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You searched for subject:(physician ownership). Showing records 1 – 3 of 3 total matches.

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University of Kentucky

1. Forlines, Grayson L. ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS.

Degree: 2018, University of Kentucky

Understanding how health care markets function is important not only because competition has a direct influence on the price and utilization of health care services, but also because the proper functioning, or lack thereof, of health care markets has a very real impact on patients who depend on health care markets and providers for their personal well-being. In this dissertation, I examine the role of government policies and regulation in health care markets, with a focus on the response of health care providers. In Chapter 1, I analyze the impact of Medicare payment rules on hospital ownership of physician practices. Since the mid-2000’s, there has been a rapid increase in hospital ownership of physician practices, however, there is little empirical research which addresses the causes of this recent wave of integration. Medicare’s “provider-based” billing policy allows hospital-owned physician practices to charge higher reimbursement rates for services provided compared to a freestanding, independent physician practice, without altering how or where services are provided. This “site-based” differential creates a premium for physicians to integrate with hospitals, and the size of this differential varies with the types of health care services provided. I find that Medicare payment rules have contributed to hospital ownership of physician practices and that the response varies across physician specialties. A 10 percent increase in the relative reimbursement rate paid to integrated physicians leads to a 1.9 percentage point increase in the probability of hospital ownership for Medical Care specialties, including cardiology, neurology, and dermatology, which explains about one-third of observed integration of these specialties from 2005 through 2015. Magnitudes for Surgical Care specialties are similar, but more sensitive across specifications. There is no significant response for Primary Care physicians. In combination with other empirical literature which finds that integration between physicians and hospitals typically results in higher prices with no impact on costs or quality of care, I cautiously interpret this responsiveness as evidence that Medicare’s provider-based billing policy overcompensates integrated physician practices and leads to an inefficiently high level of vertical integration between physician and hospitals. In Chapter 2, I analyze the effect of anti-fraud enforcement activity on Medicaid spending, with a particular focus on the False Claims Act. The False Claims Act (FCA) is a federal statute which protects the government from making undeserved payments to contractors and suppliers. Individual states have chosen to enact their own versions of the federal FCA, and these statutes have increasingly been used to target health care fraud. FCA statutes commonly include substantial monetary penalties such as “per-violation” monetary fines and tripled damages, as well as a “whistleblower” provision which allows private plaintiffs to initiate a lawsuit and collect a portion of recoveries as a reward.…

Subjects/Keywords: Medicare; Vertical Integration; Hospital ownership of physician practices; Medicaid; False Claims Act; Anti-fraud enforcement; Economics; Health Economics; Industrial Organization

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Forlines, G. L. (2018). ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS. (Doctoral Dissertation). University of Kentucky. Retrieved from https://uknowledge.uky.edu/economics_etds/35

Chicago Manual of Style (16th Edition):

Forlines, Grayson L. “ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS.” 2018. Doctoral Dissertation, University of Kentucky. Accessed September 16, 2019. https://uknowledge.uky.edu/economics_etds/35.

MLA Handbook (7th Edition):

Forlines, Grayson L. “ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS.” 2018. Web. 16 Sep 2019.

Vancouver:

Forlines GL. ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS. [Internet] [Doctoral dissertation]. University of Kentucky; 2018. [cited 2019 Sep 16]. Available from: https://uknowledge.uky.edu/economics_etds/35.

Council of Science Editors:

Forlines GL. ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS. [Doctoral Dissertation]. University of Kentucky; 2018. Available from: https://uknowledge.uky.edu/economics_etds/35


Virginia Commonwealth University

2. Liu, Xinliang. The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures.

Degree: PhD, Health Administration, 2012, Virginia Commonwealth University

Ambulatory surgery centers (ASCs) play an important role in providing surgical and diagnostic services in an outpatient setting. They can be owned by physicians who staff them. Previous studies focused on patient “cherry picking” and over-utilization of services due to physician ownership. Few studies examined the relationship between physician ownership and quality of care. Using a retrospective cohort of patients who underwent colonoscopy, this study examined the effect of physician ownership of ASCs on the occurrence of adverse events after outpatient colonoscopy. Agency theory is used to as a conceptual framework. Depending on the extent to which consumers are able to assess quality of care differences across health care settings, physician ownership can function as a mechanism to improve quality or as a deterrent to quality. Four adverse event measures are used in this study: same day ED visit or hospitalization, 30-day serious gastrointestinal events resulting in ED visit or hospitalization, 30-day other gastrointestinal events resulting in ED visit or hospitalization, and 30-day non-gastrointestinal events resulting in ED visit or hospitalization. Physician ownership status is determined based on a court decision in California in 2007. Data sources include the State Ambulatory Surgery Databases (SASD), State Inpatient Databases (SID), Emergency Department Databases (SEDD), State Utilization Data Files, the Area Resource File (ARF), and HMO/PPO data from Health Leaders. After controlling for confounding factors, the study found that colonoscopy patients treated at a physician-owned ASC had similar odds of experiencing same day ED visit or hospitalization and 30-day non-gastrointestinal events resulting in ED visit or hospitalization as those treated in a hospital-based outpatient facility. But the former had significantly higher odds of experiencing 30-day serious gastrointestinal events and 30-day other gastrointestinal events resulting in ED visit or hospitalization. The results are robust to changes in propensity score adjustment approach and to the inclusion of a lagged quality indicator. They suggest that physician ownership of ASCs was not associated with better quality of care for colonoscopy patients. As more complex procedures are shifted from hospital-based outpatient facilities to ASCs, expanded efforts to monitor and report quality of care will be worthwhile. Advisors/Committee Members: Gloria J. Bazzoli.

