A July 2023 study by RAND found that most physicians working in vertically integrated hospitals or health systems were 65% less likely to use ASCs for procedures, compared to physicians who were never a part of a vertically integrated system.
Independent physicians have autonomy in referring patients out to ASCs for procedures or to perform procedures there themselves. Some physicians within hospital systems also have privileges to perform surgeries at ASCs.
But according to the study, which looked at the economic effects of vertical integration in healthcare between 2013 and 2016, physicians whose practices were vertically integrated reduced their ASC utilization by 13% and were 9% less likely to perform any procedures in the ASC — an effect that has continued over time.
During the same time period, the number of cases performed in HOPDs did not increase, but physicians began increasing the price of their services by 29%. The hike in cost is most evident for fee-for-service Medicare beneficiaries, as Medicare billing requires Medicare to pay ASCs no more than 59% of the prevailing HOPD facility fee. This demonstrates a transition of procedures from ASCs back into HOPDs, creating higher reimbursement opportunities for hospitals.