Over an 18-month period, hospitals acquired 8,000 more medical practices, and 14,000 more physicians left independent practice to become hospital employees, according to a new analysis.
Hospitals across the country continued to acquire physician practices between July 2016 and January 2018, according to data (PDF) compiled by the Physicians Advocacy Institute (PAI) and the consulting company Avalere Health.
Some 44% of physicians were employed by hospitals or health systems as of January 2018, compared to just 1 in 4 in 2012, when PAI began tracking data on hospital acquisitions of independent medical practices, the report said.
“The continued trend of hospital-driven consolidation is dramatically reshaping the healthcare system,” said Robert Seligson, PAI’s president and CEO of the North Carolina Medical Society, in an announcement.
“PAI will continue to advocate for fair, transparent policies and champion physician clinical autonomy, regardless of the practice setting, to ensure that physicians can continue to deliver the best possible care to their patients,” he said.
The latest analysis adds to earlier research tracking the trend of physician practice acquisitions and physician employment by hospitals and health systems. Since 2012, the number of hospital-owned physician practices increased from 35,700 to more than 80,000 in 2018. The 128% growth that occurred in the study period, represents more than double the number of hospital-owned practices.
The number of hospital-employed physicians increased by more than 70%, from 94,700 in mid-2012 to 168,800 in January 2018. Those numbers increased in every six-month time period measured over the five-and-a-half-year study period.
The changes occurred in every part of the country, with hospital-owned practices increasing by 91% to 303% depending on the region. Some of the largest growth occurred in the Midwest, where more than half of all physicians are now employed by hospitals. Nearly 40% of Midwest physician practices were hospital-owned in 2018, the report said.
But there are some signs that independent practices are making a resurgence. For instance, a group of North Carolina doctors sued Atrium Health to go out on their own and established Tryon Medical Partners, an independent practice that has now opened eight medical clinics in the Charlotte area and opened its own $2.8 million gastrointestinal surgery center. Tyron is part of the Association of Independent Doctors, a group promoting the practice of independent medicine.
The PAI report cited three implications for physicians, patients and the healthcare system. For physicians, hospital employment can mean a loss of clinical autonomy in treating patients but can also alleviate certain burdens of independent practice. Government and private payer payment policies increasingly favor integrated health systems and make it challenging for physician practices to remain independent, the report said.
The shift also has implications for healthcare costs, the report said. Physicians employed by hospitals or health systems perform more services in a hospital outpatient department than independent physicians, it said. That increases costs to Medicare and patients.
A 2016 study by Avalere and PAI documented differences in Medicare payment for services performed in hospital outpatient departments versus physician office settings. For four specific cardiology, orthopedic and gastroenterology services, Medicare paid $2.7 billion more for services performed in hospital outpatient settings, with beneficiaries facing $411 million more in financial responsibility for those services than they would have if they were performed in independent physician offices.