There is considerable data showing that disparities in payment across sites of service increase costs to patients, insurers and taxpayers as well as result in marketplace consolidation that limits patient choice by reducing access to care in the community-setting.

March 17, 2016

National Estimates of Price Variation by Site of Care, American Journal of Managed Care, March 2016

Recently, researchers and policy makers have demonstrated growing interest in differences in payments across sites of care for the same healthcare service, such as in a hospital outpatient department (HOPD) versus a physician office (PO). Our objective was to examine the price differential for individuals with employer-sponsored insurance by site of care for 7 commonly […]

March 13, 2016

The impact of provider consolidation on outpatient prescription drug-based cancer care spending, Health Care Cost Institute, March 2016

Many policymakers (including state attorney general offices, Medicaid program directors, insurance commissioners) worry about the effects of medical provider consolidation on spending levels and trends. Medical provider consolidation’s impact on spending is an empirical question. On the one hand, consolidation may lead to the identification and dissemination of best practices and reductions in the use […]

February 17, 2016

Medicare Payment Differentials Across Outpatient Settings of Care, Avalere, February 2016

Medicare beneficiaries can receive the same services in different outpatient settings, yet various providers in those settings can receive different payments for that care and beneficiaries can face different cost-sharing amounts. For example, a Medicare beneficiary could receive a colonoscopy in the hospital outpatient department (HOPD), an ambulatory surgical center (ASC) or a physician office. […]

December 17, 2015

Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform, Government Accountability Office, December 2015

Medicare expenditures for HOPD services have grown rapidly in recent years. Some policymakers have raised questions about whether this growth may be attributed to services that were typically performed in physician offices shifting to HOPDs. GAO was asked to examine trends in vertical consolidation and its effects on Medicare. This report examines, for years 2007 […]

October 19, 2015

Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices, JAMA, October 19, 2015

IMPORTANCE Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. OBJECTIVE To assess the association between recent increases in physician-hospital integration and changes in […]

August 17, 2015

The Effect of Hospital/Physician Integration on Hospital Choice, National Bureau of Economic Research, August 2015

In this paper, we estimate how hospital ownership of physicians’ practices affects their patients’ hospital choices.  We match data on the hospital admissions of Medicare beneficiaries, including the identity of their admitting physician, with data on the identity of the owner of the admitting physician’s practice. We find that a hospital’s ownership of an admitting […]

May 17, 2015

Developments in Cancer Treatments, Market Dynamics, Patient Access and Value, IMS Institute, May 2015

A cluster of innovative medicines for patients with a wide variety of tumor types and based on promising new mechanisms of action has heightened excitement about prospects for major advances in cancer treatment. The large number of potential new medicines currently in clinical development or under regulatory review suggests breakthroughs will continue and bring not […]

February 17, 2015

Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote Efficiency, Government Accountability Office, February 2015

To control costs and reward efficiency, Medicare pays the majority of hospitals under PPSs, which make payments on the basis of the clinical classification of each service. In response to concerns that cancer hospitals would experience payment reductions under a PPS, beginning in 1983, Congress required the establishment of criteria under which 11 PCHs are […]

June 17, 2014

Location, Location, Location: Hospital Outpatient Prices Much Higher than Community Settings for Identical Services, National Institute for Health Care Reform, June 2014

Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price for identical services provided in a physician’s office or other community-based setting, according to a study by researchers at the former Center for Studying Health System Change (HSC). Using  private insurance claims data for about 590,000 active and […]

June 17, 2014

Impact on Medicare Payments of Shift in Site of Care for Chemotherapy Administration, Berkeley Research Group, June 2014

Two  independent  trends,  acting  in  combination,  are  currently  resulting  in  increased  Medicare  fee-for-service (FFS)  chemotherapy  payments.  The  first  trend  is  a  shift  in  the  site  of  care  for  cancer  patients  from  physicians’  offices to hospital outpatient departments. Several factors contribute to this shift; this study evaluates the effects of  one  of  those  factors —the  acquisition  […]

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