Subjects/Keywords: Ambulatory surgery centers; Hospital-based outpatient facility; Physician ownership; Colonoscopy; Outpatient surgery; Quality of care; Patient outcomes; California; Medicine and Health Sciences

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Liu, X. (2012). The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures. (Doctoral Dissertation). Virginia Commonwealth University. Retrieved from https://scholarscompass.vcu.edu/etd/2886

Chicago Manual of Style (16th Edition):

Liu, Xinliang. “The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures.” 2012. Doctoral Dissertation, Virginia Commonwealth University. Accessed September 16, 2019. https://scholarscompass.vcu.edu/etd/2886.

MLA Handbook (7th Edition):

Liu, Xinliang. “The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures.” 2012. Web. 16 Sep 2019.

Vancouver:

Liu X. The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures. [Internet] [Doctoral dissertation]. Virginia Commonwealth University; 2012. [cited 2019 Sep 16]. Available from: https://scholarscompass.vcu.edu/etd/2886.

Council of Science Editors:

Liu X. The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures. [Doctoral Dissertation]. Virginia Commonwealth University; 2012. Available from: https://scholarscompass.vcu.edu/etd/2886


Virginia Commonwealth University

3. Lucas, D. Pulane. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.

Degree: PhD, Public Policy & Administration, 2013, Virginia Commonwealth University

Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into… Advisors/Committee Members: Carl F. Ameringer, Roice D. Luke, Wally R. Smith, I-Shian Suen.

Subjects/Keywords: Disruptive; Disruptive Innovation Theory; Disruptive Transformations; Disruptive Innovation; Innovation; Technology; Technological Innovation; Medical Innovation; Medical Technology; Medical Advancement; Laparoscopy; Laparoscopic Surgery; open surgery; appendectomy; cholecystectomy; bariatric surgery; weight loss surgery; appendectomies; cholecystectomies; inpatient; outpatient; ambulatory; ambulatory surgery; ambulatory surgery center; acute care general hospital; hospital; acute care hospital; general hospital; health care; healthcare; hospital industry; health care industry; Clayton Christensen; Clayton M Christensen; Michael Porter; Harvard Business School; Virginia Commonwealth University; Center for Medicare & Medicaid Services; CMS; Health policy; public policy; public administration; organizational theory; organization theory; Population Ecology Theory; Competitive Strategy; policy analysis; John Kimberly; Organization Size; Structural Inertia; liability of smallness; health spending; health care cost; specialty medical facility; open system; niche width dynamic; outpatient department; technology shift; surgical setting; surgical setting shift; medical facility shift; substitution threat; health system; system level analysis; Ecological Approach; hospital trends; ambulatory surgery trends; reimbursement rate; Medicare; CMS coverage decision; P J DiMaggio; DiMaggio and Powell; w w Powell; Hannan and Freeman; M T Hannan; Organizational change; minimally invasive surgery; less invasive surgery; Prospective Payment System; Outpatient Prospective Payment System; entreprenuerial physician; health care organization; health care management; Roice Luke; Carl Ameringer; new technology; surgical utilization; elective surgery; Medicare Payment Advisory Commission; MedPAC; coverage decision; trends in surgery; abdominal surgery; surgical variation; physician-owned; physician ownership; physician autonomy; outpatient clinic; utilization trends; unnecessary surgery; Pfeffer Salancik; technology diffusion; redefining health care; interdisciplinary research; health care delivery; panel design; diffusion of hospital technology; state variation; regional variation; local health care market; government intervention; medical facility; health care capacity; focused factory; advances in health care; physician organization relationship; hospital competition; medical specialization; hospital expansion; medical arms race; integrated care; integrated health system; J E Wennberg; health care transformation; reimbursement scheme; surgical volume; Florida; Wisconsin; policy making; health policy analysis; competitive dynamics; center of excellence; intervening factor; service line competition; service-line competition; surgical reimbursement; innovative business model; innovative technology; environmental influence; established firm; new market entrant; patient safety; sophisticated technology; Harvard Divinity School; Wilder School of Government and Public Affairs; Public Affairs, Public Policy and Public Administration; Social and Behavioral Sciences

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Lucas, D. P. (2013). Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. (Doctoral Dissertation). Virginia Commonwealth University. Retrieved from https://scholarscompass.vcu.edu/etd/2996

Chicago Manual of Style (16th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Doctoral Dissertation, Virginia Commonwealth University. Accessed September 16, 2019. https://scholarscompass.vcu.edu/etd/2996.

MLA Handbook (7th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Web. 16 Sep 2019.

Vancouver:

Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Internet] [Doctoral dissertation]. Virginia Commonwealth University; 2013. [cited 2019 Sep 16]. Available from: https://scholarscompass.vcu.edu/etd/2996.

Council of Science Editors:

Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Doctoral Dissertation]. Virginia Commonwealth University; 2013. Available from: https://scholarscompass.vcu.edu/etd/2996

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