Trends in Orthopedic Surgeon Practice Consolidation from 2008-2019.

Abstract Background In the past decade, physician practices have merged into larger group practices (i.e., horizontal consolidation) and have been acquired by hospitals and health systems (i.e., vertical consolidation), leaving fewer practices independent. The implications of these changes can be profound, affecting the prices for and spending on physician services, access to care, patients’ choice of providers, and quality of care. Methods We used IQVIA data on orthopedic surgeon practice sites that included information on health system or hospital ownership, group medical practice participation, number of physicians, and average patient volume. We calculated the number and size of group medical practices as measures of horizontal consolidation and the percentage of practice sites owned by a health system or hospital as a measure of vertical consolidation. We also calculated the Herfindahl-Hirschman Index (HHI) to measure market concentration. Results We found significant horizontal and vertical consolidation nationally and across all regions of the United States. This consolidation has led to much more concentrated markets, as measured by HHI, for orthopedic surgeon services. These trends are consistent with studies looking at consolidation of other types of providers. Conclusion Orthopedic surgeon practices, like other provider types, have consolidated at a rapid rate over the past decade. A variety of factors may have contributed, including the move away from fee-for-service to alternative payment arrangements, changes in Medicare payment policies, private equity activity, and evolving physician preferences. Due to the potential impacts of this consolidation, more research is needed to examine some of these contributing factors.