Radiology Practice Consolidation: Fewer but Bigger Groups Over Time

Rosenkrantz, Andrew B.; Fleishon, Howard B.; Silva, Ezequiel; Bender, Claire E.; Duszak, Richard

doi:10.1016/j.jacr.2019.02.030

Cited by 29 publications

(36 citation statements)

References 23 publications

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“…From a workforce perspective, although the radiologist employment market has been particularly favorable in recent years [9], continued professional revenue declines could reverse that trend, making radiology a potentially less attractive specialty for medical students choosing residencies, or potentially precipitating a wave of early retirement among more senior radiologists who continue to practice [10]. More and more, capital investors are catalyzing the corporatization of the specialty [11] and radiology practices are rapidly consolidating [12]. How declining practice revenues will influence such trends is unknown (eg, discourage nonradiologist investors versus encourage small practices to protectively consolidate).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Duszak

Maze²,

Sessa

et al. 2020

Journal of the American College of Radiology

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Purpose: The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines.Methods: Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share c 2 testing was performed.Results: Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that À52% wRVU nadir, outpatient declines were greatest (À66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P ¼ .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (À17%) and abdominal and pelvic CT (À14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (À92%).Conclusions: Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.

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Section: Discussionmentioning

confidence: 99%

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Duszak

Maze²,

Sessa

et al. 2020

Journal of the American College of Radiology

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“…Practice consolidation is a trending topic in the medical literature in general and within various subspecialties. 11 - 13 However, there is a paucity of research regarding the specific effect of this phenomenon in otolaryngology, which historically has a strong foundation in the private practice model composed of smaller physician groups. 14 Prior analysis of the otolaryngology workforce has demonstrated that nearly one-third of practicing otolaryngologists participated in some form of solo practice in 2001.…”

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confidence: 99%

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

et al. 2022

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Objective To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021. Study Design Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services. Setting United States. Methods Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021. Results Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%. Conclusion The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.

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“…The findings in our study are largely in consensus with the widespread trend of practice consolidation in medicine as a whole. 14 , 18 , 19 , 20 , 21 , 22 It has been reported that 65% of all hospitals in the United States are part of larger health system networks. 18 The same study reported that over 500 hospitals have merged into larger health systems from 2008 to 2018.…”

Section: Discussionmentioning

confidence: 99%

“…Our study methods were based on a well-conceived study performed by Rosenkrantz et al., 14 which analyzed practice size consolidation in radiology. Institutional review board approval was not required for this retrospective study because of the use of a publicly available data set without any patient-identifying information.…”

Section: Methodsmentioning

confidence: 99%

“… 13 However, little is known about orthopaedic surgeons specifically. 12 , 14 The purpose of this study was to analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020. We hypothesized that the field of orthopaedic surgery would have experienced a growing number of surgeons working for larger practices, as well as a growing number of large orthopaedic surgery practices across all geographic locations.…”

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confidence: 99%

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Orthopaedic Group Practice Size Is Increasing

Pollock

Moore

Hogan

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020. Methods We performed a retrospective cross-sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database. Results Although we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020. Conclusions This study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices. Clinical Relevance The impact of these changes should be examined to determine large-scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.

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Radiology Practice Consolidation: Fewer but Bigger Groups Over Time

Cited by 29 publications

References 23 publications

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

Orthopaedic Group Practice Size Is Increasing

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