51 - Neonatology Physician Management Group and Hospital Ownership in the United States

Publication Number: 4050.51

Insherah Qazi, Childrens Hospital of Philadelphia, Little Rock, AR, United States; Dev Y. Gupta, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Nicolas P. Goldstein Novick, Children's Hospital of Philadelphia, Rose Valley, PA, United States; Matthew Coyle, Childrens Hospital of Philadelphia, Springfield, PA, United States; Ciaran Phibbs, Stanford University School of Medicine, Stanford, CA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States; Elizabeth Salazar, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: In the United States, neonatal private physician management groups (PMGs) are associated with significant increases in neonatal intensive care unit (NICU) spending, with similar clinical outcomes. Both the patterns of combined PMG and hospital ownership and their influence on costs and outcomes remain unknown.

Objective: To describe patterns of neonatal PMG ownership and identify predictors of PMG ownership type.

Design/Methods: This is a retrospective cohort study using 2021 merged American Hospital Association and Centers for Medicare and Medicaid Services (CMS) Healthcare Cost Reporting Information System data (HCRIS) with novel data on PMG ownership, identified through manual review of hospital website and online neonatal directories. The primary outcome was PMG type: other (Academic or Hospital), private practice, or corporate, including Mednax or Envision. We described hospital operational and financial characteristics by neonatal PMG type. We then examine the association of hospital characteristics with PMG type using multinominal logistic regression with robust standard errors unadjusted and adjusted for hospital characteristics. We mapped 2021 hospital location by PMG type over 2021 infant mortality quintiles (CDC Wide-ranging ONline Data for Epidemiologic Research).

Results: 1293/1366 (95%) hospitals with a NICU and unique CMS provider number were matched to HCRIS data. PMGs were 34% academic, 25% corporate, 15% hospital, and 24% private practice. Private PMGs were associated with hospitals with >250 beds, religious ownership, and lower operating margin (Table 1). Corporate PMGs were associated with hospitals with 50 - 249 beds, >2000 births, religious or for-profit ownership, South Atlantic location, and higher operating margin (Table 1, Figure 1). In adjusted models, private PMG was associated with religious, private equity, and for-profit public hospital ownership (respective OR [95% CI] 3.6 [2.1,5.8]; 3.3 [1.1,9.6]; 2.1 [1.3;4.0]), ≥ 250 beds (OR [95% CI] 13.3 [1.1,168.0]), and South Atlantic or Pacific region (respective OR [95% CI] 1.8 [1.1,2.9]; 2.1 [1.2,3.7]). Corporate PMG was associated with religious, for profit private, and public hospital ownership (respective OR [95% CI] 2.3 [1.3,4.2]; 4.1 [1.7,10.3]; 3.5 [2.0,6.3]), >1000 births, and all regions other than the Northeast (Table 2).

Conclusion(s): Neonatal corporate and private PMGs are associated with region and religious and for-profit hospital types. This preliminary data lays the groundwork for future study on the combined impact of PMG and hospital ownership on patient outcomes.

Figure 1. 2021 Hospitals by neonatal physician management group status overlayed over quintiles of infant mortality.
Legend: Neonatal physician management groups (PMGs) are grouped into academic (yellow), corporate (red), hospital (cyan), and private practice (blue). Quintiles of 2021 infant mortality rates from CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) are used as the base layer.

Table 1. 2021 Acute Care Hospitals by Physician Management Group Status


Table 2. Multinominal Logistic Regression of Private Practice or Corporate Neonatal Physician Management Group Adjusting for Hospital Ownership and Other Operational Characteristics