ArticleHealth services research2024
A more complete measure of vertical integration between physicians and hospitals.
Article in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Transforming the Indian Private Sector for Universal Health Coverage.Healthcare (Basel, Switzerland) · 2025Article
- Health System Affiliation and Care for Dual-Eligible and Non-Dual-Eligible Medicare Beneficiaries.JAMA network open · 2025Article
- The Association of Hospital-Cardiologist Integration With Patient Outcomes, Care Quality, and Utilization.Journal of the American College of Cardiology · 2025Article
- A more complete measure of vertical integration between physicians and hospitals.Health services research · 2024Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo develop an accurate and reproducible measure of vertical integration between physicians and hospitals (defined as hospital or health system employment of physicians), which can be used to assess the impact of integration on healthcare quality and spending. DATA SOURCES AND STUDY
settingWe use multiple data sources including from the Internal Revenue Service, the Centers for Medicare and Medicaid Services, and others to determine the Tax Identification Numbers (TINs) that hospitals and physicians use to bill Medicare for services, and link physician billing TINs to hospital-related TINs. STUDY
designWe developed a new measure of vertical integration, based on the TINs that hospitals and physicians use to bill Medicare, using a broad set of sources for hospital-related TINs. We considered physicians as hospital-employed if they bill Medicare primarily or exclusively using hospital-related TINs. We assessed integration status for all physicians who billed Medicare from 1999 to 2019. We compared this measure with others used in the existing literature. We conducted a simulation study which highlights the importance of accurately identifying integrated physicians when study the effects of integration. DATA COLLECTION/EXTRACTION
methodsWe extracted physician and hospital-related TINs from multiple sources, emphasizing specificity (a small proportion of nonintegrated physicians identified as integrated). PRINCIPAL
findingsWe identified 12,269 hospital-related TINs, used for billing by 546,775 physicians. We estimate that the percentage of integrated physicians rose from 19% in 1999 to 43% in 2019. Our approach identifies many additional physician practices as integrated; a simpler TIN measure, comparable with prior work, identifies only 30% (3877) of the TINs we identify. A service location measure, used in prior work, has both many false positives and false negatives.
conclusionWe developed a new measure of hospital-physician integration. This measure is reproducible and identifies many additional physician practices as integrated.
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Registered trials
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