Research theme
Ownership, prices and payment
How quality and spending change when hospitals and practices join systems or are bought by private equity.
How negotiated prices, bundled payments and federal payment models reach patients with cancer.
22 articles, newest first
-
At US health systems that offer their own insurance, those plans had significantly lower negotiated prices than other insurers for nearly all services studied, though the authors call for more transparency on pricing and ownership.
-
Surgical Quality at Rural Hospitals After Private Equity Acquisition
Among Medicare patients having common general surgery operations, private equity acquisition of rural hospitals was associated with increases in 30-day mortality, complications and serious complications, compared with similar rural hospitals that were not acquired.
-
Among Medicare patients having four common general surgery operations, private equity acquisition of hospitals was associated with a 2.7-percentage-point increase in 30-day postoperative mortality compared with hospitals that were not acquired.
More on this study: After the buyout, more deaths after surgery
-
For Medicare patients having elective inpatient surgery, a hospital joining a health system was associated with slightly lower 30-day spending, mainly on care after discharge, but no significant change in serious complications, deaths or readmissions.
-
Private Equity Investment in Surgical Care
From 2015 to 2019, investor-backed private equity firms invested substantially in surgical care, especially digestive disease, urology and orthopedic practices and the surgery-adjacent field of anesthesiology, increasing the consolidation of practices.
-
Variation in Postoperative Outcomes Across Federally Designated Hospital Star Ratings
For Medicare patients having heart bypass or general surgery, hospitals with higher federal star ratings had lower death rates, but outcomes varied widely within each rating level, highlighting the ratings’ limits for judging surgical quality.
-
Insurer-negotiated cancer surgery prices varied widely at National Cancer Institute-designated centers; for Medicare patients’ colon, pancreas or lung cancer surgery, higher prices were statistically but not clinically meaningfully linked to serious complications or death.
-
Optimizing care delivery in expanding health systems: Views from clinical leaders
In interviews, surgical leaders at teaching hospitals within health systems described challenges to redesigning care, such as limited beds and operating rooms, but also ways to use system growth to improve access and quality.
-
For Medicare patients having elective hip replacement, being treated at a hospital whose network owns a skilled nursing facility was associated with more nursing-facility use, fewer readmissions and slightly lower total payments within 30 days.
-
Surgical quality assurance at expanding health networks: A qualitative study
In interviews, surgical leaders at hospitals in expanding health networks said they wanted standardized tools for measuring quality, clear oversight of quality, and a culture shift toward quality improvement.
-
Surgical Leadership Competencies for Navigating Hospital Network Expansion
In interviews, surgical leaders identified key skills for navigating expanding hospital networks: steering their department’s vision, aligning it with the network’s vision, and building a network-oriented culture in their department.
-
End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma
Among Medicare patients who died of liver cancer, racial and ethnic minorities and those in more socially vulnerable areas were less likely to use hospice, and hospice was associated with lower inpatient and outpatient spending.
-
Among Medicare knee replacement patients, robotic surgery was associated with lower spending than traditional surgery, reflecting shorter stays, fewer complications and less post-hospital facility care, with savings only at hospitals using robots for most cases.
-
Among Medicare patients with complications after complex surgery for digestive cancers, transfer to another hospital was more common after surgery at low-volume hospitals and was associated with more deaths and higher Medicare spending.
-
In interviews, surgical leaders at teaching hospitals described health system expansion as mainly business-driven, sometimes disempowering department leadership but also providing resources that some used to support research and training.
-
Variation in Surgical Spending Among the Highest Quality Hospitals for Cancer Surgery
For Medicare patients having cancer surgery at the hospitals with the fewest serious complications, spending still varied, driven mostly by differences in post-hospital care and readmissions rather than complications.
-
Variations in surgical spending within hospital systems for complex cancer surgery
For Medicare patients having planned cancer surgery on the pancreas, lung or colon, spending from hospital admission through 30 days after discharge varied widely both within and across hospital systems.
-
Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition
This review concludes that the link between quality and cost in digestive surgery is complex, with higher costs not always tied to better outcomes, and describes strategies such as concentrating complex operations at high-volume centers.
-
Variation in value among hospitals performing complex cancer operations
Among Medicare patients having planned cancer surgery on the esophagus or pancreas, the lowest-value hospitals had higher complication rates and costs than the highest-value hospitals, and costs varied widely even among the highest-quality hospitals.
-
Among Medicare patients having planned liver or pancreas surgery, the highest-cost hospitals within a local area had more complications and deaths than the lowest-cost ones, suggesting local referrals to low-cost hospitals could increase value.
-
Among older Medicare patients having major planned surgery, the 5.3% who were very heavy health care users accounted for 39.6% of prior-year spending, and for some of them, surgery was associated with lower spending afterward.
-
Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery
Among Medicare patients having liver, pancreas or bile duct surgery, care at major teaching hospitals was associated with higher Medicare payments than at non-teaching hospitals, along with fewer complications and lower 30-day death rates.