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1.
Medicine (Baltimore) ; 100(12): e25231, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761713

RESUMEN

ABSTRACT: Physician-hospital integration among accountable care organizations (ACOs) has raised concern over impacts on prices and spending. However, characteristics of ACOs with greater integration between physicians and hospitals are unknown. We examined whether ACOs systematically differ by physician-hospital integration among 16 commercial ACOs operating in Massachusetts.Using claims data linked to information on physician affiliation, we measured hospital integration with primary care physicians for each ACO and categorized them into high-, medium-, and low-integrated ACOs. We conducted cross-sectional descriptive analysis to compare differences in patient population, organizational characteristics, and healthcare spending between the three groups. In addition, using multivariate generalized linear models, we compared ACO spending by integration level, adjusting for organization and patient characteristics. We identified non-elderly adults (aged 18-64) served by 16 Massachusetts ACOs over the period 2009 to 2013.High- and medium-integrated ACOs were more likely to be an integrated delivery system or an organization with a large number of providers. Compared to low-integrated ACOs, higher-integrated ACOs had larger inpatient care capacity, smaller composition of primary care physicians, and were more likely to employ physicians directly or through an affiliated hospital or physician group. A greater proportion of high-/medium-integrated ACO patients lived in affluent neighborhoods or areas with a larger minority population. Healthcare spending per enrollee in high-integrated ACOs was higher, which was mainly driven by a higher spending on outpatient facility services.This study shows that higher-integrated ACOs differ from their counterparts with low integration in many respects including higher healthcare spending, which persisted after adjusting for organizational characteristics and patient mix. Further investigation into the effects of integration on expenditures will inform the ongoing development of ACOs.


Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Convenios Médico-Hospital , Costos y Análisis de Costo , Convenios Médico-Hospital/economía , Convenios Médico-Hospital/métodos , Relaciones Médico-Hospital , Humanos , Estados Unidos
2.
Medicine (Baltimore) ; 94(42): e1762, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26496300

RESUMEN

Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Empleo/economía , Convenios Médico-Hospital/economía , Médicos/economía , Patient Protection and Affordable Care Act , Satisfacción del Paciente , Relaciones Médico-Paciente , Práctica Privada/economía , Estados Unidos
4.
Adv Health Care Manag ; 15: 165-84, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24749216

RESUMEN

PURPOSE: The hospital-physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals' ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs. DESIGN/METHODOLOGY APPROACH: We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs. FINDINGS: We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency. RESEARCH LIMITATIONS: There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted. RESEARCH IMPLICATIONS: While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model. PRACTICAL IMPLICATIONS: Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment. ORIGINALITY/VALUE: This is the first chapter to explore an alternative hospital-physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.


Asunto(s)
Relaciones Médico-Hospital , Modelos Organizacionales , Conducta Cooperativa , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/ética , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Eficiencia Organizacional , Convenios Médico-Hospital/economía , Convenios Médico-Hospital/ética , Convenios Médico-Hospital/legislación & jurisprudencia , Humanos , Relaciones Interprofesionales/ética , Objetivos Organizacionales , Estados Unidos
6.
Health Aff (Millwood) ; 30(1): 161-72, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21163804

RESUMEN

The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Convenios Médico-Hospital/organización & administración , Seguro de Salud , Mecanismo de Reembolso , Ahorro de Costo/métodos , Prestación Integrada de Atención de Salud/economía , Convenios Médico-Hospital/economía , Humanos , Illinois , Asociaciones de Práctica Independiente/economía , Asociaciones de Práctica Independiente/organización & administración , Medicare/economía , Medicare/legislación & jurisprudencia , Modelos Organizacionales , Patient Protection and Affordable Care Act , Garantía de la Calidad de Atención de Salud , Estados Unidos
8.
Milbank Q ; 86(3): 375-434, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18798884

RESUMEN

CONTEXT: Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). METHODS: This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. FINDINGS: The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. CONCLUSIONS: Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Eficiencia Organizacional/economía , Convenios Médico-Hospital/economía , Relaciones Médico-Hospital , Planes de Incentivos para los Médicos/economía , Conducta Cooperativa , Humanos , Relaciones Interprofesionales , Comercialización de los Servicios de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud/economía , Estados Unidos
14.
Med Care ; 38(3): 311-24, 2000 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-10718356

