Introduction: Physician practices in varied medical specialties have undergone consolidation over the past several decades, with acquisition of medical practices by hospital systems appearing to be a dominant mechanism of this phenomenon. The effects of acquisition on quality and cost of care are poorly understood, particularly within the field of neurosurgery. The objectives of the current study were to assess the effects of neurosurgical practice acquisition on hospital charges and quality metrics within a single market.
Methods: Neurosurgeon and practice affiliation data was accessed for the years 2017 to 2024 via the CMS provider data catalog. Neurosurgeons were classified as affiliated with either physician-owned. non-physician-owned practices, or acquired practices, which were tabulated by assessing practice switches. Hospital charges, case type, and quality metrics were compared between the three groups in both 2017 (pre-acquisition) and 2024 (post-acquisition) utilizing Intellimed Intelliclient, an aggregated database of discharge data. Statistical analysis was performed to identify differences between years and practices.
Results: Hospital charges were higher for post-acquisition practices than pre-acquisition practices ($302,491.43 vs. $142,554.38, p = 0.029), physician-owned practices ($302,491.43 vs. $236,376.05, p = 0.007) and non-physician owned practices ($302,491.43 vs. $223,616, p = 0.005) despite unchanged LOS and mortality rates. Hospital acquisition was associated with a decrease in elective case percentage (68% vs. 47%, p = 0.029), while case proportions remained constant in physician-owned and non-physician owned practices. In multivariate logistic regression, practice type remained an independent predictor of average ancillary charge (p = 0.028) along with year (p < 0.001), sCMI (p < 0.001), and case type (p = 0.019) when controlling for LOS and mortality rate.
Conclusion : Hospital acquisition of neurosurgical practices is associated with higher hospital charges and decreased elective case volume despite no changes in quality metrics such as length of stay and mortality rate. In addition to case type and severity indices, hospital charges are driven by practice type.
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