Daniel R Arnold, Jaime S King, Brent D. Fulton, Alexandra D. Montague, Katherine L. Gudiksen, Thomas L Greaney, Richard M. Scheffler
OBJECTIVE To examine the impact of "cross-market" hospital mergers on prices and quality and the extent to which serial acquisitions contribute to any measured effects. DATA SOURCES 2009-2017 commercial claims from the Health Care Cost Institute (HCCI) and quality measures from Hospital Compare. STUDY DESIGN Event study models in which the treated group consisted of hospitals that acquired hospitals further than 50 miles, and the control group was hospitals that were not part of any merger activity (as a target or acquirer) during the study period. DATA EXTRACTION METHODS We extracted data for 214 treated hospitals and 955 control hospitals. PRINCIPAL FINDINGS Six years after acquisition, cross-market hospital mergers had increased acquirer prices by 12.9% (CI: 0.6%-26.6%) relative to control hospitals, but had no discernible impact on mortality and readmission rates for heart failure, heart attacks and pneumonia. For serial acquirers, the price effect increased to 16.3% (CI: 4.8%-29.1%). For all acquisitions, the price effect was 21.8% (CI: 4.6%-41.7%) when the target's market share was greater than the acquirer's market share versus 9.7% (CI: -0.5% to 20.9%) when the opposite was true. The magnitude of the price effect was similar for out-of-state and in-state cross-market mergers. CONCLUSIONS Additional evidence on the price and quality effects of cross-market mergers is needed at a time when over half of recent hospital mergers have been cross-market. To date, no hospital mergers have been challenged by the Federal Trade Commission on cross-market grounds. Our study is the third to find a positive price effect associated with cross-market mergers and the first to show no quality effect and how serial acquisitions contribute to the price effect. More research is needed to identify the mechanism behind the price effects we observe and analyze price effect heterogeneity.
{"title":"New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality.","authors":"Daniel R Arnold, Jaime S King, Brent D. Fulton, Alexandra D. Montague, Katherine L. Gudiksen, Thomas L Greaney, Richard M. Scheffler","doi":"10.1111/1475-6773.14291","DOIUrl":"https://doi.org/10.1111/1475-6773.14291","url":null,"abstract":"OBJECTIVE\u0000To examine the impact of \"cross-market\" hospital mergers on prices and quality and the extent to which serial acquisitions contribute to any measured effects.\u0000\u0000\u0000DATA SOURCES\u00002009-2017 commercial claims from the Health Care Cost Institute (HCCI) and quality measures from Hospital Compare.\u0000\u0000\u0000STUDY DESIGN\u0000Event study models in which the treated group consisted of hospitals that acquired hospitals further than 50 miles, and the control group was hospitals that were not part of any merger activity (as a target or acquirer) during the study period.\u0000\u0000\u0000DATA EXTRACTION METHODS\u0000We extracted data for 214 treated hospitals and 955 control hospitals.\u0000\u0000\u0000PRINCIPAL FINDINGS\u0000Six years after acquisition, cross-market hospital mergers had increased acquirer prices by 12.9% (CI: 0.6%-26.6%) relative to control hospitals, but had no discernible impact on mortality and readmission rates for heart failure, heart attacks and pneumonia. For serial acquirers, the price effect increased to 16.3% (CI: 4.8%-29.1%). For all acquisitions, the price effect was 21.8% (CI: 4.6%-41.7%) when the target's market share was greater than the acquirer's market share versus 9.7% (CI: -0.5% to 20.9%) when the opposite was true. The magnitude of the price effect was similar for out-of-state and in-state cross-market mergers.\u0000\u0000\u0000CONCLUSIONS\u0000Additional evidence on the price and quality effects of cross-market mergers is needed at a time when over half of recent hospital mergers have been cross-market. To date, no hospital mergers have been challenged by the Federal Trade Commission on cross-market grounds. Our study is the third to find a positive price effect associated with cross-market mergers and the first to show no quality effect and how serial acquisitions contribute to the price effect. More research is needed to identify the mechanism behind the price effects we observe and analyze price effect heterogeneity.","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meng-Yun Lin, A. Hanchate, Austin B Frakt, James F. Burgess, Kathleen Carey
OBJECTIVE To investigate the relationship between physician-hospital integration within accountable care organizations (ACOs) and inpatient care utilization and expenditure. DATA SOURCES The primary data were Massachusetts All-Payer Claims Database (2009-2013). STUDY SETTING Fifteen provider organizations that entered a commercial ACO contract with a major private payer in Massachusetts between 2009 and 2013. STUDY DESIGN Using an instrumental variable approach, the study compared inpatient care delivery between patients of ACOs demonstrating high versus low integration. We measured physician-hospital integration within ACOs by the proportion of primary care physicians in an ACO who billed for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. The study sample comprised non-elderly adults who had continuous insurance coverage and were attributed to one of the 15 ACOs. Outcomes of interest included total medical expenditure during an episode of inpatient care, length of stay (LOS) of the index hospitalization, and 30-day readmission. An inpatient episode was defined as 30, 45, and 60 days from the admission date. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS The study examined 33,535 admissions from patients served by the 15 ACOs. Average medical expenditure within 30 days of admission was $24,601, within 45 days was $26,447, and within 60 days was $28,043. Average LOS was 3.5 days, and 5.4% of patients were readmitted within 30 days. Physician-hospital integration was associated with a 10.6% reduction in 30-day expenditure (95% CI, -15.1% to -5.9%). Corresponding estimates for 45 and 60 days were - 9.7% (95%CI, -14.2% to -4.9%) and - 9.6% (95%CI, -14.3% to -4.7%). Integration was associated with a 15.7% decrease in LOS (95%CI, -22.6% to -8.2%) but unrelated to 30-day readmission rate. CONCLUSIONS Our instrumental variable analysis shows physician-hospital integration with ACOs was associated with reduced inpatient spending and LOS, with no evidence of elevated readmission rates.
