Multiple Hospital Affiliations Linked to Greater Medical and Drug Cost

According to a JAMA Network Open study, clinicians with multiple hospital affiliations were associated with increased medical cost, clinician service use, and greater procedure breadth.

To conduct the study, researchers used Medicare data from 2016 and 2017 to analyze a panel of clinicians, including primary care clinicians, medical specialists, surgical specialists, and advanced practice practitioners.

Researchers looked to understand how having multiple hospital-affiliated is associated with clinicians’ use of medical services, the variety of procedures undertaken, and clinician-generated costs.

The data collected was then used to create two data samples comprising of medical service clinicians and drug service clinicians. The medical service sample consisted of 633,5552 clinicians, with 58 percent affiliated with multiple hospitals, and the drug service sample consisting of 210,260 clinicians with 70 percent affiliated with multiple hospitals.

The analysis of the medical service sample showed that multihospital-affiliated clinicians provided 1,111.26 more services than single-hospital–affiliated clinicians who only provided 872.15 services during the course of the study.

The study describes service measure as the total number of services that clinicians render to their Medicare beneficiaries within a given year.

The drug service sample displayed similar trends. Multihospital-affiliated clinicians provided 6,792.2 drug services, and single-hospital–affiliated clinicians provided 2,382.0 drug services. Multihospital-affiliated clinicians provided 4,410.2 more drug services than single-hospital–affiliated clinicians

The study also looked at procedure breadth or the variety of procedures undertaken.

Researchers found that multihospital-affiliated clinicians provided 16.17 additional types of procedures in the medical service sample. In addition, the study showed multihospital-affiliated clinicians used 47.42 procedures. Meanwhile, single-hospital–affiliated clinicians used 31.25 procedures.

Multihospital-affiliated drug service clinicians used 8.38 procedures, and single-hospital–affiliated drug service clinicians used 7 procedures. In comparison, multihospital-affiliated drug service clinicians provided 1.38 more procedures.

“We found that both medical and drug (per-patient) services, as well as the variety of services used, were positively associated with multihospital affiliations. These findings suggest that clinicians may shift their treatment patterns—both treatment mix and quantity—when they start working across more hospitals,” the researchers explained in the study.

Lastly, researchers looked at the difference in cost of medical and drug services paid by Medicare.

Multihospital-affiliated medical services clinicians incurred $59,430.68 more in medical costs incurred than single-hospital–affiliated clinicians, only incurring $55,734.60.

Researchers noticed similar results with drug services. For example, multihospital-affiliated drug service clinicians incurred $24,866.44 more in drug costs than single-hospital–affiliated clinicians, only incurring $44,802.32 in drug costs.

“This cross-sectional study found that a clinician having multiple hospital affiliations was associated with increased clinician service use, greater procedure breadth, and higher costs across both medical and drug services,” the researchers stated.

 “The finding that per-patient spending increased after controlling for the number and the variety of clinician-offered services suggests that clinicians may be using costlier hospital services as their hospital affiliations increased”