Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
Haas School of Business, University of California, Berkeley, Berkeley, California.
Pediatrics. 2023 Apr 1;151(4). doi: 10.1542/peds.2022-057931.
Physician management companies (PMCs) acquire physician practices and contract with hospitals to provide physician management services. We evaluated the association between PMC-NICU affiliations and prices, spending, utilization, and clinical outcomes.
We linked commercial claims to PMC-NICU affiliations and conducted difference- in-differences analyses comparing changes in prices paid for physician services per critical or intensive care NICU day, length of the NICU stay, physician spending (total paid amount for physician services during stay), spending on hospital services (total paid amount for hospital services during stay), and clinical outcomes in PMC-affiliated versus non-PMC-affiliated NICUs. The study included 2858 infants admitted to 34 PMC-affiliated NICUs and 92 461 infants admitted to 2348 NICUs without an affiliation.
PMC affiliation was associated with a differential increase in the mean price of the 5 most common types of critical and intensive care days in NICU admissions by $313 per day (95% confidence interval, $207-$419) for PMC-affiliated versus non- PMC-affiliated NICUs. This represents a 70.4% increase in prices, relative to the preaffiliation period PMC and non- PMC-affiliated NICU means. PMC-NICU affiliation was also associated with a differential increase in physician spending by $5161 per NICU stay (95% confidence interval, $3062-$7260), a 56.4% increase. There was no significant association between PMC-NICU affiliation and changes in length of stay, clinical outcomes, or hospital spending.
PMC affiliation was associated with large increases in prices and total spending for NICU services, but not with changes in length of stay or adverse clinical outcomes.
医师管理公司（PMC）收购医师执业，并与医院签订合同，提供医师管理服务。我们评估了 PMC-NICU 附属关系与价格、支出、利用和临床结果之间的关联。
我们将商业索赔与 PMC-NICU 附属关系相关联，并进行了差异中的差异分析，比较了每个重症监护或强化护理 NICU 日支付的医师服务价格、NICU 住院时间、医师支出（住院期间支付的医师服务总金额）、医院服务支出（住院期间支付的医院服务总金额）以及 PMC 附属和非 PMC 附属 NICU 之间的临床结果的变化。该研究包括 2858 名入住 34 家 PMC 附属 NICU 和 92461 名入住 2348 家无附属关系 NICU 的婴儿。
PMC 附属关系与 5 种最常见的 NICU 入住重症监护和强化护理日的平均价格差异相关，附属 PMC 的 NICU 比非附属 PMC 的 NICU 每天增加 313 美元（95%置信区间，207-419 美元）。这代表了与附属前 PMC 和非附属 NICU 平均值相比，价格上涨了 70.4%。PMC-NICU 附属关系还与医师支出的差异增加有关，每 NICU 住院增加 5161 美元（95%置信区间，3062-7260 美元），增加了 56.4%。PMC-NICU 附属关系与住院时间、临床结果或医院支出的变化之间没有显著关联。
PMC 附属关系与 NICU 服务的价格和总支出大幅增加有关，但与住院时间或不良临床结果的变化无关。
