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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedPost B, Hollenbeck BK, Norton EC
Hospital-physician integration and clinical volume in traditional Medicare.
The purpose of this study was to test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare. The researchers identified 70,000 PCPs, some of whom remained non-integrated and some who became hospital-integrated during this study period. An event study design was utilized to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work-relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated. The study found that per-physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non-integrated, work RVUs fell by 7%; the number of patients treated fell by 4%; and claims volume among PCPs who became hospital-integrated fell by over 15%.
AHRQ-funded; HS027044; HS025707.
Citation: Post B, Hollenbeck BK, Norton EC .
Hospital-physician integration and clinical volume in traditional Medicare.
Health Serv Res 2024 Feb; 59(1):e14172. doi: 10.1111/1475-6773.14172..
Keywords: Medicare, Primary Care, Healthcare Delivery, Provider: Physician
Graves JA, Lee D, Leszinsky L
Physician patient sharing relationships within insurance plan networks.
The purpose of this cross-sectional study was to assess patient relationships shared between primary care physicians (PCPs), cardiologists, and oncologists, and the level at which those relationships were indicated within insurance networks. The study found that on average, networks captured 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Fewer than 50% of in-network ties were among physicians with a mutual organizational affiliation. After adjusting for the breadth of the network, the researchers found no evidence of differences in the shared patient percentage across insurance market segments or different types of networks. One exception was among national networks compared to local and regional networks, where national plans indicated fewer shared patient ties, especially in the narrowest networks.
AHRQ-funded; HS025976.
Citation: Graves JA, Lee D, Leszinsky L .
Physician patient sharing relationships within insurance plan networks.
Health Serv Res 2023 Oct;58(5):1056-65. doi: 10.1111/1475-6773.14138..
Keywords: Health Insurance, Provider: Physician, Medicare
Slade EP, Wu RJ, Meiselbach MK
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
This study’s purpose was to compare the breadths of psychiatrist and nonpsychiatrist provider networks in Dual Eligible Special Needs Plans (D-SNPs) and other Medicare and Medicaid Advantage (MA) plans. D-SNP is a type of Medicare Advantage (MA) plan for individuals who have both Medicare and Medicaid coverage. The authors examined MA plan provider network data that was merged with plan service areas and a nationwide provider database to form a data set with 843 observations on networks subclassified by state and network type (D-SNP or other MA) covering 42 U.S. states and Washington, D.C. Mean psychiatrist network breadth was 0.319 in D-SNPs and 0.299 in other MA plans. Nonpsychiatrist network breadth was 0.346 in D-SNPs and 0.358 in other MA plans. Psychiatrist networks were narrower than nonpsychiatrist networks (0.303 vs. 0.355), but mean psychiatrist network breadth did not differ between D-SNPs and other MA plans. In regression analyses, the psychiatrist-nonpsychiatrist breadth difference was smaller in D-SNPs (-0.031) than in other MA plans (-0.060).
AHRQ-funded; HS000029.
Citation: Slade EP, Wu RJ, Meiselbach MK .
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
Psychiatr Serv 2023 Aug; 74(8):816-22. doi: 10.1176/appi.ps.20220239..
Keywords: Behavioral Health, Medicare, Provider: Physician
Valdez S, Jacobson M
Assessing the quality of SK&A's office-based physician database for identifying oncologists.
Investigators assessed the quality of SK&A's office-based physician database by capturing oncologists who bill the Medicare fee-for-service program. Using 2017 data, they found that nearly 74% of the oncologists in Medicare claims can be found in the SK&A data, with higher rates when weighted by patients, service volume, or spending.
AHRQ-funded; HS000046.
Citation: Valdez S, Jacobson M .
Assessing the quality of SK&A's office-based physician database for identifying oncologists.
Med Care Res Rev 2022 Apr;79(2):317-27. doi: 10.1177/10775587211013628..
Keywords: Medicare, Provider: Physician
Rodriguez HP, Ciemins EL, Rubio K
Physician practices with robust capabilities spend less on Medicare beneficiaries than more limited practices.
Researchers used data from the 2017 National Survey of Healthcare Organizations and Systems to examine the association of practice-level capabilities with process measures of quality, utilization, and spending. They found that quality and utilization did not differ by practice-level capabilities. Physician practice locations with robust capabilities spent less on Medicare fee-for-service beneficiaries but delivered quality of care comparable to the quality delivered in locations with low or mixed capabilities.
