Rapid physician consolidation continues, especially in primary care

A new study shows that physicians have been moving to larger group practices at a rapid pace over the past few years, and among primary practice doctors the trend has been even more pronounced.

Between June 2013 and December 2015, the proportion of physicians in groups composed of nine or fewer dropped from 40.1 percent to 35.3 percent, according to a study published in the latest issue of Health Affairs. During that same time period, the proportion in groups with a hundred or more doctors rose from 29.6 percent to 35.1 percent.

The analysis used data from Medicare’s Physician Compare data set, which captured the movements of over 500,000 physicians during the period. Authors David B. Muhlestein and Nathan J. Smith, both of Leavitt Partners, write that this movement takes place in the context of a decades-long trend, likely driven in part by the shift from fee-for-service reimbursement to risk-based payment methodologies.

Systemic changes such as those in the Centers for Medicare & Medicaid Services’ recently proposed Medicare Access and CHIP Reauthorization Act have stoked worries that the days of small and independent practices may be numbered, as FiercePracticeManagement has previously reported. While the authors see a continuation of a trend toward consolidation in their data, they note that “smaller practices still account for a large percentage of physicians overall,” even as the proportion of small practices to large ones sees a significant shift.

The more immediate worries come from the potential for unintended consequences, according to the authors, who suggest that at some point the government may end up stepping in to block further consolidation through antitrust actions. They also note contradictory evidence regarding whether smaller or larger practices deliver better outcomes at lower cost, and recommend future research to nail down the specific causes of the trend in order to get a better handle on the effects of consolidation on the overall healthcare system.