Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    Mental illness has become more common over the last decade, particularly among 18- to 25-year-olds. This Data Insights looks at trends in mental health and their implications for the future.

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  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

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  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

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  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
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How Does Hospital Ownership of Physician Practices Affect Which Hospitals Patients Use?

Why This Study Is Important

Integration between hospitals and physician practices is becoming more widespread as hospitals buy out independent practices, with unknown impacts on these physicians’ patients. This study is the first to examine whether and how hospital ownership of physician practices affects the hospital choices made by Medicare patients treated by these practices. The work specifically examines whether these patients are more likely to choose the owning hospital when they need inpatient care and whether any such influences from their physician supersede considerations based on hospital costs, quality, or distance from home.

What This Study Found

  • Depending on how the patient’s physician was defined, patients were anywhere from 16 to 33 percentage points more likely to choose to use a hospital owning their physician’s practice rather than opting to receive their care in other nearby hospitals.
  • Without the influence of practice ownership, patients were more likely to choose lower cost, higher quality hospitals closer to their homes.
  • Accounting for practice ownership, patients of hospital-owned practices were more likely to use the owning hospital even when its costs were higher or its quality was lower than offered by other local hospitals.
  • Patients’ preferences for hospitals located closer to home were weakened but not overridden when the influence of physician practice ownership was taken into account.

What These Findings Mean

  • When a hospital owns a physician’s practice, patients cared for by that practice are dramatically more likely to choose the owning hospital over other local options when they need inpatient care.
  • Moreover, the hospitals chosen by these patients are more likely to be high cost and low quality, suggesting that adverse consequences can arise from the integration of hospitals and physician practices.

More About This Study

The study sample consists of Medicare patients admitted to a hospital in 2009. Information about the ownership of these patients’ physicians’ practices was drawn from SK&A files, and data on hospital characteristics came from the American Hospital Association. The intensity of each hospital’s resource use (its costs) was derived from the Dartmouth Atlas, whereas a composite quality measure was compiled from the Medicare Hospital Compare files.

These data were used to estimate conditional logit models of the probability that a patient chose a particular hospital as a function of hospital characteristics, practice ownership variables, and interactions between the two sets of variables. Hospital characteristics included measures of its costs, quality and distance from the patient, facility size, for-profit/non-profit ownership status, system membership, and teaching status. Ownership variables reflected whether the hospital owned any practices at all, whether it owned the patient’s physician practice specifically, and whether the practice was owned by any hospital. Several alternative analyses were conducted to assess the sensitivity of results to possible endogeneity issues and omitted variable bias.

Full Citation

Baker LC, Bundorf MK, and Kessler DP. “The Effect of Hospital/Physician Integration on Hospital Choice.” Journal of Health Economics, 50:1-8. December 2016.

For more information about this study, contact Dr. Daniel Kessler at fkessler[at]stanford.edu.
For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Dr. Julie Schoenman at 202-296-4426.

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This Research Insights summarizes findings from a study showing that a patient is more likely to choose a hospital that owns her doctor’s practice - even if the costs are higher and the quality lower than at other local hospitals.

Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

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Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

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