As healthcare consolidation persists and physicians are increasingly pushed toward employed models, physicians and their patients are forced to manage the fallout of these industry shifts.
1. Physician autonomy. The longevity of independent physicians and the state of physician autonomy hangs in uncertainty amid the growing consolidation in healthcare.
"I believe the biggest threat to physicians is the progressive loss of autonomy such that they are not making the decisions for the patients, but those decisions are made for reasons and by people for other than the patient's benefit," Cary Passik, MD, and chief of cardiothoracic surgery at Good Samaritan Hospital in Suffern, N.Y., told Becker's.
Physicians are often driven to employment by a need for more bargaining power with payers as larger health systems tend to have better leverage in negotiating reimbursement rates.
Due to declining reimbursements and increasing regulatory and nonclinical burdens, more and more physicians decide to become employees of large organizations (hospitals, insurance company affiliates like Optum or Kaiser or mega-groups controlled by venture capital firms)," Vladimir Sinkov, MD, founder and CEO of Sinkov Spine Center in Las Vegas told Becker's. "Once they become employees, a significant amount of clinical and career autonomy is lost."
2. Quality and cost care for patients. Substantial evidence indicates that consolidation has led to higher prices in healthcare, according to 2020 data published by KFF. The data show that price hikes are strongest for hospitals, though other studies find that hospital-physician consolidation overall is associated with higher prices. Studies have shown that consolidation leads to higher spending, the cost of which is often passed onto patients through their insurance plans.
Evidence on the impact of consolidation on the quality of care for patients is mixed, although studies over the last 25 years have found that increased market consolidation was associated with higher risk-adjusted, one-year mortality rates for heart attacks and small decreases in patient experience measures.
Anecdotally, consolidation has resulted in some chaotic transitions at various health systems. Nashville, Tenn.-based HCA Healthcare faced scrutiny over its mismanagement of Asheville, N.C.-based Mission Health, which was acquired in 2019. Reclaim Healthcare WNC, a group of physicians, nurses, elected officials and community advocates have criticized the healthcare giant's decisions to shutter two family medicine practices in the area.
"It's been devastating in my mind," Tim Plaut, MD, a physician who worked at one of the shuttered practices, told Becker's.
3. Impact on physician practices. Independent physician practice groups have not been spared by the consolidation rush. Private equity acquisitions of physician groups increased by more than 600% from 2012 to 2021, according to analysis from Health Affairs. The most frequently acquired specialties were primary care, dermatology, obstetrics-gynecology, gastroenterology, ophthalmology, oncology, urology, radiology, orthopedics and cardiology.
"When PE firms acquire multiple providers in the same specialty within a local or regional market, those firms can gain significant market power, which can lead to higher prices or lower quality, or both, as a result of reduced competitive pressure," the authors, affiliated with University of California Berkeley and the FTC, noted in the study.