Spending per Medicare Beneficiary Is Higher in Hospital-Owned Small- and Medium-Sized Physician Practices

Health Serv Res. 2018 Aug;53(4):2133-2146. doi: 10.1111/1475-6773.12765. Epub 2017 Sep 21.

Abstract

Objective: To examine the relationship of physician versus hospital ownership of small- and medium-sized practices with spending and utilization of care.

Data source/study setting/data collection: Survey data for 1,045 primary care-based practices of 1-19 physicians linked to Medicare claims data for 2008 for 282,372 beneficiaries attributed to the 3,010 physicians in these practices.

Study design: We used generalized linear models to estimate the associations between practice characteristics and outcomes (emergency department visits, index admissions, readmissions, and spending).

Principal findings: Beneficiaries linked to hospital-owned practices had 7.3 percent more emergency department visits and 6.4 percent higher total spending compared to beneficiaries linked to physician-owned practices.

Conclusions: Physician practices are increasingly being purchased by hospitals. This may result in higher total spending on care.

Keywords: Ambulatory/outpatient care; health care organizations and systems; ownership/governance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emergency Service, Hospital
  • Health Expenditures / statistics & numerical data*
  • Hospitals*
  • Humans
  • Medicare / economics*
  • Medicare / statistics & numerical data
  • Ownership / economics*
  • Ownership / organization & administration
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Practice Patterns, Physicians'*
  • Primary Health Care / economics
  • Primary Health Care / organization & administration
  • United States