Hospital-physician integration and risk-coding intensity
dc.contributor.author | Post, Brady | |
dc.contributor.author | Norton, Edward C. | |
dc.contributor.author | Hollenbeck, Brent K. | |
dc.contributor.author | Ryan, Andrew M. | |
dc.date.accessioned | 2022-07-05T21:01:30Z | |
dc.date.available | 2023-08-05 17:01:29 | en |
dc.date.available | 2022-07-05T21:01:30Z | |
dc.date.issued | 2022-07 | |
dc.identifier.citation | Post, Brady; Norton, Edward C.; Hollenbeck, Brent K.; Ryan, Andrew M. (2022). "Hospital-physician integration and risk-coding intensity." Health Economics 31(7): 1423-1437. | |
dc.identifier.issn | 1057-9230 | |
dc.identifier.issn | 1099-1050 | |
dc.identifier.uri | https://hdl.handle.net/2027.42/172975 | |
dc.description.abstract | Hospital-physician integration has surged in recent years. Integration may allow hospitals to share resources and management practices with their integrated physicians that increase the reported diagnostic severity of their patients. Greater diagnostic severity will increase practices’ payment under risk-based arrangements. We offer the first analysis of whether hospital-physician integration affects providers’ coding of patient severity. Using a two-way fixed effects model, an event study, and a stacked difference-in-differences analysis of 5 million patient-year observations from 2010 to 2015, we find that the integration of a patient’s primary care doctor is associated with a robust 2%–4% increase in coded severity, the risk-score equivalent of aging a physician’s patients by 4–8 months. This effect was not driven by physicians treating different patients nor by physicians seeing patients more often. Our evidence is consistent with the hypothesis that hospitals share organizational resources with acquired physician practices to increase the measured clinical severity of patients. Increases in the intensity of coding will improve vertically-integrated practices’ performance in alternative payment models and pay-for-performance programs while raising overall health care spending. | |
dc.publisher | Wiley Periodicals, Inc. | |
dc.publisher | Yale University Press | |
dc.subject.other | hospitals | |
dc.subject.other | vertical integration | |
dc.subject.other | professional labor markets | |
dc.subject.other | physicians | |
dc.subject.other | healthcare spending | |
dc.subject.other | medicare | |
dc.title | Hospital-physician integration and risk-coding intensity | |
dc.type | Article | |
dc.rights.robots | IndexNoFollow | |
dc.subject.hlbsecondlevel | Medicine (General) | |
dc.subject.hlbsecondlevel | Statistics and Numeric Data | |
dc.subject.hlbsecondlevel | Public Health | |
dc.subject.hlbsecondlevel | Economics | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.subject.hlbtoplevel | Science | |
dc.subject.hlbtoplevel | Social Sciences | |
dc.subject.hlbtoplevel | Business and Economics | |
dc.description.peerreviewed | Peer Reviewed | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/172975/1/hec4516_am.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/172975/2/hec4516.pdf | |
dc.identifier.doi | 10.1002/hec.4516 | |
dc.identifier.source | Health Economics | |
dc.identifier.citedreference | Neprash, H. T., Chernew, M. E., & McWilliams, J. M. ( 2017 ). Little evidence exists to support the expectation that providers would consolidate to enter new payment models. Health Affairs, 36 ( 2 ), 346 – 354. https://doi.org/10.1377/hlthaff.2016.0840 | |
dc.identifier.citedreference | Goodman-Bacon, A. ( 2021 ). Difference-in-differences with variation in treatment timing. Journal of Econometrics, 225, 254 – 277. https://doi.org/10.1016/j.jeconom.2021.03.014 | |
dc.identifier.citedreference | Jung, J., Feldman, R., & Kalidindi, Y. ( 2019 ). The impact of integration on outpatient chemotherapy use and spending in Medicare. Health Economics, 28 ( 4 ), 517 – 528. https://doi.org/10.1002/hec.3860 | |
dc.identifier.citedreference | Koch, T. G., Wendling, B. W., & Wilson, N. E. ( 2017 ). How vertical integration affects the quantity and cost of care for medicare beneficiaries. Journal of Health Economics, 52, 19 – 32. https://doi.org/10.1016/j.jhealeco.2016.12.007 | |
