Consolidation in cardiology: 3 key findings on practice size in the US
Consolidation has been a major theme for healthcare providers in recent years, with larger practices continuing to thrive compared to their smaller counterparts. It’s like The Wizard of Oz, but with more bottom lines and fewer flying monkeys: mergers and acquisitions and buy-outs, oh my!
A new study published in the Journal of the American College of Cardiology explored how consolidation has impacted cardiology specifically, focusing on hiring trends and other economic factors. The authors used CMS data from 2013 to 2017, as well as several other key resources, for their thorough analysis.
These are three important takeaways from the team’s findings:
1. Overall, the number of healthcare practices with at least one cardiologist dropped from 8,642 in 2013 to 7,709 in 2017.
As one might expect, this has also led to more cardiologists working at a single practice; the average number of cardiologists at a practice has increased from 3.6 ± 7.8 in 2013 to 4.3 ± 10.1 in 2017. The median number of cardiologists remains unchanged at one per practice.
2. The number of cardiologists per practice is up across the board—but slightly more in urban areas than rural areas.
The mean number of cardiologists increased in both urban and rural areas, but the increase was slightly more prominent in urban areas (from 3.67 in 2013 to 4.38 in 2017) than rural areas (from 2.05 in 2013 to 2.20 in 2017).
As time goes on, will this trend continue? How will retiring specialists impact these numbers? It’s certainly a lot to think about.
3. Larger practices are becoming more and more common. The number of practices with more than 50 cardiologists total has increased 76.3% in just four years.
From 2013 to 2017, the number of practices with just one or two cardiologists decreased from 6,085 to 5,319. The number of practices with three to five cardiologists saw a slight dip as well, as did the number of practices with six to 10 cardiologists. The number of practices with 11 to 24 cardiologists increased slightly, on the other hand, along with the number with 25 to 49 cardiologists. Finally, the number of practices with 50 or more cardiologists increased from 38 to 67, a jump of 76.3%.
So why are cardiologists joining these larger practices? The authors shared some potential explanations.
“First, cardiologists may be responding to changes in the market structure where they practice, and in particular, to hospital market concentration,” wrote lead author Jose F. Figueroa, MD, MPH, Harvard School of Public Health in Boston, and colleagues. Prior work has shown that hospitals are increasingly consolidating over time, including via vertical integration, where hospitals acquire physician practices. At the same time, insurers are also consolidating over time, with many markets dominated by a small number of insurers. Therefore, there may be an incentive for cardiologists to join larger health systems or practices to increase their market power and potentially negotiate better reimbursements with insurers.”
Updated CMS policies related to alternative payment models could be another contributing factor. In addition, some of this consolidation may just be related to personal preference.
“Larger practices are more often associated with increased control in work hours, compensation arrangements such as guaranteed income in the early years of practice, and help with coverage of individual patient panels when a clinician is not available,” the authors wrote.
Also, Figueroa et al. added, the end result of this consolidation may not be good for patients—prior studies have found a connection between consolidated healthcare providers and both total costs and out-of-pocket spending.
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.