Hospital Capital Expenditures Associated With Prices And Hospital Expansion Or Withering, 2010-19.

Prices charged by hospitals in commercial markets are, on average, high and growing rapidly, and they vary within markets. The narrative around these facts has focused on hospitals gaining market power through mergers and acquisitions. Hospitals may also increase their market power by investing in capacity, services, or amenities that, although potentially desirable, increase demand and differentiate them from competitors.

Integrated health systems and medical care quality during the COVID-19 pandemic.

Objective: To examine differences between patients treated in integrated systems of care and patients treated outside of such systems during the COVID pandemic in the use of primary and preventive care, emergency services, inpatient services, and mortality.

Data Sources And Study Setting: Data are used from all enrollees in traditional Medicare aged 66 and older.

Study Design: Difference-in-differences estimates are calculated from the pre-COVID time period (January 2019-February 2020) to the initial COVID time period (March-May 2020) and the ongoing COVID time period (June 2020-December 2021) for patients treated by primary care physicians working in a health system versus not, and by the type of health system.

A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018.

Objectives: This paper provides an examination of: (1) the frequency and net rates of change for general pediatric inpatient (GPI) unit closures and openings nationally and by state; (2) how often closures or openings are caused by GPI unit changes only or caused by hospital-level changes; and (3) the relationship between hospital financial status and system ownership and GPI unit closures or openings.

Methods: This study used the Health Systems and Providers Database (2011-2018) plus 3 data sources on hospital closures. We enumerated GPI unit closures and openings to calculate net rates of change.

The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22.

Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.

Organization of Cancer Specialists in US Physician Practices and Health Systems.

Purpose: To describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers.

Methods: Using the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data, we identified 46,341 unique physicians providing cancer care. We stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty).

Organization and Performance of US Health Systems.

Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance.

Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems.

Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region.

Increases in Inpatient Psychiatry Beds Operated by Systems, For-Profits, and Chains, 2010-2016.

Objective: This study explored trends in the quantity of inpatient psychiatry beds and in facility characteristics.

Methods: Using the National Bureau of Economic Research's Health Systems and Provider Database, the authors examined changes in the number of psychiatric facilities and beds, focusing on system ownership, profit status, facility type (general acute care versus freestanding), and affiliation with psychiatric hospital chains from 2010 to 2016.

Results: The number of psychiatric beds was relatively unchanged from 2010 (N=112,182 beds) to 2016 (N=111,184).

Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states.

Objective: To characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population.

Data Sources: Physician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah.

Study Design: Using an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures.

Changes in Quality of Care after Hospital Mergers and Acquisitions.

Background: The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited.

Methods: Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership.

Concentration of high-cost patients in hospitals and markets.

Objectives: Although we know that healthcare costs are concentrated among a small number of patients, we know much less about the concentration of these costs among providers or markets. This is important because it could help us to understand why some patients are higher-cost compared with others and enable us to develop interventions to reduce costs for these patients.

Study Design: Observational study.

Putting smart money to work for quality improvement.

Objective: To investigate the effects of paying physicians for performance on quality measures of diabetes care when combined with other care management tools.

Data Sources/study Setting: In 2001, a managed care organization in upstate New York designed and implemented a pilot program to financially reward doctors for the quality of care delivered to diabetic patients. In addition to paying a performance bonus, physicians were also supplied with a diabetic registry and met in groups to discuss progress in meeting goals for diabetic care.

An economic analysis of health plan conversions: are they in the public interest?

Over the last decade, managed-care companies have been consolidating on both a regional and national scale. More recently, nonprofit health plans have been converting to for-profit status, and this conversion has frequently occurred as a step to facilitate merger or acquisition with a for-profit company. Some industry observers attribute these managed-care marketplace trends to an industry shakeout resulting from increased competition in the sector.

Quality information and consumer health plan choices.

This paper presents an empirical analysis of the effects of providing information about plan quality on consumers' health plan choices in a private employment setting. Analysis of plan switching behavior suggests that the provision of quality information had a small, but significant effect on consumer plan choices. Employees were more likely to switch from plans with lower reported quality.

Assessing the Risk of Microbial Pathogens: Application of a Judgment-Encoding Methodology.

This paper reports the results of a risk assessment of the adverse health effects from ingesting foods contaminated with certain microbial pathogens. The risk assessment was performed as part of a larger project to develop a risk-based sampling methodology for imported foods inspected by the U.S.