ArticleHealth affairs (Project Hope)2021
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration.
Article in Health affairs (Project Hope), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 66 citations in OpenAlex.
- Digitally enabled GP-specialist collaborative care helped improve hypertension outcomes and reduced hospital referrals in China.npj health systems · 2026Article
- Rhode Island Affordability Standards and Hospital-Affiliated Clinicians' Professional Fees.JAMA network open · 2026Article
- Paying in the dark: third-party administrator fees and the limits of employer cost control in self-insured health plans.Health affairs scholar · 2026Article
- Private Equity Acquisition in Primary Care and Avoidable Hospitalizations.JAMA health forum · 2026Article
- Higher intensity care for patients with multiple chronic conditions after hospital-physician integration.Health affairs scholar · 2026Article
- Site-neutral payment for routine services could save commercial purchasers and patients billions.Health affairs scholar · 2025Article
- Physician Practice Affiliation Drives Site of Care Cost Differentials: An Opportunity to Reduce Healthcare Expenditures.Journal of market access & health policy · 2025Article
- Hospital-Physician Integration and Cardiac Rehabilitation Following Major Cardiovascular Events.JAMA network open · 2025Article
- Hospital-physician integration and Medicare spending: Evidence from stable angina.Health services research · 2025Article
- Increases In Physician Professional Fees In Private Equity-Owned Gastroenterology Practices.Health affairs (Project Hope) · 2025Article
- Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications.JAMA health forum · 2025Article
- How do hospitals exert market power? Evidence from health systems and commercial health plan prices.Health affairs scholar · 2025Article
- Medicare transitional care management services' association with readmissions and mortality.Health affairs scholar · 2024Article
- The Effects of Physician Vertical Integration on Referral Patterns, Patient Welfare, and Market Dynamics.Journal of public economics · 2024Article
- Hospital behavior over the private equity life cycle.Journal of health economics · 2024Article
- Does vertical integration increase the costs for primary care inpatients? Evidence from a national pilot programme in China.Archives of public health = Archives belges de sante publique · 2024Article
- A more complete measure of vertical integration between physicians and hospitals.Health services research · 2024Article
- Decomposition of medical imaging spending growth between 2010 and 2021 in the US employer-insured population.Health affairs scholar · 2024Article
- Hospital-physician integration and clinical volume in traditional Medicare.Health services research · 2024Article
- Does Physician-Hospital Vertical Integration Affect Hospital Output?Health services insights · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
Abstract
In recent years direct ownership of physician practices by hospitals and health systems (that is, vertical integration) has become a prominent feature of the US health care system. One unexplored impact of vertical integration is the impact on referral patterns for common diagnostic tests and procedures and the associated spending. Using a 100 percent sample of 2013-16 Medicare fee-for-service claims data, we examined whether hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2 million and $32.9 million increases in Medicare spending, respectively, for the entire study period. This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.