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The trend of hospitals consolidating medical groups and physician practices in an effort to improve the coordination of patient care is backfiring and increasing the cost of patient care, according to a new study led by the University of California, Berkeley.
The counterintuitive findings, published Tuesday in the Journal of the American Medical Association, come as a growing number of local hospitals and large, multi-hospital systems in this country are acquiring physician groups and medical practices.
“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said study lead author James Robinson, professor and head of health policy and management at UC Berkeley's School of Public Health.
“The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in 'accountable care organizations' can provide care better than the traditional fee-for-service and solo practice models,” said Robinson. “The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”
Robinson teamed up with study co-author Kelly Miller, program analyst at Integrated Healthcare Association, a nonprofit organization that promotes health care quality improvement, accountability and affordability in California.
The researchers analyzed four years of data, from 2009 to 2012, on 158 major medical groups and 4.5 million patients in California.
Groups were put into three categories: owned by physicians, owned by a local hospital or hospital system, or owned by a large hospital system that spans multiple geographic markets in the state.
The measure of costs included physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except for mental health services.
The researchers did not have data on mental health services since they are paid for separately.
After controlling for such factors as the mix of severely ill patients and geographic differences in cost, the researchers found that per patient expenditures were 19.8 percent higher for physician groups in multi-hospital systems compared with physician-owned organizations.
Groups owned by local hospitals were better, but per patient costs still ran 10.3 percent higher compared with physician-owned groups.
Why would consolidation lead to increased costs? It could be that once a medical group has been acquired, physicians in those groups are expected to admit their patients to the high-priced hospital, Robinson said.
“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.
Robinson said that public policy should not encourage mergers and acquisitions as a means of promoting collaboration.
Instead, he said, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve coordination of care.
“Hospitals are an essential part of the health care system, but they should not be the center of the delivery system,” said Robinson. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”
The study authors noted that their findings are limited to California, and that further studies should be done using data from other states.
“Nevertheless, these findings are important since California is the nation's leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to 'accountable care organizations' by the Obama administration,” said Robinson.
The Robert Wood Johnson Foundation provided support for this research.
Sarah Yang writes for the UC Berkeley News Center.
KELSEYVILLE, Calif. – Rivals Clear Lake High and Kelseyville High will meet on the football field this Friday for the fifth annual Bass Bowl.
The annual rivalry game will take place at Kelseyville High School, 5480 Main St.
Kelseyville won the first and the fourth Bass Bowls, while Clear Lake High won the middle two games.
With the series tied at two games apiece, Friday's game takes on a bigger significance.
Kelseyville is coming in with a 4-3 record, 1-3 in league, while Clear Lake is 3-4, but has dropped four in a row.
Both teams could still reach the playoffs by winning their remaining games, but winning the Bass Bowl Trophy will be all the teams will be focusing on come Friday night.
Due to a league realignment and a safety concern last year because of a problem with the Kelseyville stadium, every Bass Bowl until now has been played on the Clear Lake High home field.
The usual pomp and circumstance of the prior Bass Bowls will not be evident at this year's Bass Bowl due to a decision by the Kelseyville administration that the Civil War canon, jumbotron and other features of the Bass Bowl would not be practical at their venue.
The Bass Ball Trophy will be present and will either be retained by Kelseyville or handed over to Clear Lake High to take home for the coming year.
Fans and alumni from both schools are encouraged to turn out and cheer their team and wear their teams colors.
The cheer squads from both schools have some special programs on tap, and will be expecting the fans to cheer loudly with them.
LAKE COUNTY, Calif. – Lake County residents will have the chance to help others and learn about volunteering opportunities in the community as part of the annual “Make A Difference Day” this Saturday.
The daylong event will feature the collection of food donations as part of the “stuff the bus” effort as well as a new volunteer fair.
From 9 a.m. to 3 p.m., a Lake Transit bus will be parked at the Lakeport Grocery Outlet parking lot, located at the corner of S. Main Street and Lakeport Boulevard, collecting food.
