Suzanne M. Kirchhoff
Analyst in Health Care Financing
Agrowing number of U.S. physicians are combining their practices; affiliatingwith hospitals, insurance companies, and specialty management firms; orgoing to work directly for such organizations. The moves are part of abroader trend toward consolidation in health care, with the overall numberof mergers and acquisitions in the sector at the highest level in a decade.
Alterations in physician practice appear to be a response to a number offactors. Younger doctors are more eager than their predecessors to workfor an outside institution, such as a hospital, to secure a set scheduleand salary. Private practices have become more complex to manage, even as physiciancompensation has been declining. Doctors see financial advantages to buildinglarger practices, in terms of ability to control expenses and negotiatehigher fees with insurers. Further, not all trends are toward consolidation.A small but growing number of doctors are reacting to market incentives bymoving in a different direction: creating concierge practices in which they seea limited number of patients who pay an annual retainer.
According to experts, physician practices also may be affected, in part, byprovisions of the 2010 Patient Protection and Affordable Care Act (ACA,P.L. 111-148, as amended), designed to spur closer financial and clinicalaffiliation among health care providers. For example, the ACA creates healthcare delivery systems called Accountable Care Organizations (ACOs), under which providerscontract to oversee a patient’s total course of care in a bid to manage costsand improve quality. A number of physician practices, insurers, andhospitals have announced affiliations to qualify as ACOs. In another movepartly spurred by the ACA, hospitals and health plans have been hiringphysicians to ensure they will have adequate staff to treat the millions ofAmericans projected to gain insurance during the next few years. Severalmajor studies have warned of a looming shortage of physicians,particularly primary care doctors.
Congress is playing dual roles regarding the consolidation. On the one hand,the ACA was designed, in part, to prompt affiliation among doctors andother health care providers in order to reduce fragmentation and helpcontrol government and private health spending. At the same time, lawmakersare monitoring the health care system for signs that consolidation is havingnegative effects on consumer access, prices, and competition. The healthcare sector went through a similar round of restructuring during the 1980sand 1990s, including mergers and acquisitions of physician practices,ultimately prompting a backlash from some consumers who complained they werebeing blocked from specialists and procedures. The ACA envisions a differentsystem of “patient-centered care,” where doctors and other providers aregiven incentives to improve quality and efficiency, rather than to limitservices. Still, it remains to be seen how the current round of changeswill play out as physicians and other providers form larger organizations. This reportprovides background on factors contributing to changes in physician practiceorganization, including physician supply, sources of revenue, operatingcosts, and government incentives. It also examines the different types ofintegration, the legal intricacies of affiliation, and the possibleimplications for consumer and federal policy.
Date of Report: January 2, 2013
Number of Pages: 27
Order Number: R42880
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