Full physician-hospital integration rose more than 10% between 2008 and 2013, study finds

Healthcare organizations are increasingly transitioning to full physician-hospital integration, but this shift is more complex than previously expected, according to a new study from Rice University's Baker Institute for Public Policy.

The study, released Monday, examines physician-hospital integration over time. Researchers said they looked at 4,727 hospitals using the 2008-2013 American Hospital Association annual survey data to designate four forms of integration based on the type of contractual relationship a hospital has with physicians. The four forms of integration examined were independent practice associations, open physician-hospital organizations, closed physician-hospital organizations and fully integrated organizations.

The study found the share of hospitals with salaried physicians increased from 44 percent in 2008 to 55 percent in 2013. Researchers said looser forms of physician-hospital integration, such as joint contractual networks with managed care organizations, decreased in prominence. Overall, there were 1,525 hospital integration form transitions, according to a news release.

However, the aggregate shift toward tighter vertical integration masks the fact many hospitals de-integrated or shifted to less tightly integrated physician-hospital relationships between 2008 and 2013, the authors said.

"The shift to tighter physician-hospital integration is more complex than previously expected. Future studies that distinguish between integration types are essential for setting policies that foster integrated care to improve quality and lower costs, instead of raising prices and harming patient welfare," the study concluded.


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