title: Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care.
abstract: To assess the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality.
  
  
  
  Inpatient discharges from 3,957 community hospitals in 44 states and American Hospital Association Annual Survey data from 2010 to 2012.
  
  
  
  We conducted a retrospective longitudinal regression analysis using hierarchical modeling of discharges clustered within hospitals.
  
  
  
  Detailed discharge data including costs, length of stay, and patient characteristics from the Healthcare Cost and Utilization Project State Inpatient Databases were merged with hospital survey data from the American Hospital Association.
  
  
  
  Hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge and better quality of care compared with other independent hospitals.
  
  
  
  Increasing prevalence of health systems and hospital managed care ownership may lead to higher quality but are unlikely to reduce hospital discharge costs. Encouraging participation in innovative payment and delivery reform models, such as accountable care organizations, may be more powerful options.
authors.affiliation: Truven Health Analytics, An IBM Company, Cambridge, MA.
authors.forename: Rachel Mosher
authors.initials: RM
authors.lastname: Henke
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Zeynal
authors.initials: Z
authors.lastname: Karaca
authors.affiliation: Truven Health Analytics, An IBM Company, Cambridge, MA.
authors.forename: Brian
authors.initials: B
authors.lastname: Moore
authors.affiliation: Truven Health Analytics, An IBM Company, Cambridge, MA.
authors.forename: Eli
authors.initials: E
authors.lastname: Cutler
authors.affiliation: RAND Corp, Boston, MA.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.affiliation: Truven Health Analytics, An IBM Company, Cambridge, MA.
authors.forename: William D
authors.initials: WD
authors.lastname: Marder
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Herbert S
authors.initials: HS
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006739:Hospital Administration; D006742:Hospital Bed Capacity; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D010067:Ownership; D010351:Patient Discharge / Q000191:economics; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States
keywords: Centralization; cost; health systems; hospitals; quality indicators