TY - JOUR
AU - B. Post
AU - F. Alinezhad
AU - G. J. Young
A1 - 
AB - OBJECTIVES: Hospital employment of physicians, often called hospital-physician vertical integration, has become widespread in health care delivery, but whether hospital employment tilts the case mix of physicians toward higher-complexity patients remains unknown. STUDY DESIGN: Cross-sectional and difference-in-differences analysis of 2014-2019 Medicare Standard Analytic Files. METHODS: We compared pre- and postemployment patient panels of primary care physicians who did and did not become hospital employees, analyzing changes in the prevalence of chronic conditions. We measured arthritis, depression, diabetes, hypertension, and ischemic heart disease. We also evaluated whether patients who were dropped from physician panels found alternative sources of primary care. RESULTS: Hospital-employed physicians treated patients of similar or better health; for instance, 54% of integrated physicians' patients had 2 or more chronic conditions compared with 56% among independent physicians (P < .001). After becoming hospital employees, physicians treated approximately 10% fewer Medicare patients (-9.5%; 95% CI, -11.3% to -7.7%). Within physician panels, the prevalence of patients with 2 or more chronic conditions did not significantly change after employment relative to independent physicians (-1.1%; 95% CI, -2.3% to 0.2%). Approximately 37% of patients were dropped from physician panels after employment; these patients were less likely to find alternative primary care compared with those dropped from independent physician panels (P < .001). CONCLUSIONS: Hospital employment of physicians resulted in neither a higher number nor a higher proportion of complex patients treated by integrated physicians, at least among traditional Medicare patients.
AD - Bouvé College of Health Sciences, Northeastern University, 336 Huntington Ave, 316H Robinson Hall, Boston, MA 02115. Email: b.post@northeastern.edu.
AN - 40227449
BT - Am J Manag Care
C5 - Education & Workforce; Healthcare Policy
CP - 4
DA - Apr 1
DO - 10.37765/ajmc.2025.89724
DP - NLM
ET - 20250401
IS - 4
JF - Am J Manag Care
LA - eng
N2 - OBJECTIVES: Hospital employment of physicians, often called hospital-physician vertical integration, has become widespread in health care delivery, but whether hospital employment tilts the case mix of physicians toward higher-complexity patients remains unknown. STUDY DESIGN: Cross-sectional and difference-in-differences analysis of 2014-2019 Medicare Standard Analytic Files. METHODS: We compared pre- and postemployment patient panels of primary care physicians who did and did not become hospital employees, analyzing changes in the prevalence of chronic conditions. We measured arthritis, depression, diabetes, hypertension, and ischemic heart disease. We also evaluated whether patients who were dropped from physician panels found alternative sources of primary care. RESULTS: Hospital-employed physicians treated patients of similar or better health; for instance, 54% of integrated physicians' patients had 2 or more chronic conditions compared with 56% among independent physicians (P < .001). After becoming hospital employees, physicians treated approximately 10% fewer Medicare patients (-9.5%; 95% CI, -11.3% to -7.7%). Within physician panels, the prevalence of patients with 2 or more chronic conditions did not significantly change after employment relative to independent physicians (-1.1%; 95% CI, -2.3% to 0.2%). Approximately 37% of patients were dropped from physician panels after employment; these patients were less likely to find alternative primary care compared with those dropped from independent physician panels (P < .001). CONCLUSIONS: Hospital employment of physicians resulted in neither a higher number nor a higher proportion of complex patients treated by integrated physicians, at least among traditional Medicare patients.
PY - 2025
SN - 1088-0224
SP - e95
EP - e101+
ST - Impact of hospital-physician integration on Medicare patient mix
T1 - Impact of hospital-physician integration on Medicare patient mix
T2 - Am J Manag Care
TI - Impact of hospital-physician integration on Medicare patient mix
U1 - Education & Workforce; Healthcare Policy
U3 - 10.37765/ajmc.2025.89724
VL - 31
VO - 1088-0224
Y1 - 2025
ER -