AHRQ-funded; HS024075.
Citation: Rodriguez HP, Ciemins EL, Rubio K .
Physician practices with robust capabilities spend less on Medicare beneficiaries than more limited practices.
Health Aff 2022 Mar;41(3):414-23. doi: 10.1377/hlthaff.2021.00302..
Keywords: Healthcare Costs, Medicare, Provider: Physician
Markovitz AA, Ryan AM, Peterson TA
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
This research letter describes a survey that was conducted to compare accountable care organization (ACO) awareness and perceptions among specialists versus primary care physicians (PCPs). The survey was administered in 2018 to clinicians in the Physician Organization of Michigan ACO, which was the largest Medicare Shared Savings Program (MSSP) in Michigan and among the ten largest nationally at the time. The analysis focused on 1022 non-pediatrician physician respondents practicing within 10 provider organizations. Physician respondents included PCPs (23%) and specialists (77%). The most common specialty was internal medicine (20%), followed by surgeons (14%). Specialists were less likely to be aware of ACO participation and incentives. They were also 25% less likely to know they were in an ACO compared to PCPs. In addition, specialists were 18% less likely to know their ACO was accountable for both spending and quality or that their ACO had lowered spending in the previous year. This difference in perception may help to explain ACOs’ modest impact on spending and quality.
AHRQ-funded; HS025615.
Citation: Markovitz AA, Ryan AM, Peterson TA .
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
J Gen Intern Med 2022 Feb;37(2):492-94. doi: 10.1007/s11606-020-06556-w..
Keywords: Primary Care, Healthcare Costs, Medicare, Provider: Physician
Valdez S
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examined whether or not hospitals strategically chose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market.
AHRQ-funded; HS000046.
Citation: Valdez S .
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Inquiry 2021 Jan-Dec;58:469580211022968. doi: 10.1177/00469580211022968..
Keywords: Medicare, Hospitals, Provider: Physician
Gettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation: Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords: Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Smulowitz PB, O'Malley AJ, Zaborski L
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study the investigators examined physician-level variation in ED admission rates for Medicare patients.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, Zaborski L .
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Health Aff 2021 Feb;40(2):251-57. doi: 10.1377/hlthaff.2020.00670..
Keywords: Emergency Department, Hospitalization, Medicare, Provider: Physician, Provider
Tang AB, Childers CP, Dworsky JQ
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
The National Surgical Quality Improvement Program (NSQIP) database is increasingly used for surgical research. However, it is unclear how well this database represents the breadth of work performed by different specialties. Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier Procedure Summary file, the investigators evaluated (1) what proportion of surgical work was captured by NSQIP, (2) what procedures and disciplines were undersampled, and (3) the overall concordance between the NSQIP sample and a national sample.
AHRQ-funded; HS000046.
Citation: Tang AB, Childers CP, Dworsky JQ .
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
Surgery 2020 Mar;167(3):550-55. doi: 10.1016/j.surg.2019.11.013..
Keywords: Surgery, Quality Improvement, Quality of Care, Provider: Physician, Provider, Medicare, Patient-Centered Outcomes Research
Jalali A, Martin C, Nelson RE
Provider practice competition and adoption of Medicare's Oncology Care Model.
The purpose of this study was to measure the association between regional market competition among medical oncologists with the initial adoption of the Oncology Care Model (OCM). Findings showed that practices in competitive health care markets were more likely to adopt OCM than in noncompetitive markets. Average practice size, number of practices in a hospital referral region, and the hospital bed rate were positively associated with adoption, whereas the rate of full-time equivalent hospital employees to 1000 residents was negatively associated with adoption. Recommendations included careful monitoring of market-level changes among OCM adopters to ensure that the benefits of the OCM outweigh the negative consequences of possible changes in competition.
AHRQ-funded; HS024714.
Citation: Jalali A, Martin C, Nelson RE .
Provider practice competition and adoption of Medicare's Oncology Care Model.
Med Care 2020 Feb;58(2):154-60. doi: 10.1097/mlr.0000000000001243..
Keywords: Medicare, Workforce, Provider: Physician, Provider
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
AHRQ-funded; HS026395.
Citation: Everson J, Richards MR, Buntin MB .
Horizontal and vertical integration's role in meaningful use attestation over time.
Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Sheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life