The Business of Healthcare: The Role of Physician Integration in Bundled Payments

Published Online:https://doi.org/10.1287/msom.2023.1187

References

  • Adida E, Mamani H, Nassiri S (2017) Bundled payment vs. fee-for-service: Impact of payment scheme on performance. Management Sci. 63(5):1606–1624.LinkGoogle Scholar
  • Agarwal R, Liao JM, Gupta A, Navathe AS (2020) The impact of bundled payment on healthcare spending, utilization, and quality: A systematic review: A systematic review of the impact on spending, utilization, and quality outcomes from three centers for Medicare and Medicaid services bundled payment programs. Health Affairs 39(1):50–57.CrossrefGoogle Scholar
  • Altman S (2012) The lessons of Medicare’s prospective payment system show that the bundled payment program faces challenges. Health Affairs 31(9):1923–1930.CrossrefGoogle Scholar
  • American Hospital Association (2013) Moving toward bundled payment. Accessed January 1, 2023, https://www.aha.org/issue-brief/2013-01-25-moving-towards-bundled-payment.Google Scholar
  • Andritsos DA, Tang CS (2018) Incentive programs for reducing readmissions when patient care is co-produced. Production Oper. Management 27(6):999–1020.CrossrefGoogle Scholar
  • Ata B, Killaly B, Olsen T, Parker R (2013) On hospice operations under Medicare reimbursement policies. Management Sci. 59(5):1027–1044.LinkGoogle Scholar
  • Berwick D, Hackbarth A (2012) Eliminating waste in US healthcare. JAMA 307(14):1513–1516.CrossrefGoogle Scholar
  • Bloom N, Sadun R, Van Reenen J (2013) Does management matter in healthcare. Working paper, London School of Economics, London.Google Scholar
  • Boadway R, Marchand M, Sato M (2004) An optimal contract approach to hospital financing. J. Health Econom. 23(1):85–110.CrossrefGoogle Scholar
  • Budetti PP, Shortell SM, Waters TM, Alexander JA, Burns LR, Gillies RR, Zuckerman H (2002) Physician and health system integration. Health Affairs 21(1):203–210.CrossrefGoogle Scholar
  • Burns LR, Muller R (2008) Hospital-physician collaboration: Landscape of economic integration and impact on clinical integration. Milbank Quart. 86(3):375–434.CrossrefGoogle Scholar
  • Burns L, Alexander J, Shortell S, Zuckerman H, Budetti P, Gillies R, Waters T (2001) Physician commitment to organized delivery systems. Medical Care 39(7):I–9.Google Scholar
  • Chandra A, Cutler D, Song Z (2012) Who ordered that? The economics of treatment choices in medical care. Pauly M, McGuire T, Barros P, eds. Handbook of Health Economics, vol. 2. (Elsevier, Amsterdam), 397–432.Google Scholar
  • Chen C, Delana K (2022) The role of physician integration in alternative payment models: The case of the Comprehensive Joint Replacement program. Preprint, submitted August 20, http://dx.doi.org/10.2139/ssrn.4195640.Google Scholar
  • Crainich D, Leleu H, Mauleon A (2008) The optimality of hospital financing system: The role of physician–manager interactions. Internat. J. Health Care Finance Econom. 8(4):245–256.CrossrefGoogle Scholar
  • Custer W, Moser J, Musacchio R, Willke R (1990) The production of healthcare services and changing hospital reimbursement: The role of hospital–medical staff relationships. J. Health Econom. 9(2):167–192.CrossrefGoogle Scholar
  • Daly R (2016) Physician recruitment competition spreads to urban areas: Analysis. HFM Magazine (February).Google Scholar
  • Davis K, Stremikis K, Squires D, Schoen C (2014) Mirror, mirror on the wall: How the performance of the U.S. healthcare system compares internationally. Technical report, Commonwealth Fund, New York.Google Scholar
  • De Bleser L, Depreitere R, de Waele K, Vanhaecht K, Vlayen J, Sermeus W (2006) Defining pathways. J. Nursing Management 14(7):553–563.CrossrefGoogle Scholar
  • Dor A, Watson H (1995) The hospital-physician interaction in US hospitals: Evolving payment schemes and their incentives. Eur. Econom. Rev. 39(3):795–802.CrossrefGoogle Scholar