A second bus will be located at the Clearlake Grocery Outlet on Olympic Drive from 9 a.m. to 12:30 p.m., also collecting food donations.
All nonperishable, clean, usable, unopened and not-out-of-date food will be accepted.
Organizers said all of the food donations will stay in Lake County to be distributed to local soup kitchens, food pantries, senior centers and food programs.
Also available on Make A Difference Day, Lake Transit is offering free rides in exchange for nonperishable food donations.
One food item will be good for a local ride, while a regional ride will require two food items. Three food items can be exchanged for an out-of-county ride.
Ahead of the event, food donations can be made at food barrels at Konocti Christian Academy, People Services offices in Lakeport and the thrift store in Clearlake, the Lake County Office of Education, Clearlake Grocery Outlet, Riviera Market, Sutter Lakeside Clinic, Lower Lake High School, Upper Lake High School, Middletown High School, Lake County International Charter School in Middletown, Yuba College Culinary Club and Lakeview Market in Lucerne.
New to Make A Difference Day this year is the inaugural volunteer fair, which will take place from 2 to 4 p.m. at Marymount California University's Lakeside Campus in Lucerne.
At the fair organizations can recruit potential volunteers as they browse the tables. Organizations also will have the opportunity to raise public awareness of their missions.
For more information contact Tammy Alakszay at
LAKEPORT, Calif. –Students at Terrace Middle School in Lakeport are joining more than one million other students across the country to help break down social and racial barriers by participating in the annual 'Mix It Up at Lunch Day' on Tuesday, Oct. 28.
The event, launched by the Southern Poverty Law Center’s Teaching Tolerance project in 2002, encourages students to sit with someone new in the cafeteria for just one day.
Cafeterias are the focus of Mix It Up because that’s where a school’s social boundaries are most obvious.
Many schools plan similar barrier-busting activities throughout the day. Some use the event to kick off a yearlong exploration of social divisions.
This is the second year of participation for Terrace Middle School, which includes fourth through eighth graders.
Parent and community volunteers will facilitate fun activities during lunch aimed to get kids talking.
The idea is to get students thinking about others, have fun together and build bridges toward future friendships.
“Mix It Up is a positive step that schools can take to help create learning environments where students see each other as individuals and not just as members of a separate group,” said Teaching Tolerance Director Maureen Costello. “When people step out of their cliques and get to know someone, they realize just how much they have in common.”
The Southern Poverty Law Center established Teaching Tolerance in 1991 to provide educators with free resources designed to reduce prejudice, improve intergroup relations and support equitable school experiences for the nation’s children.
LAKEPORT, Calif. – As it prepares for the Nov. 4 general election, the Lake County Registrar of Voters Office reported that it will conduct regular testing of its ballot tabulation computer and software this week.
Registrar of Voters Diane Fridley said the logic and accuracy test will take place beginning at 10 a.m. Thursday at her office, located in room 209 on the second floor of the Lake County Courthouse, 255 N. Forbes St.
Fridley said the test of her department's tabulation devices and software is conducted pursuant to California State Commission on Voting Machines and Vote Tabulating Devices regulations.
All interested persons are invited to observe the test, Fridley said.
Five of the most high-risk freshwater invaders from the Ponto-Caspian region around Turkey and Ukraine are now in Britain – including the quagga mussel, confirmed just three weeks ago on Oct. 1 in the Wraysbury River near Heathrow airport.
Researchers say that, with at least 10 more of these high-risk species established just across the channel in Dutch ports, Britain could be on the brink of what they describe as an “invasional meltdown”: as positive interactions between invading species cause booming populations that colonize ecosystems – with devastating consequences for native species.
The authors of a new study on 23 of high-risk invasive species, published in the Journal of Applied Ecology, describe Britain's need to confront the Ponto-Caspian problem – named for the invaders' homelands of the Black, Azov and Caspian seas – as a “vital element for national biosecurity.”