dc.identifier.citedreference | Levinson, D. R., Grant, D., Durley, J., Bessette, R., & Verges, M. ( 2014 ). Improper payments for evaluation and management services cost Medicare billions in 2010. https://oig.hhs.gov/oei/reports/oei-04-10-00181.asp | |
dc.identifier.citedreference | Li, J., Sukul, D., Nuliyalu, U., & Ryan, A. M. ( 2020 ). Patient coded severity and payment penalties under the hospital readmissions reduction program. Medical Care, 58 ( 11 ), 1022 – 1029. https://doi.org/10.1097/MLR.0000000000001396 | |
dc.identifier.citedreference | Lin, H., McCarthy, I. M., & Richards, M. ( 2021 ). Hospital pricing following integration with physician practices. Journal of Health Economics, 77, 102444. https://doi.org/10.1016/j.jhealeco.2021.102444 | |
dc.identifier.citedreference | Marchetti, K. A., Oerline, M., Hollenbeck, B. K., Kaufman, S. R., Skolarus, T. A., Shahinian, V. B., Caram, M. E. V., & Modi, P. K. ( 2021 ). Urology workforce changes and implications for prostate cancer care among Medicare enrollees. Urology, 155, 77 – 82. https://doi.org/10.1016/j.urology.2020.12.051 | |
dc.identifier.citedreference | Markovitz, A. A., Hollingsworth, J. M., Ayanian, J. Z., Norton, E. C., Moloci, N. M., Yan, P. L., & Ryan, A. M. ( 2019 ). Risk adjustment in Medicare ACO program deters coding increases but may lead ACOs to drop high-risk beneficiaries. Health Affairs, 38 ( 2 ), 253 – 261. https://doi.org/10.1377/hlthaff.2018.05407 | |
dc.identifier.citedreference | Massachusetts Health Policy Commission. ( 2019 ). Health policy commission board meeting. https://www.mass.gov/files/documents/2019/09/11/20190911_Presentation_vFinal to post_0.pdf | |
dc.identifier.citedreference | Medtronic ( 2018 ). 2018 selected cardiothoracic procedures coding resource. | |
dc.identifier.citedreference | Meyers, D. J., Mor, V., & Rahman, M. ( 2020 ). Provider integrated medicare advantage plans are associated with differences in patterns of inpatient care. Health Affairs, 39 ( 5 ), 843 – 851. https://doi.org/10.1377/hlthaff.2019.00678 | |
dc.identifier.citedreference | Muhlestein, D. B., & Smith, N. J. ( 2016 ). Physician consolidation: Rapid movement from small to large group practices, 2013–15. Health Affairs, 35 ( 9 ), 1638 – 1642. https://doi.org/10.1377/hlthaff.2016.0130 | |
dc.identifier.citedreference | Mummolo, J., & Peterson, E. ( 2018 ). Improving the interpretation of fixed effects regression results. Political Science Research and Methods, 6 ( 4 ), 829 – 835. https://doi.org/10.1017/psrm.2017.44 | |
dc.identifier.citedreference | Neprash, H. T., Chernew, M. E., Hicks, A. L., Gibson, T., & McWilliams, J. M. ( 2015 ). Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Internal Medicine, 175 ( 12 ), 1 – 8. https://doi.org/10.1001/jamainternmed.2015.4610 | |
dc.identifier.citedreference | Nikpay, S. S., Richards, M. R., & Penson, D. ( 2018 ). Hospital-physician consolidation accelerated in the past decade in cardiology, oncology. Health Affairs, 37 ( 7 ), 1123 – 1127. https://doi.org/10.1377/hlthaff.2017.1520 | |
dc.identifier.citedreference | Ody, C., Msall, L., Dafny, L. S., Grabowski, D. C., & Cutler, D. M. ( 2019 ). Decreases in readmissions credited to Medicare’s program to reduce hospital readmissions have been overstated. Health Affairs, 38 ( 1 ), 36 – 43. https://doi.org/10.1377/hlthaff.2018.05178 | |
dc.identifier.citedreference | O’Malley, A. S., Bond, A. M., & Berenson, R. A. ( 2011 ). Rising hospital employment of physicians: Better quality, higher costs? Issue Brief (Vol. 136, pp. 1 – 4 ). ( Center for Studying Health System Change ). http://www.ncbi.nlm.nih.gov/pubmed/21853632 | |
dc.identifier.citedreference | Ouayogodé, M. H., Fraze, T., Rich, E. C., & Colla, C. H. ( 2020 ). Association of organizational factors and physician practices’ participation in alternative payment models. JAMA Network Open, 3 ( 4 ), e202019. https://doi.org/10.1001/jamanetworkopen.2020.2019 | |
