Geographic Variation In The Consolidation Of Physicians Into Health Systems, 2016-18.

Physician consolidation into health systems increased in nearly all metropolitan statistical areas (MSAs) from 2016 to 2018. Of the 382 US MSAs, 113 had more than half of their physicians in health systems in 2018. Consolidation of physicians was most notable in the Midwest and Northeast and in small-to-midsize MSAs.

Health system integration with physician specialties varies across markets and system types.

Objective: To examine system integration with physician specialties across markets and the association between local system characteristics and their patterns of physician integration.

Data Sources: Data come from the AHRQ Compendium of US Health Systems and IQVIA OneKey database.

Study Design: We examined the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous nonhospital-based specialties across the 382 metropolitan statistical areas (MSAs) in the US.

Consolidation Of Providers Into Health Systems Increased Substantially, 2016-18.

Provider consolidation into vertically integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.

Can vertically integrated health systems provide greater value: The case of hospitals under the comprehensive care for joint replacement model?

Objective: We aim to assess whether system providers perform better than nonsystem providers under an alternative payment model that incentivizes high-quality, cost-efficient care. We posit that the payment environment and the incentives it provides can affect the relative performance of vertically integrated health systems. To examine this potential influence, we compare system and nonsystem hospitals participating in Medicare's Comprehensive Care for Joint Replacement (CJR) model.

Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures.

Introduction: Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum.

Characteristics of Academic-Affiliated Health Systems.

Purpose: Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.

Landscape of Health Systems in the United States.

Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U.

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness.

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity.

Leveraging Diverse Data Sources to Identify and Describe U.S. Health Care Delivery Systems.

Health care delivery systems are a growing presence in the U.S., yet research is hindered by the lack of universally agreed-upon criteria to denote formal systems.

A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.

Background: Small independent practices are increasingly giving way to more complex affiliations between provider organizations and hospital systems. There are several ways in which vertically integrated health systems could improve quality and lower the costs of care. But there are also concerns that integrated systems may increase the price and costs of care without commensurate improvements in quality and outcomes.

The Marginal Costs of Adverse Drug Events Associated With Exposures to Anticoagulants and Hypoglycemic Agents During Hospitalization.

Background: Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADEs).

Objective: Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay.

Research Design And Subject: Data are from 2010 to 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and Medicare Patient Safety Monitoring System (MPSMS).

Meaningful use of health information technology and declines in in-hospital adverse drug events.

Objective: Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking.

Electronic Health Record Adoption and Rates of In-hospital Adverse Events.

Objective: Nationwide initiatives have focused on improving patient safety through greater use of health information technology. We examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients.

Methods: We conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System.

Physician attitudes on ease of use of EHR functionalities related to Meaningful Use.

Objectives: To assess physician attitudes on ease of use of electronic health record (EHR) functionalities related to "Meaningful Use" (MU) and whether perceived ease of use was associated with EHR characteristics, including meeting MU criteria, technical assistance from EHR vendors or regional extension centers, and the amount of clinical staff training.

Study Design: A cross sectional analysis of the 2011 Physician Workflow study, nationally representative of US office-based physicians.

Methods: Cross-sectional data were used to examine physician attitudes on ease of use of 14 EHR functionalities related to MU, among physicians with any EHR system.

HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to increase electronic health record (EHR) adoption by providers and hospitals. Experts expressed skepticism about whether the program would indeed hasten adoption and could be implemented in time for the initial reporting period. Could EHR vendors meet the certification requirements, and could the industry innovate to meet small-practice needs? This study, in addition to documenting increased provider adoption, provides the first evidence of increased competitiveness and innovation in the EHR industry spurred by HITECH.

Despite substantial progress In EHR adoption, health information exchange and patient engagement remain low in office settings.

The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others.

More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most.

The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. We used recent data from the American Hospital Association Annual Survey of Hospitals--IT Supplement to assess progress and challenges.

Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010-12.

Federally qualified health centers play an important role in providing health care to underserved populations. Recent substantial federal investments in health information technology have enabled health centers to expand their use of electronic health record (EHR) systems, but factors associated with adoption are not clear. We examined 2010-12 administrative data from the Health Resources and Services Administration's Uniform Data System for more than 1,100 health centers.

EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption.

While adoption of electronic health record (EHR) systems has grown rapidly, little is known about physicians' perspectives on its adoption and use. Nationally representative survey data from 2011 are used to compare the perspectives of physicians who have adopted EHRs with those that have yet to do so across three key areas: the impact of EHRs on clinical care, practice efficiency and operations; barriers to EHR adoption; and factors that influence physicians to adopt EHRs. Despite significant differences in perspectives between adopters and non-adopters, the majority of physicians perceive that EHR use yields overall clinical benefits, more efficient practices and financial benefits.

Supporting HITECH implementation and assessing lessons for the future: The role of program evaluation.

In addition to supporting the adoption and use of health IT, HITECH also included funds to support independent national program evaluation activities. The main challenges of evaluating health IT programs of the breadth and scale of the HITECH programs are the importance of context in the implementation and impact of the programs, the complexity and heterogeneity of the interventions, and the unpredictable nature of the innovative practices spurred by HITECH. The lessons learned include the importance of tailoring evaluation activities to each phase of implementation, flexible mixed methods, and continuous formative evaluation.

Evolving vendor market for HITECH-certified ambulatory EHR products.

Background: The ambitious goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act require rapid development and certification of new ambulatory electronic health record (EHR) products.

Objectives: To examine where the vendor market for EHR products stands now and the policy issues emerging from the market's evolution.

Study Design: Descriptive study with policy analysis.

Clinical benefits of electronic health record use: national findings.

Objective: To assess whether physicians' reported electronic health record (EHR) use provides clinical benefits and whether benefits depend on using an EHR meeting Meaningful Use criteria or length of EHR experience.

Data Source: The 2011 Physician Workflow study, representative of U.S.

Emerging and encouraging trends in e-prescribing adoption among providers and pharmacies.

Objective: The objective of this study is to describe the growth in provider (physician, nurse practitioner, and physician assistant) adoption of e-prescribing and the growth in pharmacies actively accepting e-prescriptions using nationally representative data from December 2008 to December 2012. Additionally, this study explored e-prescribing adoption variation by urban and rural counties.

Study Design: Descriptive analysis of nationally representative, transactional e-prescribing data.

Physician capability to electronically exchange clinical information, 2011.

Objectives: To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement.

Study Design: Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care.

Methods: The survey was administered by mail with telephone follow-up and had a 61% weighted response rate.

Physician experience with electronic health record systems that meet meaningful use criteria: NAMCS physician workflow survey, 2011.

Data from the National Ambulatory Medical Care Survey's (NAMCS) Physician Workflow Survey, 2011. About three-quarters of physicians with electronic health record (EHR) systems have systems that meet meaningful use criteria. Physicians with EHR systems that meet meaningful use criteria were more likely to report that their system provides time savings than physicians with systems not meeting meaningful use criteria, but only in some areas.