Physician integration hasn’t improved care at hospitals

Having more physicians employed by hospitals hasn’t provided benefits for patient care, according to a study published in the Annals of Internal Medicine.

The study, led by Kristin W. Scott, MPhil, PhD at Harvard University, evaluated data from more than 800 hospitals who switched to the employment model for physicians and nearly 2,100 which didn’t, comparing mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.

42 percent of hospitals directly employed physicians in 2012, up from 29 percent in 2003. In the same time frame, there were substantial declines in the shares of hospitals with no association with physicians beyond the “traditional medical staff model” (44 percent in 2003 to 38 percent in 2012) or with contractual nonemployment relationships (27 percent to 19 percent). Beginning in 2009, employment became the most prevalent affiliation model among U.S. hospitals.

There were notable differences between the types of hospitals who switched to an employment model, finding them more likely to be large (11.6 percent switching vs. 7.1 percent nonswitching), major teaching hospitals (7.5 percent to 4.5 percent), and not-for-profit (19.9 percent vs. 8.8 percent).

What Scott and her coauthors didn’t find was improvement in quality metrics from hospitals switching to employing physicians.

“Although mixed evidence has suggested potential benefits or costs associated with this change, we found no effect on patient care across an array of metrics, even up to two years out,” Scott and her coauthors wrote. “Whether hospital–physician employment relationships are a key part of delivering higher-quality, more efficient care is unclear, but our findings cast doubt on the notion that such a change in itself is likely to have a meaningful effect.”

For example, the estimated change for mortality two years after switching was relatively the same for both switching (-0.41 percent) and nonswitching hospitals (-0.52 percent).

The lone exception was a statistically significant, yet still slight decrease in pneumonia readmissions among switching hospitals (-1.35 percent vs. -0.75 for nonswitching).

The authors listed many reasons why hospitals and physicians find the employment model more attractive—from delivery care reforms in the Affordable Care Act to greater leverage with private payers to doctors wanting to escape from the complexities of private practice. But when it comes to improving care, the study found employing more physicians alone won’t accomplish that goal.

“As hospital systems continue to acquire physician practices and employ physicians, a focus on true clinical integration, as well as a renewed focus on improving the quality of patient care and clinical outcomes, will be essential,” Scott and her coauthors wrote.