The Role of Physician Integration in Alternative Payment Models: The Case of the Comprehensive Joint Replacement Program

References

• Alexander D (2020) How do doctors respond to incentives? Unintended consequences of paying doctors to reduce costs. J. Political Econom. 128(11):4046–4096. Crossref, Google Scholar
• Baker LC, Bundorf MK, Kessler DP (2014a) Vertical integration: Hospital ownership of physician practices is associated with higher prices and spending. Health Affairs 33(5):756–763.Crossref, Google Scholar
• Baker LC, Bundorf MK, Royalty AB, Levin Z (2014b) Physician practice competition and prices paid by private insurers for office visits. JAMA 312(16):1653–1662.Crossref, Google Scholar
• Barnett ML, Wilcock A, McWilliams JM, Epstein AM, Joynt Maddox KE, Orav EJ, Grabowski DC, Mehrotra A (2019) Two-year evaluation of mandatory bundled payments for joint replacement. New England J. Medicine 380(3):252–262.Crossref, Google Scholar
• Bartel A, Chan CW, Kim S (2020) Should hospitals keep their patients longer? The role of inpatient care in reducing postdischarge mortality. Management Sci. 66(6):2326–2346.Link, Google Scholar
• Bastani H, Goh J, Bayati M (2018) Evidence of upcoding in pay-for-performance programs. Management Sci. 65(3):1042–1060.Link, Google Scholar
• Bozic KJ, Grosso LM, Lin Z, Parzynski CS, Suter LG, Krumholz HM, Lieberman JR, et al. (2014) Variation in hospital-level risk-standardized complication rates following elective primary total hip and knee arthroplasty. J. Bone Joint Surgery Amer. 96(8):640–647.Crossref, Google Scholar
• Burns LR, Muller RW (2008) Hospital-physician collaboration: Landscape of economic integration and impact on clinical integration. Milbank Quart. 86(3):375–434.Crossref, Google Scholar
• Burns LR, Pauly MV (2018) Transformation of the health care industry: Curb your enthusiasm? Milbank Quart. 96(1):57–109.Crossref, Google Scholar
• Burns LR, Goldsmith JC, Sen A (2014) Horizontal and vertical integration of physicians: A tale of two tails. Adv. Health Care Management 15:39–117.Crossref, Google Scholar
• Capps C, Dranove D, Ody C (2018) The effect of hospital acquisitions of physician practices on prices and spending. J. Health Econom. 59:139–152.Crossref, Google Scholar
• Chen C, Savva N (2018) Unintended consequences of hospital regulation: The case of the hospital readmissions reduction program. Preprint, submitted August 22, http://dx.doi.org/10.2139/ssrn.3236983.Google Scholar
• Dai T, Tayur S (2020) Om forum—Healthcare operations management: A snapshot of emerging research. Manufacturing Service Oper. Management 22(5):869–887.Link, Google Scholar
• DuGoff EH, Schuler M, Stuart EA (2014) Generalizing observational study results: Applying propensity score methods to complex surveys. Health Serv. Res. 49(1):284–303.Crossref, Google Scholar
• Dunn A, Shapiro AH (2018) Physician competition and the provision of care: Evidence from heart attacks. Amer. J. Health Econom. 4(2):226–261.Crossref, Google Scholar
• FitzGerald J, Boscardin J, Hahn B, Ettner S (2007) Impact of the Medicare short stay transfer policy on patients undergoing major orthopedic surgery. Health Serv. Res. 42(1p1):25–44.Crossref, Google Scholar
• Gelman A (2007) Struggles with survey weighting and regression modeling. Statist. Sci. 22(2):153–164.Google Scholar
• Goldsmith J, Kaufman N, Burns L (2016) The tangled hospital-physician relationship. Health Affairs Blog (May 9), https://www.healthaffairs.org/content/forefront/tangled-hospital-physician-relationship.Google Scholar
• Haas DA, Zhang X, Kaplan RS, Song Z (2019) Evaluation of economic and clinical outcomes under Centers for Medicare & Medicaid Services mandatory bundled payments for joint replacements. JAMA Internal Medicine 179(7):924–931.Crossref, Google Scholar
