Numerous stakeholders, including national specialty leadership, must maintain awareness of this phenomenon (practice consolidation) given its potential for far-reaching implications on practice and care delivery within the profession.
Ever wonder, how many radiology practices there are, what their size is, and how much consolidation has occurred in recent years? All of those questions are addressed in a fruitful effort by Rosenkrantz et al published online in the Journal of the American College of Radiology.
Digging into the publicly available Physician Compare database, Rosenkrantz et al found significant evidence of consolidation in the workforce between 2014 and 2018, including increases in practice size and a decline in the number of practices. They also identified 32,096 practicing radiologists in 2018 (16,504 of them in single specialty radiology practices) compared to 30,262 radiologists in practice in 2014.
The Physician Compare database is based on data from Medicare’s Physician Provider Enrollment, Chain, and Ownership System (PECOS), a data source that includes taxpayer ID numbers, group size, and group name. When radiologists identified with more than one TIN, they were assigned to the larger group; for comparison purposes, the authors accessed the September 2014 database and the November 2018 database.
The authors looked at both practice size and type (multispecialty or single-specialty) and analyzed both the number of groups by size category and the number of radiologists practicing in each group size, with categories defined as: 1-2; 3-9; 10-24; 25-49; 50-99; 100-499; and greater than 500.
Between 2014 and 2018, the authors saw the number of single-specialty radiology practices decline from 2,812 in 2014 to 2,216 in 2018, with significant declines in the three smallest practice sizes. The number of one-to-two radiologist single-specialty practices declined from 1,151 to 797; 3 to 9-radiologist practices declined from 794 to 589; and 10 to 24-radiologist practices declined from 567 to 470.The number of practices of 25–49 radiologists increased from 222 to 243; practices of 50-99 radiologist practices increased from 69 to 88; and the number of mega-practices sized 100 to 499 grew from 9 to 29.
When viewed by the percentage of all radiologists practicing in each practice size category, the fractions declined in every practice size of less than 100 radiologists. The percentage of radiologists practicing in groups of 1-2 declined from 3.2% to 2.1%; 3 to 9 members declined from 10.2% to 6.7%; 10 to 24 members from 18.2% to 14.1%; 25 to 49 members from 16.6% to 15.1%; and 50 to 99 members from 13.3% to 11.5%.
Both practice size categories greater than 99 radiologists claimed a greater percentage of radiologists in 2018 than in 2014: The percentage of radiologists practicing in groups of 100 to 499 radiologists increased from 15.7% to 21.8%; and the percentage claimed by groups ≥500 (all multispecialty) increased from 22.9% to 28.7%
The article did not distinguish between evolutionary consolidation occurring within private practices and the separate trend of corporate consolidation, driven by a handful of players of large size. However, they did look at their findings through a geographic lens and found that the related trends of increased practice size and decreased number of practices applied across geographic regions to varying degrees.
Trends Noted Across Geographies
In their discussion of the results, the authors speculated that a number of factors thought to have contributed to widespread physician consolidation may have driven consolidation in radiology as well—economies of scale, access to capital and technology, ability to participate in population-based care, APMs, and value-based payment. Other aims could be standardized care pathways, quality improvement, greater subspecialization, and the tendency of millennials to value lifestyle over practice-building.
The authors concluded that the consolidation trend raises a number of potential concerns, beginning with the fact that size has not been demonstrated to necessarily improve quality. Other concerns include the entrance of corporate entities in radiology that could prioritize profits over quality and the ability of larger practices to demand higher prices and increase the cost of care. Another concern is that access to certain services such as interventional radiology could be impacted if smaller rural practices are driven out of markets by larger entities.
“Numerous stakeholders, including national specialty leadership, must maintain awareness of this phenomenon given its potential for far-reaching implications on practice and care delivery within the profession,” they wrote. “Organized medicine, including national radiology specialty societies, will need to evaluate this trend and impact on society membership. Furthermore, how these organizations will adapt their offerings, mission, and even leadership are relevant considerations.”
The aerticle can be accessed here.
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