Effect of financial incentives on <scp>hospital‐cardiologist</scp> integration and cardiac test location

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