• Ham DW, Miratrix L (2022) Benefits and costs of matching prior to a difference in differences analysis when parallel trends does not hold. Preprint, submitted May 17, https://arxiv.org/abs/2205.08644.Google Scholar
• Hausman N, Lavetti K (2021) Physician practice organization and negotiated prices: Evidence from state law changes. Amer. Econom. J. Appl. Econom. 13(2):258–296.Crossref, Google Scholar
• HCPLAN (2019) APM measurement progress of alternative payment models. Technical report, https://hcp-lan.org/workproducts/apm-methodology-2019.pdf.Google Scholar
• Healthcare Cost and Utilization Project (2005) State inpatient databases (SID). Agency for Healthcare Research and Quality, Rockville, MD. Google Scholar
• Ho V, Metcalfe L, Vu L, Short M, Morrow R (2019) Annual spending per patient and quality in hospital-owned versus physician-owned organizations: An observational study. J. General Internal Medicine 35(3):649–655.Crossref, Google Scholar
• KFF (2014) Hospital adjusted expenses per inpatient day. The Henry J. Kaiser Family Foundation. http://kff.org/other/state-indicator/expenses-per-inpatient-day/.Google Scholar
• Kim H, Meath THA, Grunditz JI, Quiñones AR, Ibrahim SA, McConnell KJ (2018) Characteristics of hospitals exiting the newly voluntary comprehensive care for joint replacement program. JAMA Internal Medicine 178(12):1715–1717.Crossref, Google Scholar
• Koch T, Ulrick SW (2021) Price effects of a merger: Evidence from a physician’s market. Econom. Inquiry 59(2):790–802.Crossref, Google Scholar
• Koch T, Wendling B, Wilson NE (2018) Physician market structure, patient outcomes, and spending: An examination of Medicare beneficiaries. Health Serv. Res. 53(5):3549–3568.Crossref, Google Scholar
• Lan Y, Chandrasekaran A, Goradia D, Walker D (2022) Collaboration structures in integrated healthcare delivery systems: An exploratory study of accountable care organizations. Manufacturing Service Oper. Management 24(3):1796–1820.Link, Google Scholar
• Ledford MK, Lambrew JM, Rothman DJ, Podesta JD (2008) The healthcare delivery system: A blue print for reform. Center for American Progress and Institute on Medicine as a Profession.Google Scholar
• Lin H, McCarthy IM, Richards MR, Whaley C (2021) Owning the agent: Hospital influence on physician behaviors. Technical Report, National Bureau of Economic Research.Google Scholar
• Lundy D (2016) A day at the office: Is private practice orthopaedic surgery dead? Clin. Orthop. Relat. Res. 474(11):2354–2356.Crossref, Google Scholar
• Machta RM, Reschovsky J, Jones DJ, Furukawa MF, Rich EC (2020) Can vertically integrated health systems provide greater value: The case of hospitals under the comprehensive care for joint replacement model? Health Serv. Res. 55(4):541–547.Crossref, Google Scholar
• McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL (2016) Early performance of accountable care organizations in Medicare. New England J. Medicine 374(24):2357–2366.Crossref, Google Scholar
• Meath THA, Juarez C, McConnell KJ, Kim H (2022) Hospital characteristics associated with heterogeneity in institutional postacute care spending reductions under the comprehensive care for joint replacement model. JAMA Health Forum 3(6):e221657.Crossref, Google Scholar
• Neprash HT, McWilliams JM (2019) Provider consolidation and potential efficiency gains: A review of theory and evidence. Antitrust Law J. 82(2):551–578.Google Scholar
• Neprash HT, Chernew ME, Hicks AL, Gibson T, McWilliams JM (2015) Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Internal Medicine 175(12):1932–1939.Crossref, Google Scholar
