Implications of Vertical Integration in the Oncology Market Restricted; Files Only
Hu, Xin (Summer 2023)
Published
Abstract
The share of oncology practices acquired by hospitals more than doubled in the past decade in the United States. This phenomenon, known as “vertical integration”, was found to increase healthcare spending. On the other hand, vertical integration may improve care efficiency and quality through facilitating functional, service, and clinical care integration. Nevertheless, empirical evidence of its impact on care delivery and outcomes is inconclusive. This dissertation investigates the influence of Medicare payment policies and the confounding effect of provider characteristics on trends in vertical integration in the oncology market, and the implications of vertical integration for both physicians and patients. The three essays of the dissertation examined: 1) the association between Medicare site-based reimbursement policy and vertical integration in oncology, and the confounding effect of providers’ versatility; 2) the impact of vertical integration on physicians’ use of novel cancer therapy; 3) the impact of vertical integration on patients’ cancer care quality, spending, and outcomes.
The findings of this dissertation showed evidence that Medicare site-based reimbursement policy is positively associated with vertical integration in the oncology market when accounting for provider-specific time-invariant characteristics. However, providers’ versatility has a stronger and negative association with vertical integration despite the differential Medicare reimbursement rates by site-of-care. Oncologists already practicing in the integrated setting adopted novel cancer therapy faster, and those who subsequently integrated into hospital systems showed a modest increase in the likelihood of using novel cancer therapy. Following vertical integration of oncologists, patients experienced significant improvement in guideline-adherent supportive care use, but no significant changes in healthcare spending or cancer outcomes. Together, the findings suggested that both payment policies set by Medicare and providers’ versatility in terms of their ability to diversify revenue through ancillary services played important roles in business decisions for vertical integration. While the downstream effect on physicians and patients showed improvement in clinical care integration and faster dissemination of new therapy, there are small and non-significant impacts on cancer outcomes such as survival.
Table of Contents
CHAPTER 1: Introduction 1
1.1. Organization Structures and Vertical Integration in the US Oncology Market 1
1.2. Introduction to Essay 1: Medicare Site-Based Payment Policy and Vertical Integration in Oncology: The Role of Provider’s Versatility 6
1.3. Introduction to Essay 2: Vertical Integration and Oncologists’ Adoption of Immunotherapy in Non-Small Cell Lung Cancer 8
1.4. Introduction to Essay 3: Vertical Integration and Patients’ Quality of Cancer Care, Outcomes, and Spending 11
References 17
CHAPTER 2: Medicare Site-Based Payment Policy and Vertical Integration in Oncology: The Role of Provider’s Versatility 21
2.1. Introduction 23
2.2. Methods 27
2.3. Results 33
2.4. Discussion 37
2.5. Conclusion 40
References 41
CHAPTER 3: Vertical Integration and Oncologists’ Adoption of Immunotherapy in Non-Small Cell Lung Cancer 63
3.1. Introduction 64
3.2. Methods 66
3.3. Results 71
3.4. Discussion 73
3.5. Conclusion 76
References 77
CHAPTER 4: Vertical Integration and Patients’ Quality of Cancer Care, Outcomes, and Spending 97
4.1. Introduction 98
4.2. Methods 100
4.3. Results 105
4.4. Discussion 107
4.5. Conclusion 110
References 111
About this Dissertation
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Palabra Clave | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
File download under embargo until 16 August 2029 | 2023-07-27 21:41:51 -0400 | File download under embargo until 16 August 2029 |
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|