Original Article

OPEN: Expenditures and Quality: Hospital- and Health System–Affiliated Versus Independent Physicians in Virginia

Authors: Louis F. Rossiter PhD

Abstract

Objectives: The American Medical Association has reported that 2016 was the first year in which fewer than half (47.1%) of all practicing physicians owned their own practice. Across the United States, there has been consolidation of physicians and hospital and health systems, resulting in questions about the effect of this on healthcare expenditures. The aim of this study was to compare the expenditures per patient between hospital- and health system–affiliated physicians and independent physicians.

Methods: The author used Virginia’s new statewide all-payer claims database to analyze expenditures and quality for 3 years for hospital- and health system–affiliated physicians versus independent physicians. The database had all claims statewide for Virginians with individual or group commercial insurance coverage: 1.95 million patients in 2013, 2 million in 2014, and 2.1 million in 2015. The average annual expenditure for each physician was adjusted for average patient condition burden (risk) and differences in geographic input costs using regression analysis. Measures of primary care quality were obtained from the claims data using evidence-based measures from national health quality organizations.

Results: Hospital- and health system–affiliated physicians had annual expenditures per patient ranging from 10.3% to 14.6% higher than independent physicians. Most of the measures of primary care quality were not significantly different.

Conclusions: Virginia patients, employers, and managed care companies incurred higher per-patient expenditures with hospital and health system physicians than with independent physicians.

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Table 1. Adjusted annual expenditures differences per patient by hospital and health system physicians and independent physicians, 2013–2015

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Table 2. EBMs of quality primary care for hospital and health system physicians and independent physicians, 2013–2015

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References

1. Gaynor M, Mostashari F, Ginsburg PB. Making healthcare markets work: competition policy for health care. https://www.brookings.edu/research/making-health-care-markets-work-competition-policy-for-health-care. Published April 13, 2017. Accessed July 31, 2018.
 
2. Kane CK. Updated data on physician practice arrangements: physician ownership drops below 50 percent. https://www.ama-assn.org/sites/default/files/media-browser/public/health-policy/PRP-2016-physician-benchmark-survey.pdf. Published 2017. Accessed April 26, 2018.
 
3. Baker LC, Bundorf MK, Kessler DP. Vertical integration: hospital ownership of physician practices is associated with higher prices and spending. Health Aff (Millwood) 2014;33:756-763.
 
4. Fulton BD. Health care market concentration trends in the United States: evidence and policy responses. Health Aff (Millwood) 2017;36:1530-1538.
 
5. Milliman. GlobalRVUs. http://www.milliman.com/GlobalRVUs. Accessed July 31, 2018.
 
6. Milliman Advanced Risk Technologies-Decision Confidence. http://www.millimanriskadjustment.com/uploadedFiles/Mara_Site/mara-brochure-2013.pdf. Accessed July 31, 2018.
 
7. Robinson JC, Miller K. Total expenditures per patient in hospital-owned and physician-owned physician organizations in California. JAMA 2014;312:1663-1669.
 
8. Medicare Payment Advisory Commission. Provider consolidation: the role of Medicare policy. In: Report to the Congress: Medicare and the Health Care Delivery System. http://www.medpac.gov/docs/default-source/reports/jun17_reporttocongress_sec.pdf. Published June 2017. Accessed August 4, 2018.