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.
  • Awards

    We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards. This year’s awards are virtual because of the COVID-19 pandemic, yet we invite you to meet the winners and learn about their award-winning work. NIHCM is also announcing the largest grant program in our history — $1 million to support work in journalism and research.

    Meet the Winners Press Release
  • Data Insights

    This infographic highlights the health challenges faced by the homeless community and outlines short and long term solutions to improve the health and well-being of these individuals, through social, economic and housing interventions.

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  • Data Insights

    This new Data Insights highlights the rapid rise in overdose deaths involving cocaine and methamphetamine, illustrates the geographic variations in utilization and death rates, and quantifies the increasing burden that these drugs are placing on the hospital system.

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  • Data Insights

    This infographic delves into an emerging public health emergency involving rapidly rising rates of stimulant use and related overdose deaths, which has been occurring in the shadow of the opioid crisis.

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  • News

    NIHCM would like to provide you and your organizations with a list of resources concerning COVID-19 and vulnerable populations. We will continually update this list.

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  • News

    To help you find answers to questions concerning COVID-19, NIHCM is providing you with links to expert sources that are frequently updated. We will continually update this list.

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Events

June 24, 2020
Alliance-covid19-webinar-image

This COVID-19 Webinar Miniseries synthesizes the information in the headlines to provide cohesive insight into the status of the response and remaining gaps in the system that must be addressed to limit the severity of the COVID-19 outbreak in the United States.

June 18, 2020
Homelessness Webianr Graphic

This webinar looked at the state of homelessness in the US and provided strategies to improve outcomes for homeless individuals both in the short term and in the long term.

In the News

June 2020
Population Health Spotlight
graphic-newsletter-june

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

June 24, 2020
Alliance-covid19-webinar-image

This COVID-19 Webinar Miniseries synthesizes the information in the headlines to provide cohesive insight into the status of the response and remaining gaps in the system that must be addressed to limit the severity of the COVID-19 outbreak in the United States.

June 18, 2020
Homelessness Webianr Graphic

This webinar looked at the state of homelessness in the US and provided strategies to improve outcomes for homeless individuals both in the short term and in the long term.

In the News

June 2020
Population Health Spotlight
graphic-newsletter-june

Grants

Journalism GrantsJournalism Grant Program

The 2020-2021 round of grant making for this program is now underway. Letters of Inquiry will be due by July 27, 2020.

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Investigator-Initiated Research Grant Program

The 2020-2021 round of grant making for this program is now underway. The deadline to submit Letters of Inquiry has been extended to July 20, 2020.

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Awards

The 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards.

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