Physician Competition in the Era of Accountable Care Organizations.
Ontology highlight
ABSTRACT:
SUBMITTER: Richards MR
PROVIDER: S-EPMC5867079 | biostudies-other | 2018 Apr
REPOSITORIES: biostudies-other
Publications
Physician Competition in the Era of Accountable Care Organizations.
Richards Michael R MR Smith Catherine T CT Graves Amy J AJ Buntin Melinda B MB Resnick Matthew J MJ
Health services research 20170327 2
<h4>Objective</h4>To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation.<h4>Data source</h4>2015 SK&A office-based physician survey linked to all commercial and public payer ACOs.<h4>Study design</h4>We construct three separate Herfindahl-Hirschman Index (HHI) measures and plot their distributions. We then investigate how prevailing levels of concentration change when incorporating more detailed o ...[more]
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Project description:ObjectiveTo assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs.Data sourcesWe used Medicare Data on Provider Practice and Specialty (MD-PPAS), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), IRS Form 990, 100% Medicare FFS claims, and race/ethnicity estimated using the Medicare Bayesian Improved Surname Geocoding 2.0 algorithm.Study designUsing a sample of 16 007 POs providing primary care in 2015, we assessed racial/ethnic disparities on 12 measures derived from claims (2 cancer screenings; diabetic eye examinations; continuity of care; two medication adherence measures; three measures of follow-up visits after acute care; all-cause emergency department (ED) visits, all-cause readmissions, and ambulatory care-sensitive admissions). We decomposed these "total" disparities into within-PO and between-PO components using models with PO random effects. We then pair-matched 1853 of these POs that were affiliated with health systems to similar nonaffiliated POs. We examined differences in within-PO disparities by affiliation status by interacting each nonwhite race/ethnicity with an affiliation indicator.Data collection/extraction methodsMedicare Data on Provider Practice and Specialty identified POs billing Medicare; PECOS and IRS Form 990 identified health system affiliations. Beneficiaries age 18 and older were attributed to POs using a plurality visit rule.Principal findingsWe observed total disparities in 12 of 36 comparisons between white and nonwhite beneficiaries; nonwhites received worse care in 10. Within-PO disparities exceeded between-PO disparities and were substantively important (>=5 percentage points or>=0.2 standardized differences) in nine of the 12 comparisons. Among these 12, nonaffiliated POs had smaller disparities than affiliated POs in two comparisons (P < .05): 1.6 percentage points smaller black-white disparities in follow-up after ED visits and 0.6 percentage points smaller Hispanic-white disparities in breast cancer screening.ConclusionsWe find no evidence that system-affiliated POs have smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
| S-EPMC7720702 | biostudies-literature
Project description:RationaleEnhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes.ObjectivesOur research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement.MethodA scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability.ResultsThe search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records.DiscussionAgreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce.ConclusionsOur scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.
| S-EPMC10521513 | biostudies-literature
Project description:ImportanceThe benefits of public payment policy may extend to private populations through "spillover" effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare payment systems could be a versatile policy tool in future reform efforts.ObjectivesTo determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients.DesignThis was a retrospective, longitudinal study which was conducted using Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015. We compared patients seen by physicians who participated in a Medicare ACO to patients whose physicians were not part of an ACO. We used a difference-in-differences (DIDs) design to test whether physician participation in an ACO was associated with reduced spending among their commercially insured patients. We also tested for heterogeneous effects: we assessed whether spillovers were larger among patients with clinical conditions (acute myocardial infarction, pneumonia, congestive heart failure) that have previously been targeted by Medicare payment programs.SettingThis was a population-based study of commercially insured patients in Michigan.ParticipantsPatients who experienced a significant clinical episode (eg, labor and delivery, acute myocardial infarction) between 2010 and 2015.ExposureOur patient-level exposure is treatment by a Medicare ACO-affiliated physician.Main outcomes and measuresMedical spending of 0-90 days and 91-365 days after a clinical episode.ResultsPatients in the exposure group (n=54,750) and in the control group (n=137,883) were similar in demographic characteristics of age, sex, and type of clinical episodes. Adjusted mean 90-day spending in the preexposure period was $21,292 among the exposure group and $21,157 among the comparison group; these means declined to $21,250 and $20,995 in the postperiod, yielding a DIDs estimate of $119 [95% confidence interval (CI), -$170 to $408]. Adjusted means for 91-365 days spending in the preperiod were $4258 among the exposure group and $4251 among the comparison group; these means rose to $4338 and $4421 in the postperiod, yielding a DIDs estimate of -$90 (95% CI, -$312 to $132). We also separately examined patients with conditions that have been targeted by other Medicare payment programs. Among these patients, 90-day spending did not differ between exposure and comparison groups (DIDs, -$223; 95% CI, -$2037 to $1591), although 91-365 days spending decreased among the exposure group with marginal statistical significance (DIDs, -$1160; 95% CI, -$2459 to $140).Conclusions and relevancePhysicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population.
