Abstract:
BACKGROUND:Recent 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. OBJECTIVE:To measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information. DESIGN:Retrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics. PATIENTS:Patients 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 MEASURES:Annual 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. RESULTS:Estimates 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 RELEVANCE:We 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.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Ho V,Metcalfe L,Vu L,Short M,Morrow Rdoi
10.1007/s11606-019-05312-zsubject
Has Abstractpub_date
2020-03-01 00:00:00pages
649-655issue
3eissn
0884-8734issn
1525-1497pii
10.1007/s11606-019-05312-zjournal_volume
35pub_type
杂志文章abstract:OBJECTIVE:To compare the efficacies and cost-effectiveness of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either sh...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599133
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients. DESIGN:Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrol...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.11028.x
更新日期:2002-08-01 00:00:00
abstract::While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excelle...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2004.30329.x
更新日期:2004-10-01 00:00:00
abstract::This perspective describes federal efforts in the United States (U.S.) to integrate care for an especially complex, vulnerable, and costly patient population: adults eligible for both Medicare and Medicaid insurance. The goal of the paper is to demystify for clinical policy leaders and practicing clinicians the origin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05914-y
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Despite growing emphasis on public reporting of health care quality data, available data are often ignored. OBJECTIVE:To evaluate the usefulness of web-based physician-level data for patients choosing a new primary care physician (PCP). DESIGN:Patients seeking a new PCP (n = 2225) were invited to view web-...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0278-1
更新日期:2007-10-01 00:00:00
abstract::This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventio...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00362.x
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND:Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE:To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN:Prospective cohort stu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2168-4
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. OBJECTIVE:This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacolog...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4329-6
更新日期:2018-05-01 00:00:00
abstract::In this short story, through a challenging case where his sound diagnostic work has seemingly gone unrecognized, an internist is reminded of what is most important in clinical care. ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1363-4
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:To determine the frequency with which an acute confusional state is caused by a stroke and to evaluate the usefulness of obtaining computed tomography scans in this setting. DESIGN:Retrospective analysis. SETTING:Tertiary referral center. PATIENTS:The authors reviewed 127 neurology consultations requested ...
journal_title:Journal of general internal medicine
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doi:10.1007/BF02599217
更新日期:1994-09-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2877-y
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. OBJECTIVE:To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0202-8
更新日期:2007-06-01 00:00:00
abstract::The fourth-year medicine clerkship was restructured at one of four sites. Teams consisting of one attending physician and three students cared for eight new patients per week. The overall experience of the restructured clerkship was rated significantly more positively than the experiences at all other sites and the te...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600292
更新日期:1993-01-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599105
更新日期:1992-01-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1324-y
更新日期:2010-08-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:1998-02-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-019-04971-2
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence. DESIGN:Prospective, counterbalanced experimental design. SETTING:Laboratory study co...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2005.30145.x
更新日期:2005-04-01 00:00:00
abstract:INTRODUCTION:Most residents have limited education or exposure to health policy during residency. AIMS:We developed a course to (1) educate residents on health policy topics applicable to daily physician practice; (2) expose residents to health policy careers through visits with policy makers and analysts; (3) promote...
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更新日期:2009-12-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2011-03-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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doi:10.1007/BF02596487
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598969
更新日期:1991-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2009-02-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-019-05079-3
更新日期:2019-08-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:
更新日期:2001-12-01 00:00:00
abstract::In the HTML version of this paper, Ms. Goddu was incorrectly listed. The correct citation should be AP Goddu. Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.3 stigmatizing vs. 25.1 neutral, p < 0.001). Reading the stigmatizing language note was associated...
journal_title:Journal of general internal medicine
pub_type: 已发布勘误
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更新日期:2019-01-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:2019-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05644-1
更新日期:2020-07-01 00:00:00