  • Dranove D, Jin Z (2010) Quality disclosure and certification: Theory and practice. J. Econom. Literature 48(4):935–963.CrossrefGoogle Scholar
  • Dummit L, Marrufo G, Marshall J, Bradley A, Smith L, Hall C, Lee Y, et al. (2015) CMS bundled payments for care improvement (BPCI) initiative models 2-4: Year 1 evaluation and monitoring annual report. Technical report, The Lewin Group, Falls Church, VA.Google Scholar
  • Ellis R, McGuire T (1986) Provider behavior under prospective reimbursement: Cost sharing and supply. J. Health Econom. 5(2):129–151.CrossrefGoogle Scholar
  • Fisher E, Wennberg D, Stukel T, Gottlieb D, Lucas FL, Pinder E (2003) The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Ann. Internal Medicine 138(4):273–287.CrossrefGoogle Scholar
  • Friedberg M, Chen P, White C, Jung O, Raaen L, Hirshman S, Hoch E, et al. (2015) Effects of healthcare payment models on physician practice in the United States. Report, RAND Corporation, Santa Monica, CA.CrossrefGoogle Scholar
  • Froimson M, Rana A, White R, Marshall A, Schutzer S, Healy W, Naas P, Daubert G, Iorio R, Parsley B (2013) Bundled payments for care improvement initiative: The next evolution of payment formulations: AAHKS bundled payment task force. J. Arthroplasty 28(8):157–165.CrossrefGoogle Scholar
  • Gaynor M, Town R (2012) The Impact of Hospital Consolidation–Update (The Synthesis Project, Robert Wood Johnson Foundation, Princeton, NJ).Google Scholar
  • Ghamat S, Zaric GS, Pun H (2021) Care-coordination: Gain-sharing agreements in bundled payment models. Production Oper. Management 30(5):1457–1474.CrossrefGoogle Scholar
  • Goldsmith J, Kaufman N, Burns L (2016) The tangled hospital-physician relationship. Accessed January 1, 2023, http://healthaffairs.org/blog/2016/05/09/the-tangled-hospital-physician-relationship/.Google Scholar
  • Grady D, Redberg RF (2010) Less is more: How less healthcare can result in better health. Arch. Internal Medicine 170(9):749–750.CrossrefGoogle Scholar
  • Grandusky R, Kronenberg K (2006) Hospital-physician gainsharing. Trustee Magazine 59(3):8–15.Google Scholar
  • Guo P, Tang CS, Wang Y, Zhao M (2019) The impact of reimbursement policy on social welfare, revisit rate, and waiting time in a public healthcare system: Fee-for-service vs. bundled payment. Manufacturing Service Oper. Management 21(1):154–170.Google Scholar
  • Gupta D, Mehrotra M (2015) Bundled payments for healthcare services: Proposer selection and information sharing. Oper. Res. 63(4):772–788.LinkGoogle Scholar
  • Gupta D, Mehrotra M, Tang X (2021) Gainsharing contracts for CMS’ episode-based payment models. Production Oper. Management 30(5):1290–1312.CrossrefGoogle Scholar
  • Han Z, Arikan M, Mallik S (2022) Competition between hospitals under bundled payments and fee-for-service: An equilibrium analysis of insurer’s choice. Manufacturing Service Oper. Management 24(3):1821–1842.Google Scholar
  • Jelovac I, Macho-Stadler I (2002) Comparing organizational structures in health services. J. Econom. Behav. Organ. 49(4):501–522.CrossrefGoogle Scholar
  • Jiang H, Pang Z, Savin S (2012) Performance-based contracts for outpatient medical services. Manufacturing Service Oper. Management 14(4):654–669.LinkGoogle Scholar
  • Kolstad J (2013) Information and quality when motivation is intrinsic: Evidence from surgeon report cards. Amer. Econom. Rev. 103(7):2875–2910.CrossrefGoogle Scholar
  • Lee D, Zenios S (2012) An evidence-based incentive system for Medicare’s end-stage renal disease program. Management Sci. 58(6):1092–1105.LinkGoogle Scholar
  • Leisch F (2004) Flexmix: A general framework for finite mixture models and latent class regression in R. J. Statist. Software 11(1).Google Scholar