| S-EPMC6417956 | biostudies-literature
Project description:ObjectiveTo provide the first nationally based information on physician practice involvement in ACOs.Data sources/study settingPrimary data from the third National Survey of Physician Organizations (January 2012-May 2013).Study designWe conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses.Data collection/extraction methodsWe evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes.Principal findingsWe found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO.ConclusionsPhysician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices.
| S-EPMC4213047 | biostudies-literature
Project description:ObjectiveTo identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS).Data sourceThird National Survey of Physician Organizations (NSPO3, n = 1,398).Study designOrganizational and external factors from NSPO3 were analyzed.Data collection/extraction methodsLinear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores.Principal findingsA total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development.ConclusionsOur PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations.
| S-EPMC5980166 | biostudies-literature
Project description:Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending-2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.
| S-EPMC7384249 | biostudies-literature
Project description:ImportanceThe share of the population covered by accountable care organizations (ACOs) is growing, but the association between this increase and physician employment is unknown.ObjectiveTo investigate the association between the growth of ACOs and changes in physician work hours, probability of being self-employed, and probability of working in a hospital.Design, setting, and participantsA fixed-effects design was used in this cross-sectional study to compare changes in physician employment in hospital referral regions with high vs low ACO growth. A nationally representative 1% sample of all working US physicians obtained annually from 2011 through 2015 from the American Community Survey (N = 49 582) was included. Data analysis was conducted from March 28, 2017, to April 10, 2018.Main outcomes and measuresPhysician hours worked per week, probability of being self-employed, and probability of working in a hospital.ResultsOf the 49 582 physicians included in the study, 63.5% were men; the mean (SD) age of sampled physicians was 46.01 (11.59) years. In 2011, sampled physicians worked a mean (SD) of 52.2 (16.1) hours per week, 24.43% were self-employed, and 42.03% worked in a hospital. A 10-percentage point increase in ACO enrollment in a hospital referral region was associated with a statistically significant reduction of 0.82 (95% CI, -1.52 to -0.13; P = .02) work hours in men and a decrease of 2% (95% CI, -3.8% to -0.1%; P = .04) in the probability of all physicians being self-employed. The association with self-employment was strongest (-5.0%; 95% CI, -8.7% to -1.4%; P = .006) in physicians aged 50 to 69 years, who were also more likely (4.0%; 95% CI, 1.0% to 6.9%; P = .009) to work in a hospital.Conclusions and relevanceThe growth of ACOs within hospital referral regions appears to be associated with a reduction in hours of work and self-employment among physicians. These results suggest that ACOs may affect physician employment patterns.
| S-EPMC6324284 | biostudies-literature
Project description:ObjectiveTo test the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations (POs) and to examine variability in quality across health systems.Data sources2015 Medicare Data on Provider Practice and Specialty linked physicians to POs. Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and IRS Form 990 data identified health system affiliations. Fee-for-service Medicare enrollment and claims data were used to examine quality.Study designThis cross-sectional analysis of beneficiaries with high needs, defined as having more than twice the expected spending of an average beneficiary, examined six quality measures: continuity of care, follow-up visits after hospitalizations and emergency department (ED) visits, ED visits, all-cause readmissions, and ambulatory care-sensitive hospitalizations. Using a matched-pair design, we estimated beneficiary-level regression models with PO random effects to compare quality of care in system-affiliated and nonaffiliated POs. We then limited the sample to system-affiliated POs and estimated models with system random effects to examine variability in quality across systems.Principal findingsAmong 2 323 301 beneficiaries with high needs, 52.3% received care from system-affiliated POs. Rates of ED visits were statistically significantly different in system-affiliated POs (117.5 per 100) and nonaffiliated POs (106.8 per 100, P < .0001). Small differences in the other five quality measures were observed across a range of sensitivity analyses. Among systems, substantial variation was observed for rates of continuity of care (90% of systems had rates between 70.8% and 89.4%) and follow-up after ED visits (90% of systems had rates between 56.9% and 73.5%).ConclusionsSmall differences in quality of care were observed among beneficiaries with high needs receiving care from system POs and nonsystem POs. Health systems may not confer hypothesized quality advantages to patients with high needs.
