Research in Progress: University of Pennsylvania, Peter Groeneveld - Cardiology Physician Group Practice Vertical Integration and the Use of Cardiovascular Imaging

Peter ("Pete") W. Groeneveld, MD, MS is Professor of Medicine at the University of Pennsylvania’s Perelman School of Medicine and a primary care physician at Philadelphia’s Corporal Michael J. Crescenz VA Medical Center. He is the Founding Director of Penn’s Cardiovascular Outcomes, Quality, and Evaluative Research (CAVOQER) Center, Director of Research at Penn’s Leonard Davis Institute of Health Economics (LDI), Chair of the VA’s Research and Development Committee, Co-Director of Penn’s Master of Science in Health Policy (MSHP) program, and Associate Director of the VA’s Center for Health Equity Research and Promotion. Dr. Groeneveld’s research is focused on the quality, outcomes, costs, and equity of high-technology cardiovascular care, and his methodological expertise is in the analysis of a wide variety of health care data, including administrative claims, clinical registries, electronic medical records, and surveys. His research has been funded by the VA, NIH, AHRQ, and the Commonwealth of Pennsylvania, and he has co-authored over 100 peer-reviewed publications. Dr. Groeneveld is a Fellow of the American Heart Association and of the American College of Physicians, and he is an elected member of the American Society for Clinical Investigation (ASCI).

Title: Cardiology Physician Group Practice Vertical Integration and the Use of Cardiovascular Imaging

Abstract: A substantial proportion of previously independent U.S. cardiology physician practices have become vertically integrated into larger health systems.  It is unclear if vertical integration affected the clinical practice patterns of these cardiologists.  Longitudinal data from cardiology practice surveys from 2008-2013 were combined with Medicare fee-for-service claims for two common cardiology imaging tests: echocardiograms and cardiac nuclear studies. Cardiologists who transitioned from independent to hospital- or health system-owned practices ordered 17% more echocardiograms and 10% more cardiac nuclear imaging studies after their practices had transitioned.  Our findings surprisingly suggest that vertical integration of cardiologists' practices was associated with higher rates of cardiovascular imaging.  Potential explanations include preferential integration of group practices with lower pre-integration imaging rates, increased post-integration clinician incentives for ordering tests, and/or reduced administrative barriers to obtaining testing after integration.