  • Ma CA (1994) Healthcare payment systems: Cost and quality incentives. J. Econom. Management Strategy 3(1):93–112.CrossrefGoogle Scholar
  • McCarthy I, Huang SS (2018) Vertical alignment between hospitals and physicians as a bargaining response to commercial insurance markets. Rev. Indust. Organ. 53(1):7–29.CrossrefGoogle Scholar
  • McClellan M (2011) Reforming payments to healthcare providers: The key to slowing healthcare cost growth while improving quality? J. Econom. Perspect. 25(2):69–92.CrossrefGoogle Scholar
  • McClellan M, O’Shea J, Dang-Vu C, Bencic S, Bleiberg S, Tobin J (2014) Specialty payment model opportunities assessment and design. Technical report, The Brookings Institution, Washington, DC.Google Scholar
  • Mechanic R, Altman S (2009) Payment reform options: Episode payment is a good place to start. Health Affairs 28(2):w262–w271.CrossrefGoogle Scholar
  • Mehrotra A, Hussey P (2015) Including physicians in bundled hospital care payments: Time to revisit an old idea? JAMA 313(19):1907–1908.CrossrefGoogle Scholar
  • Patel M (2016) Medical waste: Why American healthcare is so expensive. Accessed February 7, 2017, http://knowledge.wharton.upenn.edu/article/medical-waste-american-health-care-expensive/.Google Scholar
  • Patel A, Oladipo VA, Kerzner B, McGlothlin JD, Levine BR (2022) A retrospective review of relative value units in revision total knee arthroplasty: A dichotomy between surgical complexity and reimbursement. J. Arthroplasty 37(6):S44–S49.CrossrefGoogle Scholar
  • Pauly M, Redisch M (1973) The not-for-profit hospital as a physicians’ cooperative. Amer. Econom. Rev. 63(1):87–99.Google Scholar
  • Rajagopalan S, Tong C (2022) Payment models to coordinate healthcare providers with partial attribution of outcome costs. Manufacturing Service Oper. Management 24(1):600–616.LinkGoogle Scholar
  • Schoen C (2016) The Affordable Care Act and the US economy: A Five-Year Perspective. (Commonwealth Fund, New York).CrossrefGoogle Scholar
  • Shih T, Chen L, Nallamothu B (2015) Will bundled payments change healthcare? Examining the evidence thus far in cardiovascular care. Circulation 131(24):2151–2158.CrossrefGoogle Scholar
  • Shortell S, Alexander J, Budetti P, Burns L, Gillies R, Waters T, Zuckerman H (2001) Physician-system alignment: Introductory overview. Medical Care 39(7):1–8.Google Scholar
  • Sloan F (2000) Not-for-profit ownership and hospital behavior. Culyer AJ, Newhouse JP, eds. Handbook of Health Economics (Elsevier, Amsterdam).Google Scholar
  • Sood N, Huckfeldt PJ, Escarce JJ, Grabowski DC, Newhouse JP (2011) Medicare’s bundled payment pilot for acute and postacute care: Analysis and recommendations on where to begin. Health Affairs 30(9):1708–1717.CrossrefGoogle Scholar
  • Tsai T, Joynt K, Wild R, Orav J, Jha A (2015) Medicare’s bundled payment initiative: Most hospitals are focused on a few high-volume conditions. Health Affairs 34(3):371–380.CrossrefGoogle Scholar
  • Wholey D, Burns L (1991) Convenience and independence: Do physicians strike a balance in admitting decisions? J. Health Soc. Behav. 33(3):254–272.CrossrefGoogle Scholar
  • Wilensky G, Wolter N, Fischer M (2007) Gain sharing: A good concept getting a bad name? Health Affairs 26(1):w58–w67.CrossrefGoogle Scholar
  • Yee CA, Pizer SD, Frakt A (2020) Medicare’s bundled payment initiatives for hospital-initiated episodes: Evidence and evolution. Milbank Quart. 98(3):908–974.CrossrefGoogle Scholar
  • Zhang D, Gurvich I, Van Mieghem J, Park E, Young R, Williams M (2016) Hospital readmissions reduction program: An economic and operational analysis. Management Sci. 62(11):3351–3371.LinkGoogle Scholar
INFORMS site uses cookies to store information on your computer. Some are essential to make our site work; Others help us improve the user experience. By using this site, you consent to the placement of these cookies. Please read our Privacy Statement to learn more.