| S-EPMC7720706 | biostudies-literature
Project description:ImportanceIt is critical to develop a better understanding of the strategies provider organizations use to improve the performance of frontline clinicians and whether ACO participation is associated with differential adoption of these tools.ObjectivesCharacterize the strategies that physician practices use to improve clinician performance and determine their association with ACOs and other payment reforms.Data sourcesThe National Survey of Healthcare Organizations and the National Survey of ACOs fielded 2017-2018 (response rates = 47 percent and 48 percent).Study designDescriptive analysis for practices participating and not participating in ACOs among 2190 physician practice respondents. Linear regressions to examine characteristics associated with counts of performance domains for which a practice used data for feedback, quality improvement, or physician compensation as dependent variables. Logistic and fractional regression to examine characteristics associated with use of peer comparison and shares of primary care and specialist compensation accounted for by performance bonuses, respectively.Principal findingsACO-affiliated practices feed back clinician-level information and use it for quality improvement and compensation on more performance domains than non-ACO-affiliated practices. Performance measures contribute little to physician compensation irrespective of ACO participation.ConclusionACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.
| S-EPMC6863236 | biostudies-literature
Project description:BackgroundHealthcare workers' relationship with industry is not merely an agent mediating between consumer and vendor, but they are also inventors of the interventions they exist to deliver. Driven by the background of the digital health era, scientific research and technological (Sci-tech) innovation in the medical field are becoming more and more closely integrated. However, scholars shed little light on Sci-tech relevance to evaluate the innovation performance of healthcare organizations, a distinctive feature of healthcare organizations' innovation in the digital health era.MethodsAcademic publications and patents are the manifestations of scientific research outputs and technological innovation outcomes, respectively. The study extracted data from publications and patents of 159 hospitals in China to evaluate their innovation performance. A total of 18 indicators were constructed, four of which were based on text similarity match and represented the Sci-tech relevance. We then applied factor analyses, analytical hierarchy process, and logistic regression to construct an evaluation model. We also examined the relationship between hospitals' innovation performance and their geographical locations. Finally, we implemented a mediation analysis to show the influence of digital health on hospital innovation performance.ResultsA total of 16 indicators were involved, four of which represented the Sci-tech including the number of articles matched per patent (NAMP), the number of patents matched per article (NPMA), the proportion of highly matched patents (HMP), and the proportion of highly matched articles (HMA). Indicators of HMP (r = 0.52, P = 2.40 × 10-12), NAMP (r = 0.52, P = 2.54 × 10-12), and NPMA (r = 0.51, P = 5.53 × 10-12) showed a strong positive correlation with hospital innovation performance score. The evaluation model in this study was different from other Chinese existing hospital ranking systems. The regional innovation performance index (RIP) of healthcare organizations is highly correlated with per capita disposable income (r = 0.58) and regional GDP (r = 0.60). There was a positive correlation between digital health innovation performance scores and overall hospital innovation performance scores (r = 0.20). In addition, the hospitals' digital health innovation performance affected the hospital's overall innovation score with the mediation of Sci-tech relevance indicators (NPMA and HMA). The hospitals' digital health innovation performance score showed a significant correlation with the number of healthcare workers (r = 0.44).ConclusionThis study constructed an assessment model with four invented indicators focusing on Sci-tech relevance to provide a novel tool for researchers to evaluate the innovation performance of healthcare organizations in the digital health era. The regions with high RIP were concentrated on the eastern coastal areas with a higher level of economic development. Therefore, the promotion of scientific and technological innovation policies could be carried out in advance in areas with better economic development. The innovations in the digital health field by healthcare workers enhance the Sci-tech relevance in hospitals and boost their innovation performance. The development of digital health in hospitals depends on the input of medical personnel.
| S-EPMC10359909 | biostudies-literature