Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
JAMA Intern Med. 2022 Apr 1;182(4):396-404. doi: 10.1001/jamainternmed.2022.0004.
Physician management companies (PMCs), often backed by private equity (PE), are increasingly providing staffing and management services to health care facilities, yet little is known of their influence on prices.
To study changes in prices paid to practitioners (anesthesiologists and certified registered nurse anesthetists) before and after an outpatient facility contracted with a PMC.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used difference-in-differences methods to compare price changes before and after a facility contracted with a PMC with facilities that did not and to compare differences between PMCs with and without PE investment. Commercial claims data (2012-2017) from 3 large national insurers in the Health Care Cost Institute database were combined with a novel data set of PMC facility contracts to identify prices paid to anesthesia practitioners in hospital outpatient departments and ambulatory surgery centers. The cohort included 2992 facilities that never contracted with a PMC and 672 facilities that contracted with a PMC between 2012 and 2017, collectively representing 2 255 933 anesthesia claims.
Temporal variation in facility-level exposure to PMC contracts for anesthesia services.
Main outcomes were (1) allowed amounts and the unit price (allowed amounts standardized per unit of service) paid to anesthesia practitioners; and (2) the probability that a practitioner was out of network.
From before to after the PMC contract period, allowed amounts increased by 16.5% (+$116.39; 95% CI, $76.11 to $156.67; P < .001), and the unit price increased by 18.7% (+$18.79; 95% CI, $12.73 to $24.84; P < .001) in PMC facilities relative to non-PMC facilities. Results did not show evidence that anesthesia practitioners were moved out of network (+2.25; 95% CI, -2.56 to 7.06; P < .36). In subsample analyses, PMCs without PE investment increased allowed amounts by 12.9% (+$89.88; 95% CI, $42.07 to $137.69; P < .001), while PE-backed PMCs (representing half of the PMCs in the sample) increased allowed amounts by 26.0% ($187.06; 95% CI, $133.59 to $240.52; P < .001). Similar price increases were observed for unit prices.
In this cohort study, prices paid to anesthesia practitioners increased after hospital outpatient departments and ambulatory surgery centers contracted with a PMC and were substantially higher if the PMC received PE investment. This research provides insights into the role of corporate ownership in health care relevant to policy makers, payers, practitioners, and patients.
医师管理公司（PMC）通常由私募股权（PE）支持，它们越来越多地向医疗机构提供人员配备和管理服务，但对于它们对价格的影响知之甚少。
研究在与 PMC 签订合同的门诊机构前后，医生（麻醉师和注册护士麻醉师）的支付价格变化。
设计、设置和参与者：这项回顾性队列研究使用差异中的差异方法，将与 PMC 签订合同的医疗机构前后的价格变化与未签订合同的医疗机构进行比较，并将具有和不具有私募股权投资的 PMC 进行比较。来自健康成本研究所数据库的 3 家大型全国保险公司的商业索赔数据（2012-2017 年）与 PMC 设施合同的新数据集相结合，以确定在医院门诊和门诊手术中心支付给麻醉师的价格。该队列包括 2992 家从未与 PMC 签订合同的医疗机构和 2012 年至 2017 年间与 PMC 签订合同的 672 家医疗机构，共计 2992 家医疗机构，代表了 2992 家医疗机构。2992 名麻醉师的 255933 项索赔。
设施层面接触麻醉服务 PMC 合同的时间变化。
主要结果是（1）向麻醉师支付的允许金额和单价（按每单位服务标准化的允许金额）；（2）医生不在网络内的概率。
与非 PMC 设施相比，在 PMC 设施中，从签订 PMC 合同前到签订 PMC 合同后，允许金额增加了 16.5%（增加 116.39 美元；95%CI，76.11 美元至 156.67 美元；P<0.001），单价增加了 18.7%（增加 18.79 美元；95%CI，12.73 美元至 24.84 美元；P<0.001）。结果并未表明麻醉师被转移到网络之外（增加 2.25；95%CI，-2.56 美元至 7.06 美元；P<0.36）。在亚样本分析中，没有私募股权投资的 PMC 允许金额增加了 12.9%（增加 89.88 美元；95%CI，42.07 美元至 137.69 美元；P<0.001），而获得私募股权投资的 PMC（占样本中 PMC 的一半）允许金额增加了 26.0%（增加 187.06 美元；95%CI，133.59 美元至 240.52 美元；P<0.001）。单价也出现了类似的价格上涨。
在这项队列研究中，与 PMC 签订合同的门诊和门诊手术中心的麻醉师支付价格在签订合同后有所增加，如果 PMC 获得了私募股权投资，价格则大幅上涨。这项研究为决策者、支付者、从业者和患者提供了有关公司所有权在医疗保健方面的作用的见解。