• Physicians Advocacy Institute (2024) Updated report: Hospital and corporate acquisition of physician practices and physician employment 2019–2023. Technical report, Physicians Advocacy Institute.Google Scholar
• Post B, Buchmueller T, Ryan AM (2018) Vertical integration of hospitals and physicians: Economic theory and empirical evidence on spending and quality. Medical Care Res. Rev. 75(4):399–433.Crossref, Google Scholar
• Quinn K (2015) The 8 basic payment methods in health care. Ann. Intern. Med. 163(4):300–306.Crossref, Google Scholar
• Saghafian S, Song L, Newhouse J, Landrum MB, Hsu J (2023) The impact of vertical integration on physician behavior and healthcare delivery: Evidence from gastroenterology practices. Management Sci. 69(12):7158–7179.Link, Google Scholar
• Scott KW, Orav JE, Cutler DM, Jha AK (2017) Changes in hospital–Physician affiliations in us hospitals and their effect on quality of care. Ann. Internal Medicine 166(1):1–8.Crossref, Google Scholar
• Shih A, Davis K, Schoenbaum S, Gauthier A, Nuzum R, McCarthy D (2008) Organizing the US Health Care Delivery System for High Performance, vol. 59 (The Commonwealth Fund, New York).Google Scholar
• Soltani M, Batt RJ, Bavafa H (2025) Quality improvement spillovers: Evidence from the hospital readmissions reduction program. Management Sci. 71(7):6112–6130.Link, Google Scholar
• Sun E, Baker LC (2015) Concentration in orthopedic markets was associated with a 7 percent increase in physician fees for total knee replacements. Health Affairs 34(6):916–921.Crossref, Google Scholar
• Taheri PA, Butz DA, Greenfield LJ (2000) Length of stay has minimal impact on the cost of hospital admission. J. Amer. College Surgeons 191(2):123–130.Crossref, Google Scholar
• The Lewin Group (2018) CMS comprehensive care for joint replacement model: Performance year 1 evaluation report. Technical report, https://innovation.cms.gov/files/reports/cjr-firstannrpt.pdf.Google Scholar
• The Lewin Group (2019) CMS comprehensive care for joint replacement model: Performance year 2 evaluation report. Technical report, https://innovation.cms.gov/files/reports/cjr-secondannrpt.pdf.Google Scholar
• The Lewin Group (2020) CMS comprehensive care for joint replacement model: Performance year 3 evaluation report. Technical report, https://innovation.cms.gov/data-and-reports/2020/cjr-thirdannrpt.Google Scholar
• The Lewin Group (2021) CMS comprehensive care for joint replacement model: Performance year 4 evaluation report. Technical report, https://innovation.cms.gov/data-and-reports/2021/cjr-py4-annual-report.Google Scholar
• Vlachy J, Ayer T, Ayvaci M, Raghunathan S (2023) The business of healthcare: The role of physician integration in bundled payments. Manufacturing Service Oper. Management 25(3):996–1012.Link, Google Scholar
• Wang G (2022) The effect of Medicaid expansion on wait time in the emergency department. Management Sci. 68(9):6648–6665.Link, Google Scholar
• Wilcock AD, Barnett ML, McWilliams JM, Grabowski DC, Mehrotra A (2021) hospital responses to incentives in episode-based payment for joint surgery: A controlled population-based study. JAMA Internal Medicine 181(7):932–940.Crossref, Google Scholar
• Young GJ, Zepeda ED, Flaherty S, Thai N (2021) Hospital employment of physicians in Massachusetts is associated with inappropriate diagnostic imaging: Study examines association between hospital employment of physicians and diagnostic imaging. Health Affairs 40(5):710–718.Crossref, Google Scholar
• Zeng F, Waldo D (2016) Total knee arthroplasty post acute care costs by discharge status. Value Health 19(3):A13–A14.Crossref, Google Scholar