RESUMEN

BACKGROUND: Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. OBJECTIVES: The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, in conjunction with process integration, on hospital costs. STUDY DESIGN: We studied a 1995 American Hospital Association (AHA) special survey that has information on 44 different physician-hospital integrative activities and on global capitation contracts held by management service organizations, physician-hospital organizations, and other similar entities. These data were combined with the AHA's Annual Survey of Hospitals, InterStudy HMO data, the area resource file, and state regulation data. Multivariate analysis was used to assess the relationship between capitation and integration and then to examine the influence of these factors and others on hospital costs. We studied 319 urban hospitals with complete data. FINDINGS: Provider capitation was found to promote integration between hospitals and physicians in relation to administrative/practice management, physician financial risk sharing, joint ventures to create new services, computer linkages, and an overall measure of physician-hospital integration. However, anticipated effects of integration and capitation on hospital costs were not evident. CONCLUSIONS: Global capitation is motivating tighter integration between physicians and hospitals in a number of respects. Although capitation is currently having the intermediate effect of encouraging process integration, it is not yet having the ultimate anticipated effect of lowering hospital costs.


Asunto(s)
Capitación/estadística & datos numéricos , Prestación Integrada de Atención de Salud/economía , Costos de Hospital/estadística & datos numéricos , Convenios Médico-Hospital/economía , Hospitales Urbanos/economía , Programas Controlados de Atención en Salud/economía , Modelos Econométricos , American Hospital Association , Control de Costos , Investigación sobre Servicios de Salud , Humanos , Análisis de los Mínimos Cuadrados , Comercialización de los Servicios de Salud , Análisis Multivariante , Evaluación de Procesos y Resultados en Atención de Salud , Estados Unidos
15.
Healthc Financ Manage ; 53(4): 33-6, 1999 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10557976

RESUMEN

Recently issued proposed regulations describing how the IRS intends to enforce the intermediate tax sanctions statute of the Internal Revenue Code have important ramifications for integrated delivery systems (IDSs). The regulations' interpretation of who within an IDS may be subject to excise taxes under the statute is broad, basing an individual's risk of being taxed on his or her degree of influence over a given entity within the organization, rather than over the organization as a whole. To protect individuals within an IDS from exposure to intermediate tax sanctions, the organization should understand who is likely to be at risk and take steps to ensure that all transactions with such persons are in compliance with the conditions set forth in the proposed regulations.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Afiliación Organizacional/economía , Exención de Impuesto/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Adhesión a Directriz/legislación & jurisprudencia , Convenios Médico-Hospital/economía , Convenios Médico-Hospital/legislación & jurisprudencia , Responsabilidad Legal/economía , Cuerpo Médico/legislación & jurisprudencia , Afiliación Organizacional/legislación & jurisprudencia , Poder Psicológico , Riesgo , Síndicos/legislación & jurisprudencia , Estados Unidos
16.
Healthc Financ Manage ; 53(1): 42-7, 1999 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-10339163

RESUMEN

To surmount the economic pressures of managed care, specialists are pursuing various initiatives designed to increase revenues and market share that may put them into competition with healthcare systems. Systems contemplating collaboration with specialists to gain their loyalty may first consider employing a strategy involving physician gain sharing. It should be understood, however, that there are legal hurdles to be overcome in developing gain sharing, that there are different gain-sharing models to be used, and that there are limitations as well as benefits to such an initiative. These limitations require healthcare systems to consider other, more durable specialist integration strategies. The balance of power between a healthcare system and specialists will affect the success of whatever integration strategy is employed.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Economía Médica , Convenios Médico-Hospital/economía , Modelos Organizacionales , Planes de Incentivos para los Médicos/economía , Especialización , Conducta Cooperativa , Prestación Integrada de Atención de Salud/organización & administración , Eficiencia Organizacional , Convenios Médico-Hospital/organización & administración , Programas Controlados de Atención en Salud/economía , Medicina/organización & administración , Innovación Organizacional , Técnicas de Planificación , Estados Unidos
17.
Healthc Financ Manage ; 52(8): 79-80, 1998 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10182282

RESUMEN

Hospital-physician integration alone will not help providers achieve the leverage and/or cost structure necessary to succeed under managed care. Hospitals first need to gain institutional dominance in their markets, facilitate the consolidation of physician groups, and create fair hospital-physician partnerships.


Asunto(s)
Sector de Atención de Salud , Convenios Médico-Hospital/economía , Comercialización de los Servicios de Salud , California , Prestación Integrada de Atención de Salud , Competencia Económica , Práctica de Grupo/economía , Práctica de Grupo/organización & administración , Convenios Médico-Hospital/organización & administración , Humanos , Programas Controlados de Atención en Salud/economía , Estados Unidos
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