Consolidation is rife across the healthcare industry, and it is happening among physicians, payers, corporate entities and hospital groups.
Seven spine surgeons from independent practices and health systems across seven states, including New York, California, Texas and Illinois, discuss how consolidation is evolving in their market and what they expect for the future.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Dec. 14.
Editor's note: Responses were lightly edited for clarity and length.
Question: What does consolidation look like in your market? How do you expect it to change?
Chester Donnally, MD. Texas Spine Consultants (Addison): Big hospitals will continue to buy smaller groups. The older partners will cash in, the younger members won't know any better. This isn't unique to spine or even medicine, nor is this new. Consolidation is part of capitalism. If you are good (profitable) and desirable, then a larger group will reward your efforts. I think part of the change could be instead of the "big general hospital" groups leading the way, possibly leaders in the orthopedic field will be the one's expanding. We have already seen this with Rothman Orthopaedics and Hospital for Special Surgery in Florida, but will a four-person spine group in Dallas be their next target? Time will tell.
Brian Fiani, DO. Weill Cornell Medicine/NewYork-Presbyterian Hospital (New York City): The consolidation trend will continue and will most often be steered by private equity. Consolidation has several benefits including the ability to provide vertical integration with ASCs, comprehensive multi-specialty practice models, or other ancillary services. Financial support and additional practice resources are more readily available through these types of groups.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Consolidation looks different in our market than most places in America. However, certain unifying trends have become very apparent. The market drivers of groups seeking acquisition, coalescence or individuals seeking the apparent safety of employment in the academic or medical foundation model is decreasing reimbursements. This, along with increasing cost of doing business and of course inflation in the last year or so, have forced many to make a change.
The most stubborn and successful surgeons are doing their best to endure the winds but it is not certain where we will end up. There are some who are attempting to forge alliances between former competitors, and this is certainly a great alternative to employment. The issue with forming an enormous 100-plus physician group is the enormous amount of overhead. This can quickly turn into a runaway cost. The magic number of surgeons and other specialists to join and create a corporation of corporations remains to be seen, but there is certainly a way forward, maintaining market share while doing good quality work and preserving their individual brands and practice styles.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Connecticut is a state with several large cities, but it is also largely suburban and nestled between the metropolises of New York City and Boston. Healthcare here has been dominated mainly by two health systems: Hartford Healthcare and Yale New Haven Health. Many patients in areas like Fairfield County, Conn., often sought care in New York City. The pandemic really changed that, as many patients have sought out more local care rather than traveling out of state for their care. The importance of local care has stood firm even as we emerge from the heights of the pandemic. This has led to a growth for our in state health systems and in turn has fueled several recent acquisitions. This trend will likely continue in the coming years.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): There is consolidation happening among physicians, insurers and hospital groups. With current economic and regulatory pressures, I expect the trend for consolidation to continue. There is, however, always going to be a place for small practices or solo physicians even in this market. With consolidation, most medical practices have to increase their patient volume to keep up with the ever-increasing overhead costs of running a large and complex organization. Higher patient volume typically means less time spent with each individual patient. There is always going to be a subset of patients who look for more personalized and higher quality care where the physician and the office staff can provide them with more time and attention. Current and pending cuts in physician reimbursement and ever-increasing regulatory burdens by public and private payers continue to make it difficult to run a solo practice, but an inventive and entrepreneurial physician and their staff will find a way to make it work to provide the highest quality of care for their patients.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In the truest of terms, and surveying the local market, it appears that consolidation has occurred years previous, with stratification among predictable lines being apparent. Competition along predetermined benchmarks, albeit insurance variability, pre-existing conditions whereby inclusion/exclusion criteria favors some institutions and not necessarily the patient. At best estimation, most privatized centers will exclude particulars and larger health systems will continue to oblige by remaining inclusive to patient centered care models. Minor changes may be temporary shifts in volume status, as faltering surety coverage enters a recession-based predictive forecast and job loss begins affecting many more citizens. Current numbers and flow patterns at surgery sites temporarily suggest this untimely slow down is upon us.
Harel Deutsch, MD. Midwest Orthopaedics at Rush (Chicago): Consolidation is happening and will likely continue to happen where patients are locked into an ecosystem and they have a hard time going outside that organization.