Do Medicare's Facility Fees Incentivize Hospitals to Vertically Integrate with Oncologists?

Samuel Valdez
Author Information
  1. Samuel Valdez: University of California, Los Angeles, CA, USA. ORCID

Abstract

Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examines whether or not hospitals strategically choose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market. To address this question, I match data on hospitals' ownership of clinical oncologists with Medicare payment data disaggregated to the physician and specific service level. I leverage a 2014 policy change that drastically altered the payment structure of Medicare's facility fees paid to hospitals for evaluation and management services-and yet, it did not alter the direct payments made to physicians. Contrary to popular belief, I find no evidence that the financial incentives of facility fees have an effect on the probability that a hospital and a clinical oncologist vertically integrate.

Keywords

References

  1. J Health Econ. 2017 Mar;52:19-32 [PMID: 28182998]
  2. Med Care Res Rev. 2022 Apr;79(2):317-327 [PMID: 34027744]
  3. J Health Econ. 2006 Jan;25(1):175-80 [PMID: 16318890]
  4. Health Aff (Millwood). 2017 Apr 1;36(4):680-688 [PMID: 28373334]
  5. J Health Econ. 2018 May;59:139-152 [PMID: 29727744]
  6. J Gen Intern Med. 2015 Aug;30 Suppl 3:S595-601 [PMID: 26105676]
  7. Health Serv Res. 2013 Apr;48(2 Pt 2):696-712 [PMID: 23347041]
  8. N Engl J Med. 2018 Feb 08;378(6):539-548 [PMID: 29365282]
  9. MGMA Connex. 2012 Nov-Dec;12(10):17-9 [PMID: 23342724]
  10. Health Aff (Millwood). 2017 Feb 1;36(2):346-354 [PMID: 28167725]
  11. Health Aff (Millwood). 2014 May;33(5):756-63 [PMID: 24799571]
  12. Adv Health Care Manag. 2013;15:39-117 [PMID: 24749213]
  13. Health Aff (Millwood). 2018 Jul;37(7):1123-1127 [PMID: 29985694]
  14. J Health Econ. 2016 Dec;50:1-8 [PMID: 27639202]

Grants

  1. T32 HS000046/AHRQ HHS

MeSH Term

Aged
Hospitals
Humans
Medicare
Motivation
Oncologists
Ownership
United States

Word Cloud

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