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.

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 […]

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  […]

May 17, 2014

Innovation in cancer care and implications for health systems, IMS Institute, May 2014

Cancer remains a top priority for health systems around the world as incidence levels rise, fueled by growing and aging populations.  While some incidence is preventable and early diagnosis and treatment can reduce or delay mortality significantly the reality is that countries struggle to bring together the right combination of measures including vaccines, diagnostics and […]

April 22, 2014

340B Covered Entity Acquisitions of Physician-based Oncology Practices, Berkeley Research Group, April 22, 2014

The Physician-based Oncology Practice Acquisition study has three objectives: – Understand historical trends in physician-based oncology practice acquisitions by entities participating in the 340B program (“Covered Entities”) – Measure impact of such acquisitions on 340B chargebacks – Compare timing of such acquisitions with the registration date on the OPA database as a sub-entity of the […]

Contact Us