dc.identifier.citedreference | Physicians Advocacy Institute. ( 2019 ). Updated physician practice acquisition study: National and regional employment changes in physician employment 2012-2018. http://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/021919-Avalere-PAI-Physician-Employment-Trends-Study-2018-Update.pdf?ver=2019-02-19-162735-117 | |
dc.identifier.citedreference | Pope, G. C., Kautter, J., Ellis, R. P., Ash, A. S., Ayanian, J. Z., Iezzoni, L. I., & Robst, J. ( 2004 ). Risk adjustment of medicare capitation payments using the CMS-HCC model. Health Care Financing Review, 25, 119 – 141. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194896/ | |
dc.identifier.citedreference | Post, B. ( 2021 ). Association of a medicare outpatient payment reform with hospital-primary care integration: Heterogeneity across markets and physicians (in press). Medical Care, Published ( 9 ). https://pubmed.ncbi.nlm.nih.gov/34593710/ | |
dc.identifier.citedreference | Post, B., Buchmueller, T., & Ryan, A. M. ( 2018 ). Vertical integration of hospitals and physicians: Economic theory and empirical evidence on spending and quality. Medical Care Research and Review, 75, 399 – 433. https://doi.org/10.1177/1077558717727834 | |
dc.identifier.citedreference | Post, B., Norton, E. C., Hollenbeck, B., Buchmueller, T., & Ryan, A. M. ( 2021 ). Hospital-physician integration and Medicare’s site-based outpatient payments. Health Services Research, 56 ( 1 ), 7 – 15. https://doi.org/10.1111/1475-6773.13613 | |
dc.identifier.citedreference | Richards, M., Seward, J., & Whaley, C. ( 2020 ). Treatment consolidation after vertical integration: Evidence from outpatient procedure markets. https://doi.org/10.7249/WRA621-1 | |
dc.identifier.citedreference | Schulte, F. ( 2019, October 18). Whistleblower accuses seattle’s group health medicare advantage plan of fraud. Shots - Health News: National Public Radio. https://www.npr.org/sections/health-shots/2019/10/18/770466908/whistleblower-alleges-fraud-at-a-large-medicare-advantage-plan-in-seattle | |
dc.identifier.citedreference | Scott, K. W., Orav, E. J., Cutler, D. M., & Jha, A. K. ( 2017 ). Changes in hospital–physician affiliations in U.S. Hospitals and their effect on quality of care. Annals of Internal Medicine, 166 ( 1 ), 1. https://doi.org/10.7326/M16-0125 | |
dc.identifier.citedreference | Sukul, D., Hoffman, G. J., Nuliyalu, U., Adler-Milstein, J. R., Zhang, B., Dimick, J. B., & Ryan, A. M. ( 2019 ). Association between medicare policy reforms and changes in hospitalized medicare beneficiaries’ severity of illness. JAMA Network Open, 2 ( 5 ), e193290. https://doi.org/10.1001/jamanetworkopen.2019.3290 | |
dc.identifier.citedreference | Timbie, J. W., Kranz, A. M., DeYoreo, M., Eshete-Roesler, B., Elliott, M. N., Escarce, J. J., Totten, M. E., & Damberg, C. L. ( 2020 ). Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations. Health Services Research, 55 ( S3 ), 1107 – 1117. https://doi.org/10.1111/1475-6773.13581 | |
dc.identifier.citedreference | Welch, W. P., Cuellar, A. E., Stearns, S. C., & Bindman, A. B. ( 2013 ). Proportion of physicians in large group practices continued to grow in 2009-11. Health Affairs, 32 ( 9 ), 1659 – 1666. https://doi.org/10.1377/hlthaff.2012.1256 | |
dc.identifier.citedreference | Young, G. J., Zepeda, E. D., Flaherty, S., & Thai, N. ( 2021 ). Hospital employment of physicians in Massachusetts is associated with inappropriate diagnostic imaging. Health Affairs, 40 ( 5 ), 710 – 718. https://doi.org/10.1377/hlthaff.2020.01183 | |
dc.identifier.citedreference | Zepeda, E. D., Nyaga, G. N., & Young, G. J. ( 2020 ). The effect of hospital-physician integration on operational performance: Evaluating physician employment for cardiovascular services. Decision Sciences, 51 ( 2 ), 282 – 316. https://doi.org/10.1111/deci.12401 | |
dc.identifier.citedreference | Abraham, S., & Sun, L. ( 2018 ). Estimating dynamic treatment effects in event studies with heterogeneous treatment effects. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3158747 | |
dc.identifier.citedreference | Alpert, A., Hsi, H., & Jacobson, M. ( 2017 ). Evaluating the role of payment policy in driving vertical integration in the oncology market. Health Affairs, 36 ( 4 ), 680 – 688. https://doi.org/10.1377/hlthaff.2016.0830 | |
