Starting around 2006, the Centers for Medicare and Medicaid Services (CMS) progressively reduced Medicare Fee-for-Service (M-FFS) payments for the principal noninvasive cardiac tests, when performed in a cardiologist office (Office), yet kept payments flat to increasing for the same tests, performed in the hospital-based outpatient (HBO) setting. This produced a growing gap between HBO and Office payments for the same tests, and thus an incentive for hospitals to acquire cardiology practices in order to move cardiac tests to the HBO location and capture the HBO/Office payment differential. We use difference-in-differences analysis, in which we compare national M-FFS trends in cardiac test location to those for a control group of several large, integrated Medicare Advantage (M-Adv) health systems over 2005–2015, which were not affected by these reimbursement changes, and provide evidence that these reimbursement changes led to a large shift in testing from Office to HBO. This shift was concurrent with a sharp rise in hospital-cardiologist integration. The rise in integration and the proportion of testing in HBO varied greatly across states. Independent practice remains viable in very large states, but is endangered in many states, and is all but extinct in a growing number of states.

中文翻译：

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财务激励对医院-心脏病专家整合和心脏检查地点的影响

从 2006 年左右开始，医疗保险和医疗补助服务中心 (CMS) 逐步减少了在心脏病专家办公室 (Office) 进行的主要无创心脏检查的医疗保险按次服务费 (M​​-FFS) 付款，但仍保持付款不变在医院门诊 (HBO) 环境中进行的相同测试有所增加。这使得 HBO 和 Office 之间对相同检查的支付之间的差距越来越大，从而激励医院获得心脏病学实践，以便将心脏检查转移到 HBO 地点并捕获 HBO/Office 的支付差异。我们使用双重差分分析，将 2005 年至 2015 年期间全国心脏测试地点的 M-FFS 趋势与几个大型综合医疗保险优势 (M-Adv) 卫生系统的对照组的趋势进行比较，未受到这些报销变更的影响，并提供证据证明这些报销变更导致测试从 Office 大幅转向 HBO。这一转变与医院与心脏病专家的融合急剧增加同时发生。HBO 的融合程度和测试比例在各州之间存在很大差异。独立实践在非常大的国家中仍然可行，但在许多国家中受到威胁，并且在越来越多的国家中几乎已经灭绝。