Economic impact of converting an interventional pain medicine physician office-based practice into a provider-based ambulatory pain practice

Background: one consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. these acquired practices are often converted into hospital- or provider-based clinics. this designation brings the increased services of the hospital,the accreditation of the hospital,and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). one potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. the aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. objective: determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu. setting: community hospital-based academic interventional pain medicine practice. study design: economic analysis of effect of change in price structure on clinical volumes. methods: the current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. results: clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. limitations: single practice entity and single geographic location in southeastern united states. conclusions: the conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. these results imply that factors other than price are a driver of patient choice.