High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care [Primary Care]
Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-ba...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Basu, S., Phillips, R. S., Song, Z., Bitton, A., Landon, B. E. Tags: Business Of Health, Physicians Primary Care Source Type: research
Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities [Skilled Nursing Facilities]
Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries’ costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a conc...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: McHugh, J. P., Foster, A., Mor, V., Shield, R. R., Trivedi, A. N., Wetle, T., Zinn, J. S., Tyler, D. A. Tags: Hospitals, Medicare Skilled Nursing Facilities Source Type: research
A Physicians Perspective On Vertical Integration [Market Concentration]
Vertical integration has been a central feature of health care delivery system change for more than two decades. Recent studies have demonstrated that vertically integrated health care systems raise prices and costs without observable improvements in quality, despite many theoretical reasons why cost control and improved quality might occur. Less well studied is how physicians view their newfound partnerships with hospitals. In this article I review literature findings and other observations on five aspects of vertical integration that affect physicians in their professional and personal lives: patients’ access to ph...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Berenson, R. A. Tags: Hospitals, Managed Competition, Physicians, Health Spending Market Concentration Source Type: research
Regulated Medicare Advantage And Marketplace Individual Health Insurance Markets Rely On Insurer Competition [Market Concentration]
Two important individual health insurance markets—Medicare Advantage and the Marketplaces—are tightly regulated but rely on competition among insurers to supply and price health insurance products. Many local health insurance markets have little competition, which increases prices to consumers. Furthermore, both markets are highly subsidized in ways that can exacerbate the impact of market power—that is, the ability to set price above cost—on health insurance prices. Policy makers need to foster robust competition in both sectors and avoid designing subsidies that make the market-power problem worse...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Frank, R. G., McGuire, T. G. Tags: Insurance Market Market Concentration Source Type: research
Beyond Antitrust: Health Care And Health Insurance Market Trends And The Future Of Competition [Market Concentration]
The United States relies on competition to balance costs and quality in the health care system. But concentration is increasing throughout the hospital, physician, and insurer markets. Midsize community hospitals face declining demand and growing competition from both larger hospitals and smaller freestanding diagnostic and surgical centers, leaving the midsize hospitals vulnerable to closure or merger with other facilities. Competition among insurers has been limited by the development of hospital systems that extend the bargaining power of "must-have" hospitals (those perceived to provide the best care for complex and le...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Glied, S. A., Altman, S. H. Tags: Managed Competition, Insurance Market Market Concentration Source Type: research
Coping With Concentration [Market Concentration]
This article analyzes the principal market-oriented approaches that have been used in the past and proposed for the future. It argues that antitrust law has an important but constrained role to play and has proved to be especially inept in dealing with extant market power. It finds serious deficiencies in the conduct decrees imposed by some courts and in open-ended regulatory regimes such as those established by Certificate of Public Advantage laws. Although not without administrative complications, policies that target providers who possess market power by capping prices may be the most effective means to control costs an...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Greaney, T. L. Tags: Hospitals Market Concentration Source Type: research
Physician Practice Consolidation Driven By Small Acquisitions, So Antitrust Agencies Have Few Tools To Intervene [Market Concentration]
The growing concentration of physician markets throughout the United States has been raising antitrust concerns, yet the Department of Justice and the Federal Trade Commission have challenged only a small number of mergers and acquisitions in this field. Using proprietary claims data from states collectively containing more than 12 percent of the US population, we found that 22 percent of physician markets were highly concentrated in 2013, according to federal merger guidelines. Most of the increases in physician practice size and market concentration resulted from numerous small transactions, rather than a few l...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Capps, C., Dranove, D., Ody, C. Tags: Legal/Regulatory Issues, Business Of Health, Physicians Market Concentration Source Type: research
Corporate Investors Increased Common Ownership In Hospitals And The Postacute Care And Hospice Sectors [Market Concentration]
The sharing of investors across firms is a new antitrust focus because of its potential negative effects on competition. Historically, the ability to track common investors across the continuum of health care providers has been limited. Thus, little is known about common investor ownership structures that might exist across health care delivery systems and how these linkages have evolved over time. We used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors w...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Fowler, A. C., Grabowski, D. C., Gambrel, R. J., Huskamp, H. A., Stevenson, D. G. Tags: Hospitals, Long-Term Care Market Concentration Source Type: research
Insurer Market Power Lowers Prices In Numerous Concentrated Provider Markets [Market Concentration]
Using prices of hospital admissions and visits to five types of physicians, we analyzed how provider and insurer market concentration—as measured by the Herfindahl-Hirschman Index (HHI)—interact and are correlated with prices. We found evidence that in the range of the Department of Justice’s and Federal Trade Commission’s definition of a moderately concentrated market (HHI of 1,500–2,500), insurers have the bargaining power to reduce provider prices in highly concentrated provider markets. In particular, hospital admission prices were 5 percent lower and cardiologist, radiologist, and he...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Scheffler, R. M., Arnold, D. R. Tags: Hospitals, Physicians, Health Spending, Insurance Market Market Concentration Source Type: research
Health Care Market Concentration Trends In The United States: Evidence And Policy Responses [Market Concentration]
Policy makers and analysts have been voicing concerns about the increasing concentration of health care providers and health insurers in markets nationwide, including the potential adverse effect on the cost and quality of health care. The Council of Economic Advisers recently expressed its concern about the lack of estimates of market concentration in many sectors of the US economy. To address this gap in health care, this study analyzed market concentration trends in the United States from 2010 to 2016 for hospitals, physician organizations, and health insurers. Hospital and physician organization markets became increasi...
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Fulton, B. D. Tags: Hospitals, Managed Competition, Insurance Market Market Concentration Source Type: research
A Midsummer Nights Strange Reality [Eye On Health Reform]
After GOP efforts to repeal and replace the ACA collapsed in the Senate, attention is focused on whether cost-sharing reduction payments will continue. (Source: Health Affairs)
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Jost, T. S. Tags: Health Reform, Affordable Care Act Eye On Health Reform Source Type: research
Market Concentration [From The Editor-in-Chief]
(Source: Health Affairs)
Source: Health Affairs - September 5, 2017 Category: International Medicine & Public Health Authors: Weil, A. R. Tags: Health Reform From The Editor-in-Chief Source Type: research
A Midsummer Nights Strange Reality [Web First]
After GOP efforts to repeal and replace the ACA collapsed in the Senate, attention is focused on whether cost-sharing reduction payments will continue. (Source: Health Affairs)
Source: Health Affairs - August 14, 2017 Category: International Medicine & Public Health Authors: Jost, T. S. Tags: Health Reform, Affordable Care Act Web First Source Type: research
Innovations And Precise Terms [Letters]
(Source: Health Affairs)
Source: Health Affairs - August 7, 2017 Category: International Medicine & Public Health Authors: Fulmer, T., Naylor, M., Szanton, S. Tags: Research And Technology Letters Source Type: research
Independent Physician Groups: The Author Replies [Letters]
(Source: Health Affairs)
Source: Health Affairs - August 7, 2017 Category: International Medicine & Public Health Authors: Casalino, L. R. Tags: Physicians Letters Source Type: research