{"title":"Association between physician-hospital integration and inpatient care delivery in accountable care organizations: An instrumental variable analysis.","authors":"Meng-Yun Lin, A. Hanchate, Austin B Frakt, James F. Burgess, Kathleen Carey","doi":"10.1111/1475-6773.14311","DOIUrl":"https://doi.org/10.1111/1475-6773.14311","url":null,"abstract":"OBJECTIVE\u0000To investigate the relationship between physician-hospital integration within accountable care organizations (ACOs) and inpatient care utilization and expenditure.\u0000\u0000\u0000DATA SOURCES\u0000The primary data were Massachusetts All-Payer Claims Database (2009-2013).\u0000\u0000\u0000STUDY SETTING\u0000Fifteen provider organizations that entered a commercial ACO contract with a major private payer in Massachusetts between 2009 and 2013.\u0000\u0000\u0000STUDY DESIGN\u0000Using an instrumental variable approach, the study compared inpatient care delivery between patients of ACOs demonstrating high versus low integration. We measured physician-hospital integration within ACOs by the proportion of primary care physicians in an ACO who billed for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. The study sample comprised non-elderly adults who had continuous insurance coverage and were attributed to one of the 15 ACOs. Outcomes of interest included total medical expenditure during an episode of inpatient care, length of stay (LOS) of the index hospitalization, and 30-day readmission. An inpatient episode was defined as 30, 45, and 60 days from the admission date.\u0000\u0000\u0000DATA COLLECTION/EXTRACTION METHODS\u0000Not applicable.\u0000\u0000\u0000PRINCIPAL FINDINGS\u0000The study examined 33,535 admissions from patients served by the 15 ACOs. Average medical expenditure within 30 days of admission was $24,601, within 45 days was $26,447, and within 60 days was $28,043. Average LOS was 3.5 days, and 5.4% of patients were readmitted within 30 days. Physician-hospital integration was associated with a 10.6% reduction in 30-day expenditure (95% CI, -15.1% to -5.9%). Corresponding estimates for 45 and 60 days were - 9.7% (95%CI, -14.2% to -4.9%) and - 9.6% (95%CI, -14.3% to -4.7%). Integration was associated with a 15.7% decrease in LOS (95%CI, -22.6% to -8.2%) but unrelated to 30-day readmission rate.\u0000\u0000\u0000CONCLUSIONS\u0000Our instrumental variable analysis shows physician-hospital integration with ACOs was associated with reduced inpatient spending and LOS, with no evidence of elevated readmission rates.","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brystana G. Kaufman, S. Nicole Hastings, Cassie Meyer, Karen M. Stechuchak, Ashley Choate, Kasey Decosimo, Caitlin Sullivan, Virginia Wang, Kelli D. Allen, Courtney H. Van Houtven
ObjectiveTo conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults.Data Sources and Study SettingThis was a secondary analysis of primary data from a VA 8‐hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA.Study DesignThis budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP‐only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty.Data CollectionPersonnel time and implementation outcomes were collected from hospitals (2017–2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation.Principal FindingsAverage implementation costs were $9450 for REP+CONNECT and $5622 for REP‐only; average program delivery costs were less than $30 per participant in both VA and non‐VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP‐only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled.ConclusionsSTRIDE is a low‐cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE.Trial RegistrationClinicalsTrials.gov NCT03300336. Prospectively registered on 3 October 2017.
{"title":"The business case for hospital mobility programs in the veterans health care system: Results from multi‐hospital implementation of the STRIDE program","authors":"Brystana G. Kaufman, S. Nicole Hastings, Cassie Meyer, Karen M. Stechuchak, Ashley Choate, Kasey Decosimo, Caitlin Sullivan, Virginia Wang, Kelli D. Allen, Courtney H. Van Houtven","doi":"10.1111/1475-6773.14307","DOIUrl":"https://doi.org/10.1111/1475-6773.14307","url":null,"abstract":"ObjectiveTo conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults.Data Sources and Study SettingThis was a secondary analysis of primary data from a VA 8‐hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA.Study DesignThis budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP‐only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty.Data CollectionPersonnel time and implementation outcomes were collected from hospitals (2017–2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation.Principal FindingsAverage implementation costs were $9450 for REP+CONNECT and $5622 for REP‐only; average program delivery costs were less than $30 per participant in both VA and non‐VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP‐only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled.ConclusionsSTRIDE is a low‐cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE.Trial Registration<jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"http://clinicalstrials.gov\">ClinicalsTrials.gov</jats:ext-link> NCT03300336. Prospectively registered on 3 October 2017.","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}