The healthcare landscape is undergoing significant changes, with a notable trend being the vertical integration of medical providers. This phenomenon, where hospitals or health systems acquire physician practices, has led to a shift in how medical care is delivered and billed. The presentation at the WCRI Conference in Boston, MA, by Bogdan Savych and Eric Harrison, delved into the effects of this integration on the utilization of care and patient outcomes, particularly for workers with injuries.
Changes in Utilization
The study presented at the conference highlighted a substantial increase in the percentage of physician practices owned by hospitals or health systems, rising from 37% in 2012 to 48% in 2018. This shift has implications for the amount of care provided. The findings suggest that vertical integration leads to an increase in the number of services per visit and the number of evaluation and management services. However, there was no significant change in the overall number of visits per claim.
Impact on Patient Outcomes
Despite the increased utilization of services, the study found very little evidence of improved recovery or reduced duration of disability for injured workers. This is a critical finding as it challenges the assumption that more care or more integrated care would naturally lead to better patient outcomes.
Competition and Quality of Care
The premise of vertical integration is that it could potentially reduce competition, which is traditionally seen as a driver for improving the quality of care. However, the study’s results do not support the hypothesis that increased integration leads to better care. Instead, it suggests that structural integration does not necessarily result in clinical integration, which is essential for coordinated patient services and adherence to best practices.
Financial Implications
The financial impact of vertical integration is significant. The study showed that vertical integration increases the cost of visits for medical care by approximately 8-10%, with even higher effects in states without fee schedules. When controlling for specific medical procedures, the increase in costs was less pronounced, suggesting changes in utilization patterns.
Billing Patterns and Costs
The study also observed changes in billing patterns, with an increase in high-intensity office visits and procedures billed by vertically integrated providers. This shift in billing practices contributes to higher medical payments per claim, with an increase of about 7.3% at six months of maturity and 11% at twelve months.
Specific Findings for Low Back Pain Cases
Low back pain cases, in particular, showed a marked increase in the likelihood of early MRIs, which is not recommended by treatment guidelines unless specific red-flag conditions are present. This increase in early MRIs is associated with more care, a higher likelihood of surgery, and longer durations of disability.
Conclusion
The findings from the WCRI Conference presentation underscore that while vertical integration is reshaping the healthcare market, it does not necessarily translate into better outcomes for patients. Instead, it leads to higher costs and increased utilization of services without a corresponding improvement in recovery times. These insights are crucial for policymakers and stakeholders in the healthcare industry as they consider the implications of medical provider consolidation on the quality and cost of care.
In summary, the impact of vertical integration on the healthcare system is multifaceted, with increased costs and changes in utilization patterns being evident. However, the anticipated benefits in terms of improved patient outcomes and competition-driven quality of care have not materialized according to the study’s findings. This calls for a careful evaluation of the trend towards vertical integration, considering both its economic and clinical implications.
Artificial Intelligence assisted in the development of this article. Frankly, it’s about time some sort of intelligence was used in Bob’s blog.