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Move from Smaller to Larger Practices Continues, Especially Among PCPs

SALT LAKE CITY, UT – Physicians continue to move from smaller to larger group practices, especially if they have a primary care practice.

A study released online by Health Affairs notes the persistence of the trend in the period 2013–15. Differences in consolidation patterns continue between specialists and primary care physicians, as well as among states, according to the authors from Leavitt Partners, a healthcare intelligence business.

Results indicate that, between June 2013 and December 2015, the proportion of physicians in groups composed of nine or fewer dropped from 40.1% to 35.3%, while, during that same time period, the proportion in groups with a hundred or more doctors jumped from 29.6% to 35.1%.

For the study, researchers used data from Medicare Physician Compare to conclude that, while small group practices still account for a large proportion of all physician practices, there is significant trend of consolidation into large group practices.

Changes among primary care physicians — defined in this study as family practice, general practice, geriatric medicine, internal medicine, or pediatric medicine — were significantly greater compared to specialist physicians, the study authors noted. In addition to the variance among specialties, they add, “marked variation in the rate of change between states suggests that any continuing trends are likely to vary between different states.”

Background information in the article explains that the Affordable Care Act and other federal policy initiatives have created incentives for smaller practices to consolidate into larger medical groups or be acquired by hospitals.

The American Medical Association reported last year that more than 60% of physicians work in practices with 10 physicians or fewer, and that practice size didn't change much between 2012 and 2014. The AMA also said, however, that nearly 57% of the physicians worked in practices that were wholly owned by physicians in 2014, a drop from 60.1% in 2012, and that the percentage of physicians working for hospitals or in practices that had some hospital ownership increased from 29% in 2012 to 32.8% in 2014.

The authors of the more recent study suggested that, at some point, there could be a move to block further consolidation through antitrust actions. They also pointed out that studies vary on whether the quality of care is better at smaller or larger practices, and suggested more research to help answer that question.