Post Brady, Kitsakos Aliya, Alinezhad Farbod, Young Gary
Department of Health Sciences, Bouve College of Health Science, Northeastern University, Boston, Massachusetts, USA.
Center for Health Policy and Healthcare Research, Northeastern University, Boston, Massachusetts, USA.
Health Serv Res. 2025 Feb;60(1):e14383. doi: 10.1111/1475-6773.14383. Epub 2024 Sep 22.
To examine the association between hospital-cardiologist integration and Medicare spending for stable angina patients.
This study used Medicare Standard Analytic Files from 2013 to 2020 and the Centers for Medicare and Medicaid Services National Downloadable File for accompanying physician data.
This was a retrospective cohort study of Medicare beneficiaries with a new diagnosis of stable angina between 2013 and 2020.
DATA COLLECTION/EXTRACTION METHODS: Patients with a new diagnosis of stable angina were categorized by whether they received care from an independent or a hospital-integrated cardiologist.
Total spending for this sample was high: an average of $103,946 per patient over 12 months. Adjusted for covariates, patients of integrated cardiologists did not spend significantly more or less than clinically comparable patients of independent cardiologists (-$3856, 95% CI: -$8631 to 920, p = 0.11). This was true for overall inpatient (-$2622, 95% CI: -6069 to 825, p = 0.14) and outpatient (-1162, 95% CI: -$3510 to 1185, p = 0.33) spending as well as cardiology-specific inpatient and outpatient spending. Among high-risk patients, overall spending between the integrated and independent groups was comparable, though patients of integrated cardiologists incurred lower spending than those of their independent counterparts in inpatient care (-$13,589; 95% CI: -24,432 to -2746, p = 0.01). In a supplemental analysis, findings suggested that site-neutral payments would have resulted in lower spending among patients of integrated physicians.
Specific clinical settings may lend themselves to efficiencies created by integration for certain complex patients, though we do not test a causal mechanism here. Adoption of site-neutral payment policy may also lead to lower spending among patients of integrated physicians.
Hospital-physician integration has increased significantly in the United States. Policymakers and health policy experts have expressed concerns that hospital-physician integration leads to increased health spending and may threaten healthcare affordability. While some studies link integration to greater spending, many use incomplete measures of spending, do not consider the potential benefits of care coordination, or rely on outdated data.
Spending among patients with stable angina, a common cardiovascular condition, was nearly equal, on average, across patients of integrated and independent cardiologists. Inpatient spending on high-risk patients was somewhat lower for those under the care of integrated cardiologists. Overall, patients of integrated cardiologists incurred largely comparable spending relative to patients of independent cardiologists, indicating that the impact of hospital-physician integration may depend on the clinical context.
研究医院与心脏病专家整合与稳定型心绞痛患者医疗保险支出之间的关联。
本研究使用了2013年至2020年的医疗保险标准分析文件以及医疗保险和医疗补助服务中心的国家可下载文件中的随行医生数据。
这是一项对2013年至2020年间新诊断为稳定型心绞痛的医疗保险受益人的回顾性队列研究。
数据收集/提取方法：新诊断为稳定型心绞痛的患者根据其接受独立心脏病专家还是医院整合心脏病专家的治疗进行分类。
该样本的总支出较高：每位患者在12个月内平均支出103,946美元。经协变量调整后，整合心脏病专家的患者支出与独立心脏病专家的临床可比患者相比，没有显著多花或少花（-3856美元，95%置信区间：-8631美元至920美元，p = 0.11）。总体住院支出（-2622美元，95%置信区间：-6069美元至825美元，p = 0.14）、门诊支出（-1162美元，95%置信区间：-3510美元至1185美元，p = 0.33）以及心脏病专科住院和门诊支出均是如此。在高危患者中，整合组和独立组的总体支出相当，不过整合心脏病专家的患者在住院治疗方面的支出低于独立心脏病专家的患者（-13,589美元；95%置信区间：-24,432美元至-2746美元，p = 0.01）。在一项补充分析中，研究结果表明，场地中立支付可能会使整合医生的患者支出降低。
特定的临床环境可能有助于为某些复杂患者实现整合带来的效率提升，尽管我们在此并未测试因果机制。采用场地中立支付政策也可能导致整合医生的患者支出降低。
美国医院与医生的整合显著增加。政策制定者和卫生政策专家担心医院与医生的整合会导致医疗支出增加，并可能威胁到医疗保健的可负担性。虽然一些研究将整合与更高的支出联系起来，但许多研究使用的支出衡量方法不完整，没有考虑到护理协调的潜在益处，或者依赖过时的数据。
稳定型心绞痛（一种常见的心血管疾病）患者中，整合心脏病专家和独立心脏病专家的患者平均支出几乎相等。整合心脏病专家护理的高危患者的住院支出略低。总体而言，整合心脏病专家的患者与独立心脏病专家的患者支出大致相当，这表明医院与医生整合的影响可能取决于临床背景。