dc.identifier.citedreference | Athey, S., & Imbens, G. W. ( 2018, August 15). Design-based analysis in difference-in-differences settings with staggered adoption. ArXiv. http://arxiv.org/abs/1808.05293 | |
dc.identifier.citedreference | Baker, L. C., Bundorf, M. K., Devlin, A. M., & Kessler, D. P. ( 2018 ). Hospital ownership of physicians: Hospital versus physician perspectives. Medical Care Research and Review, 75 ( 1 ), 88 – 99. https://doi.org/10.1177/1077558716676018 | |
dc.identifier.citedreference | Baker, L. C., Bundorf, M. K., & Kessler, D. P. ( 2014 ). Vertical integration: Hospital ownership of physician practices is associated with higher prices and spending. Health Affairs, 33 ( 5 ), 756 – 763. https://doi.org/10.1377/hlthaff.2013.1279 | |
dc.identifier.citedreference | Baker, L. C., Bundorf, M. K., & Kessler, D. P. ( 2016 ). The effect of hospital/physician integration on hospital choice. Journal of Health Economics, 50, 1 – 8. https://doi.org/10.1016/j.jhealeco.2016.08.006 | |
dc.identifier.citedreference | Bastani, H., Goh, J., & Bayati, M. ( 2019 ). Evidence of upcoding in pay-for-performance programs. Management Science, 65 ( 3 ), 1042 – 1060. https://doi.org/10.1287/mnsc.2017.2996 | |
dc.identifier.citedreference | Bishop, T. F., Shortell, S. M., Ramsay, P. P., Copeland, K. R., & Casalino, L. P. ( 2016 ). Trends in hospital ownership of physician practices and the effect on processes to improve quality. American Journal of Managed Care, 22 ( 3 ), 172 – 176. http://www.ncbi.nlm.nih.gov/pubmed/27023022 | |
dc.identifier.citedreference | Capps, C., Dranove, D., & Ody, C. ( 2018 ). The effect of hospital acquisitions of physician practices on prices and spending. Journal of Health Economics, 59, 139 – 152. https://doi.org/10.1016/j.jhealeco.2018.04.001 | |
dc.identifier.citedreference | Carlin, C. S., Dowd, B., & Feldman, R. ( 2015 ). Changes in quality of health care delivery after vertical integration. Health Services Research, 50 ( 4 ), 1043 – 1068. https://doi.org/10.1111/1475-6773.12274 | |
dc.identifier.citedreference | Cengiz, D., Dube, A., Lindner, A., & Zipperer, B. ( 2019 ). The effect of minimum wages on low-wage jobs. Quarterly Journal of Economics, 134 ( 3 ), 1405 – 1454. https://doi.org/10.1093/qje/qjz014 | |
dc.identifier.citedreference | Centers for Medicare and Medicaid Services. ( 2019 ). 2019 estimated improper payment rates for Centers for Medicare & Medicaid services (CMS) programs. https://www.cms.gov/newsroom/fact-sheets/2019-estimated-improper-payment-rates-centers-medicare-medicaid-services-cms-programs | |
dc.identifier.citedreference | Chernew, M. E. ( 2021 ). Disparities in payment across sites encourage consolidation. Health Services Research, 56 ( 1 ), 5 – 6. https://doi.org/10.1111/1475-6773.13612 | |
dc.identifier.citedreference | Cunningham, S. ( 2021 ). Causal inference: The mixtape. Yale University Press. | |
dc.identifier.citedreference | de Chaisemartin, C., & D’Haultfœuille, X. ( 2020 ). Two-way fixed effects estimators with heterogeneous treatment effects. American Economic Review, 110 ( 9 ), 2964 – 2996. https://doi.org/10.1257/aer.20181169 | |
dc.identifier.citedreference | Desai, S., & McWilliams, J. M. ( 2018 ). Consequences of the 340B drug pricing program. New England Journal of Medicine, 378 ( 6 ), 539 – 548. https://doi.org/10.1056/NEJMsa1706475 | |
dc.identifier.citedreference | Dranove, D., & Ody, C. ( 2019 ). Employed for higher pay? How medicare payment rules affect hospital employment of physicians. American Economic Journal: Economic Policy, 11 ( 4 ), 249 – 271. https://www.aeaweb.org/articles?id=10.1257/pol.20170020 | |
dc.identifier.citedreference | Geruso, M., & Layton, T. ( 2020 ). Upcoding: Evidence from medicare on squishy risk adjustment. Journal of Political Economy, 128 ( 3 ), 984 – 1026. https://doi.org/10.1086/704756 | |
dc.working.doi | NO | en |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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