Vertical integration in cardiology practices cuts patient 'value': 5 things to know

Vertical integration across independent cardiologists has led to higher costs in Medicare over the last 15 years with "minimal evidence" of any increase in quality of care, according to findings presented during 2024 American Heart Association Scientific Sessions in Chicago.

"The Association of Cardiologist Vertical Integration with Care Quality, Patient Outcomes, and Utilization," published in The American Journal of Managed Care, was presented by senior author Vinay Kini, MD, a cardiologist and health services researcher with Weill Cornell Medicine in New York City. The results indicate that those paying for Medicare cardiology services are receiving "less value" due to consolidation. 

Here are five other things to know about the findings: 

1. Data show that the percentage of U.S. cardiologists employed by hospitals increased from 26% in 2008 to 61% in 2018. 

2. Researchers followed cardiologists as consolidation increased and could trace when physicians switched from using individual provider numbers to hospital tax ID numbers to bill Medicare. Based on each billing for Medicare fee-for-service patients, they tracked billing for hospitalization for incident heart failure and acute myocardial infarction. Using a three-year "lookback period," the researchers excluded prior hospitalizations and examined mortality, readmission and other quality-of-care indicators. 

3. The cardiologists were then split into three groups for a differences-in-differences analysis: nonintegrated, always integrated or "switchers," who had changed from individual to hospital tax ID. The sample covered 186,052 patients with acute MI and 259,849 patients with HF treated by "switchers," and another group of 168,052 acute MI patients and 245,769 HF patients cared for by nonintegrated cardiologists. 

4. "In a nutshell, we really found no differences between the two groups," in terms of quality, Dr. Kini said. The only significant difference, according to the report, was a small difference in the 30-day followup clinic visit. 

5. Authors also found "no differences in utilization between patients treated by hospital-employed cardiologists post-switch versus independent cardiologists." Dr. Kini said that given the increase in costs associated with consolidated healthcare, vertical integration results in lower value. 

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