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.

April 17, 2016

Cost Drivers of Cancer Care: A Retrospective Analysis of Medicare and Commercially Insured Population Claim Data 2004-2014, Milliman, April 2016

Nearly 14.5 million Americans with a history of cancer were alive in 2014 and that number is projected to increase to 18.1 million in 2020. A number of factors will contribute to this increase, including the growth and aging of the U.S. population, an overall reduction in mortality, the earlier detection of cancer (lead timebefore […]

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 […]

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 […]

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