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The American Journal of Managed Care October 2017
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Trends in Hospital–Physician Integration in Medical Oncology

Jeffrey D. Clough, MD, MBA; Michaela A. Dinan, PhD; and Kevin A. Schulman, MD
The authors used Medicare claims data to examine trends in hospital–physician integration in high-volume specialties, including medical oncology.
ABSTRACT

Objectives:
Hospitals have rapidly acquired medical oncology practices in recent years. Experts disagree as to whether these trends are related to oncology-specific market factors or reflect a general trend of hospital–physician integration. The objective of this study was to compare the prevalence, geographic variation, and trends in physicians billing from hospital outpatient departments in medical oncology with other specialties.

Study Design: Retrospective analysis of Medicare claims data for 2012 and 2013.

Methods: We calculated the proportion of physicians and practitioners in the 15 highest-volume specialties who billed the majority of evaluation and management visits from hospital outpatient departments in each year, nationally and by state.

Results: We included 338,998 and 352,321 providers in 2012 and 2013, respectively, of whom 9715 and 9969 were medical oncologists. Among the 15 specialties examined, medical oncology had the highest proportion of hospital outpatient department billing in 2012 and 2013 (35.0% and 38.3%, respectively). Medical oncology also experienced the greatest absolute change (3.3%) between the years, followed by thoracic surgery (2.4%) and cardiology (2.0%). There was marked state-level variation, with the proportion of medical oncologists based in hospital outpatient departments ranging from 0% in Nevada to 100% in Idaho. 

Conclusions: Hospital–physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends.

Am J Manag Care. 2017;23(10):624-627
Takeaway Points

Hospitals have rapidly acquired medical oncology practices in recent years. It is unknown whether this is due to oncology-specific factors or reflects a general trend. We analyzed publicly available physician-specific billing data and found: 
  • In 2012, 35.0% of medical oncologists, and in 2013, 38.3%, were primarily billing from hospital outpatient settings, a proportion substantially higher than in other high-volume specialties.
  • There was wide geographic variation in the proportion of hospital-based medical oncologists by state, ranging from 0% in Nevada to 100% in Idaho.

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Author Affiliations: Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine (JDC, MAD, KAS), Durham, NC.

Source of Funding: This work was supported internally by the Duke Clinical Research Institute.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (JDC, MAD, KAS); acquisition of data (JDC); analysis and interpretation of data (JDC, MAD, KAS); drafting of the manuscript (JDC, MAD); critical revision of the manuscript for important intellectual content (JDC, MAD, KAS); statistical analysis (MAD); obtaining funding (JDC, KAS); and supervision (KAS). 

Address Correspondence to: Jeffrey D. Clough, MD, MBA, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail: jeffrey.clough@duke.edu. 
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