What happens when doctors consolidate in multispecialty practices? Fees go up, according to a new study.
Multispecialty consolidation drives up the price of a standard office visit, according to a study from the National Bureau of Economic Research.
The study by Stanford University researchers found that generalist physicians charge higher fees when they are integrated with specialist physicians—with a greater effect in markets where there is not a lot of competition among specialists.
The same was found in reciprocal settings: Specialist fees are higher when they are integrated with generalists, and the effect is stronger in markets where there is not a lot of competition for generalists.
“Our results suggest that multispecialty practice has anticompetitive effects,” the researchers said.
The study set out to examine the consequences of multispecialty physician practice, a common and increasing form of vertical integration. Research has focused almost exclusively on integration between hospitals and physicians, leaving a gap when it comes to the effect of integration of physicians of different specialties. The majority of physicians work in a multispecialty practice and the share is increasing, the study noted.
Researchers used data on 40 million commercially insured patients from all 50 states from the Health Care Cost Institute to determine the price of a standard office visit to general practice and specialist physicians from 2008 to 2012.
They estimated the extent to which changes in multispecialty practice during that time frame affected the price of an office visit with a generalist and specialist physician in approximately 17,000 urban zip codes.
The study provides another reason to support a single-payer healthcare system, comments Don McCanne, M.D., on the Physicians for a National Health Program website. In that case, prices would be negotiated to cover legitimate costs and fair margins, he says.