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Research

Working Papers

Getting Down to Business: Chain Ownership and Fertility Clinic Performance with Julia Bodner (R&R Management Science)

Chain ownership has been credited with boosting firm performance in the retail and service sectors but criticized for prioritizing profits over the well-being of patients in the healthcare sector. This paper finds that chain organizations improve healthcare outcomes in a setting with relatively minimal market frictions and information asymmetries: the market for In Vitro Fertilization (IVF). After acquisition by a fertility chain, IVF clinic volume increases by 28.2%, and IVF success rates increase by 13.6%. We provide evidence that fertility chains facilitate resource and knowledge transfers needed to enhance clinic quality, benefit underperforming clinics, and expand the IVF market.

Turbocharging Profits? Contract Gaming and Revenue Allocation in Healthcare with Atul Gupta and Adam Sacarny (Draft available upon request)

Firms often exploit loopholes in government contracts to boost revenues. The welfare consequences of this behavior depend on how firms use the marginal windfall dollar. This paper studies how hospitals allocated $3 billion obtained via a Medicare payment loophole. The average gaming hospital increased both Medicare and total revenue by around 10%, implying large spillovers on other payers. Some of these funds flowed to operating costs, a result driven entirely by non-profits. The rest flowed off hospital balance sheets, mostly due to for-profit hospitals. These funds enriched executives and shareholders. We detect modest reductions in mortality rates at non-profits but no changes at for-profits. Our results imply the consequences of such engineered windfalls vary substantially by hospital ownership.

Work in Progress

“Gender Composition of Physician Teams and Childbirth Outcomes”

(with Solène Delecourt and Manasvini Singh)

“The Impact of Hospital Mergers and Acquisitions on Consumer Finances”

(with Alexander Adia and Adam Leive)

Study on physician departures and the impact on peer decision-making and personnel changes

(with Mathijs De Vaan)

Publications

Yu, J., Bond, A., Braun, R. T., La Forgia, A., RoyChoudhury, A., Zhang, M., Kim., J, & Casalino, L. (2023). Physician Management Companies and Neonatology Prices, Utilization, and Adverse Clinical Outcomes. Pediatrics.

 

La Forgia, A. (2022). The Impact of Management on Clinical Performance: Evidence from Physician Practice Management Companies. Management Science. [Ungated Version]

 –AOM William H. Newman Award Finalist, 2020; AOM HCM Division Best Paper Award, 2020; AOM HCM Best Paper Based on a Dissertation Award, 2020; Industry Studies Association’s Giarratani Rising Star Award, 2020

La Forgia, A., Bond, A., Braun, R. T., Yao, L. Kjaer, K., Zhang, M., & Casalino, L. (2022). Association of Physician Management Companies and Private Equity Investment With Commercial Health Care Prices Paid to Anesthesia Practitioners. JAMA Internal Medicine. [Ungated Version]

– Media Coverage: ModernHealthcareHealthcareDiveBecker’s Hospital ReviewJAMA PodcastWall Street JournalWashington Post, Fortune

– Public Policy: FTC challenges PE-backed anesthesia groupU.S. Anesthesia Partners, Welsh Carson face class action over monopoly allegations

– Finalist for the 2023 NIHCM Research Award

La Forgia, A., Bond, A., Braun, R. T., Kjaer, K., Zhang, M., & Casalino, L. (2021). Association of Surprise Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York. JAMA Internal Medicine. [Ungated Version]

– Media Coverage: U.S. News and World ReportBenefitsProKaiser Health News,  Forbes

– Public Policy: HHS report evaluating No Surprises Act

 

La Forgia, A., Maeda, J. L., & Banthin, J. S. (2017). Are Integrated Plan Providers Associated with Lower Premiums on the Health Insurance Marketplaces? Medical Care Research and Review.

– Media Coverage: The New York Times Upshot

 

Book Chapters and Proceedings

La Forgia, A. (2020). The Impact of Acquisitions on Clinical Decisions: Evidence from Physician Practice Management Companies. Proceedings of the Eightieth Annual Meeting of the Academy of Management.

 

La Forgia, A., & Burns, L. R. (2017). Health Insurance in China. In L.R Burns & G. Liu (Eds.), China’s Health Care System and Reform (pp. 291-320). Cambridge, UK: Cambridge University Press.

Interviews, News, and Popular Press

Wolinksy, Howard. (November 2023). Private Equity Moves into Medical Practice. Chicago Medical Society. 

 

Bichell, Rae Ellen. (October 12, 2022). Routine births are turning into moneymaking ‘emergency’ events at hospitals that work with private equity-backed staffing companies. Fortune.

 

Anesthesia Practice Management Success with Justin Harvey, Episode 154. (July 18, 2022). Here’s What Happens To Anesthesia Contracts When Private Practices Get Bought Out w. Dr. Ambar La Forgia.

 

Tribble, Sarah Jane. (June 15, 2022). Buy and Bust: When Private Equity Comes for Rural Hospitals. Kaiser Health News.

 

Krupp, Lexi. (March 22, 2022). Vermont’s largest hospital system and a massive insurance company are deadlocked. Thousands of patients are caught in the middle. Vermont Public Radio.

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