The researchers used American Hospital Association's annual survey data, which included information from 4,727 hospitals reporting from 2008 to 2013. The paper is titled "The Integration and De-integration of Physicians and Hospitals Over Time" and deals with independent practice associations, open physician-hospital organizations, closed physician-hospital organizations and fully integrated organizations.
The researchers found:
1. The share of hospitals with physicians on salary rose from 44 percent to 55 percent of all facilities while looser forms of physician-hospital integration decreased in prominence.
2. There were 1,525 hospital integrations during the study period; in 599 cases, the hospital switched from no integration to some form of integration. There were 710 transitions from some form of integration to fully integrated hospitals, and 550 hospitals changed from no integration to full integration.
3. There were 489 cases where the hospitals de-integrated.
4. Hospitals looking to participate in Medicare ACOs must build relationships with primary care physicians and control referrals as the PCPs become hospital employees.
5. Hospital ownership becomes attractive to physician groups as well if the group lacks the ability to adopt EHRs. "Physician groups that lack the financial and technical expertise to adopt electronic health records that have increasingly become necessary to obtain higher reimbursements by public and private payers will be the likeliest source of integration in the future," said study co-author Marah Short.
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