They say monitoring efforts should be focused on areas at most risk of multiple invasions: the lower reaches of the Rivers Great Ouse, Thames and Severn and the Broadlands, where shipping ballast water and ornamental plant trading is most likely to inadvertently deposit the cross-channel invaders.
All of these areas are projected to see an influx of up to 20 Ponto-Caspian invading species in the near future.
“Pretty much everything in our rivers and lakes is directly or indirectly vulnerable,” said Dr. David Aldridge, co-author from the University of Cambridge's Department of Zoology, who confirmed the quagga find.
“The invader we are most concerned about is the quagga mussel, which alarmingly was first discovered in the UK just two weeks ago. This pest will smother and kill our native mussels, block water pipes and foul boat hulls. We are also really worried about Ponto-Caspian shrimps, which will eat our native shrimps,” Aldridge said.
The most aggressive invasive shrimp have ominous monikers: the demon shrimp, bloody red shrimp and the notorious killer shrimp – dubbed the “pink peril.”
These organisms have already been recorded in Britain, and experts warn they will act as a gateway for further species due to favorable inter-species interactions that facilitate invasion, such as food provision and “commensalism” – in which one species obtains benefits from another's place in an ecosystem.
The researchers point to the example of the zebra mussel, a Ponto-Caspian outrider and relation of the quagga first seen in the UK in 1824 and now widespread.
Zebra and quagga mussels smother Britain's native mussels, preventing them from feeding and moving.
The invading mussels also provide an ideal home for Ponto-Caspian amphipods such as killer and demon shrimps, which have striped patterns to blend in with the mussels' shells.
These amphipods, in turn, provide food for larger invaders such as goby fish.
Ponto-Caspian gobies have now made their way down the Rhine, one of the main “corridors” to Britain, with populations exploding in the waterways of western France over the last few years. The invading gobies eat native invertebrate and displace native fish such as the already threatened Bullhead.
Once the Ponto-Caspian species reach coastal areas of The Netherlands, they are transported across the channel in ballast water taken on by cargo ships, or hidden in exported ornamental plants and aquatic equipment such as fishing gear.
“If we look at The Netherlands nowadays it is sometimes hard to find a non-Ponto-Caspian species in their waterways,” said Aldridge.
“In some parts of Britain the freshwater community already looks more like the Caspian Sea. The Norfolk Broads, for example, typically viewed as a wildlife haven, is actually dominated by Ponto-Caspian zebra mussels and killer shrimps in many places.”
“Invasive species – such as the quagga mussel – cost the UK economy in excess of £1.8 billion ($2.9 billion) every year,” said Sarah Chare, deputy director of fisheries and biodiversity at the UK Environment Agency. “The quagga mussel is a highly invasive non-native species, affecting water quality and clogging up pipes. If you spot one then please report it to us through the online recording form.”
Through an in-depth analysis of all reported field and experimental interactions between the 23 most high-risk invasive Ponto-Caspian species, the researchers were able to identify 157 different effects – the majority of which enabled positive reinforcement between species (71) or made no difference (64).
Dates and locations of the first British reports of 48 other freshwater invaders from around the world show that 33 percent emerged in the Thames river basin, making it the UK hot spot for invaders, followed by Anglian water networks (19%) and the Humber (15%).
The time between a Ponto-Caspian species being reported in The Netherlands and Britain has shrunk considerably – from an average of 30 years at the beginning of the 20th century to just five in the last decade.
“Due to glottalization and increased travel and freight transport, the rate of colonization of invasive species into Britain from The Netherlands keeps accelerating – posing a serious threat to the conservation of British aquatic ecosystems,” said co-author Dr Belinda Gallardo, now based at the Doñana Biological Station in Spain.
“Cross-country sharing of information on the status and impacts of invasive species is fundamental to early detection, so that risks can be rapidly assessed. A continuing process for evaluating invasive species and detecting new introductions needs to be established, as this problem is increasing dramatically.”