care (48% prohibited/discouraged, 11% encouraged, and 40% based on shared-decision making) and direct breastfeeding (37% prohibited/discouraged, 15% encouraged, and 48% based on shared-decision making). Among presumed uninfected dyads, 59% of hospitals discharged at least some mother-infant dyads early. We found variation in practices by U.S. census region.ConclusionApproaches to newborn care and breastfeeding support for mother-infant dyads with positive SARS-CoV-2 testing differed across U.S. birth hospitals during the COVID-19 pandemic. Early discharge of presumed uninfected mother-infant dyads was common.
| S-EPMC8776982 | biostudies-literature