A variety of health reform initiatives have been recently launched that seek to integrate care delivery across providers, functions, and operating units. The hope is that such clinical integration will decrease care fragmentation and, in the process, help patients obtain more efficient care. In this context, we analyzed medical claims from patients undergoing radical prostatectomy to evaluate the effects of deeper clinical integration in the hospitals where these patients were treated on the costs of their surgical care.

METHODS

Using national Medicare data (2008-2011), we mapped interactions between physicians around shared patients undergoing radical prostatectomy in different hospitals. We then used network analytical tools to characterize the level of clinical integration (as measured by the assortativity coefficient) among surgical and medical specialists and primary care physicians in each hospital. Finally, we fit a series of multilevel regression models to examine how a hospital's level of clinical integration related to price-standardized episode payments for radical prostatectomy procedures performed in it.

RESULTS

Compared to hospitals with lower levels of clinical integration, those with higher levels, on average, took care of more men with prostate cancer (P<0.01), were staffed by more physicians (P<0.01), and were more likely to have an academic affiliation (P<0.01). After controlling for these measurable differences and other health system factors, we found that episode payments for patients undergoing radical prostatectomy varied significantly across hospitals by their level of clinical integration (P<0.01). Among hospitals with lower levels of clinical integration (higher assortativity), the mean episode payment for prostatectomy was estimated to be $12,792, while among hospitals with higher levels of clinical integration (lower assortativity), the corresponding estimate was $12,122 (Figure).

CONCLUSIONS

Greater clinical integration is associated with significantly lower surgical episode costs for patients undergoing radical prostatectomy. Thus, health reform initiatives that foster clinical integration may lower spending on surgery.