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Study: Physician Practices Acquired by Hospitals Improve Chronic Disease Management

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Physician practices that are acquired by hospitals tend to increase their use of techniques that help manage chronic illnesses, according to new research by Weill Cornell Medicine scientists. The trend is associated with the change in ownership, according to the study, which was published March 17 in the American Journal of Managed Care.

Dr. Tara Bishop
Photo credit: Michael Seto

Over the past decade, some reports have pointed to an increasing trend in the sale of privately owned physician practices to hospitals. But it was unclear how such a change in ownership would affect the care that patients receive. For the study, the investigators analyzed one aspect of patient care: The extent to which practices use population-based strategies such as disease registries, patient educators and nurse care managers to help patients with chronic illnesses manage, coordinate and take charge of their care.

The researchers looked at three national surveys of physician groups and found that, while there wasn't a significant increase in the number of practices purchased by hospitals, those that did change ownership were better able to implement care management practices.

"It's interesting for physicians who are considering selling their practice to know what might change for the better and for patients who may find that their doctor's office is now owned by a hospital," said lead author Dr. Tara Bishop, the Nanette Laitman Clinical Scholar in Healthcare Policy and Research/Clinical Evaluation and an associate professor of healthcare policy and research in the Division of Outcomes and Effectiveness Research at Weill Cornell Medicine.

Dr. Bishop and her colleagues analyzed data from the three largest national surveys of physician practices in the United States — one conducted in 2006-2007, the second in 2007-2009, and the third in 2012-2013. The researchers compared responses provided by 73 large practices in the 2006-2007 dataset to those provided in 2012-2013, as well as responses provided by 768 small- and medium-sized practices obtained in 2007-2009 to those obtained in 2012-2013.

Hospital ownership of large practices increased from 26.6 percent to 35.6 percent from 2006-2007 to 2012-2013, but this change was not statistically significant. However, it hardly changed — 8.3 percent to 11.3 percent — for small and medium practices. "The majority of practices are still physician-owned," Dr. Bishop said, though she noted that the trend toward hospital ownership may have increased since 2013.

The researchers also measured whether practices increased their use of care-management processes, which doctors consider as proven tools for managing chronic illnesses. Practices that were acquired by hospitals — especially large practices — embraced these processes significantly more than ones that remained in physician ownership. Hospital ownership didn't affect practices' use of electronic medical records, however.

It makes sense that a hospital would have more resources to implement some of these processes. "It may be harder for small, independently owned practices to muster those resources," Dr. Bishop said.

She notes, however, that there may be negative aspects to acquisition not revealed by the surveys — such as increases in the cost of care, or limits on physicians' autonomy.

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