Physician practice consolidation evades federal agencies' attempts to address antitrust concerns because it occurs largely through small acquisitions or individual hires, according to a study published by Health Affairs.
After reviewing claims data from 2007-13 for several states encompassing about 12 percent of the U.S. population, researchers found most of the growth of the largest physician groups stemmed from hiring physicians on an individual basis or buying small practices. Among physician groups with more than 100 physicians, half of the growth over the time period studied resulted from acquisitions of practices with 10 or fewer physicians, while an additional one-third of the growth resulted from hiring physicians.
"Our examination of the sizes of acquired groups revealed that the growth of large physician groups resembles 'whale eats krill,' rather than 'shark eats shark,'" the authors wrote.
The piecemeal physician practice acquisitions make it difficult to address fairly widespread consolidation in some markets, according to the study. Researchers noted 22 percent of the markets studied were considered highly concentrated under federal merger guidelines in 2013. However, among highly concentrated markets, only about 28 percent had an acquisition on record that could be considered anticompetitive.
Additionally, most of the individual acquisitions fly under the radar of federal antitrust agencies because the deals are below the $78.2 million threshold for reporting. The authors found a deal of this magnitude would be an acquisition of roughly 100 primary care physicians or 50 specialists.
"Although physician practice consolidation is leading to worrisome levels of concentration in many markets, the current methods used by federal antitrust agencies would often fail to identify any single acquisition warranting investigation," the authors concluded.
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