Browsing by Author "Metcalfe, Leanne"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study
    (2019) Ho, Vivian; Metcalfe, Leanne; Vu, Lan; Short, Marah Noel; Morrow, Robert; James A. Baker III Institute for Public Policy
    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.
  • Thumbnail Image
    Item
    Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers
    (Elsevier, 2017) Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R.
    Study objective: We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. Methods: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state’s population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Results: Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Conclusion: Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities.
  • Thumbnail Image
    Item
    Using Medicare data to measure vertical integration of hospitals and physicians
    (Springer Nature, 2020) Ho, Vivian; Tapaneeyakul, Sasathorn; Metcalfe, Leanne; Vu, Lan; Short, Marah Noel; James A. Baker III Institute for Public Policy
    Researchers, healthcare providers, and policy makers have become increasingly interested in the cost and quality effects of vertical integration (VI) between hospitals and physicians. However, tracking VI is often financially costly. Because the Medicare Data on Provider Practice and Specialty (MD-PPAS) annual dataset may be more cost-effective for researchers to access than private data sources, we examine the accuracy of MD-PPAS in identifying VI by comparing it to physician and hospital affiliations reported in Blue Cross Blue Shield Texas (BCBSTX) PPO claims data for 2014–2016. The BCBSTX data serve as a gold standard, because physician–hospital affiliations are based on the insurer’s provider contract information. We merged the two datasets using the physician National Provider Identifier (NPI), then determined what percentage of physicians had the same Tax Identification Number (TIN) in both sources, and whether the TIN implied the physician belonged to a physician- or hospital-owned practice. We found that 71.3% of successfully matched NPIs reported the same TIN, and 95.1% of patient-level observations were attributed to organizations with the same ownership type in both datasets, regardless of TIN. We compared regression estimates of patient-level annual spending on an indicator variable for physician versus hospital ownership for the primary attributed physician and found that estimates were within one percentage point whether one determined VI based on the BCBSTX or the MD-PPAS data. The results suggest that MD-PPAS, which costs less to obtain than from a for-profit data source, can be used to reliably track VI between hospitals and physicians.