Cardiologists leaving independent practice at rapid pace

A majority of cardiology practices have sold or leased themselves to hospitals rather than operate independently, according to a new survey.

MedAxiom's “2013 Annual Integration Report” said 53% of cardiology groups were fully integrated with a hospital, up from 32% in 2011. The survey did not break down how many practices had been sold to hospitals or how many were leased.

In a lease situation, a practice rents itself to a hospital. Whether physicians become hospital employees depends on the lease. Leasing is often used by practices that are interested in selling but want to test a relationship with a hospital before committing to a sale.

MedAxiom's report, based on a survey of about 150 practices with a total of 2,400 doctors, mirrors findings by the American College of Cardiology's September 2012 survey that said the percentage of cardiology practices owned by hospitals tripled in the last five years. The ACC survey found that 24% of groups were owned by hospitals in 2012, compared with 8% in 2007. The proportion of practices with physician owners declined from 73% in 2007 to 60% in 2012. The percentage of cardiologists employed by hospitals grew from 11% to 35%, but those at physician-owned practices went from 59% to 36%.

The firm, which focuses on cardiology practices, said doctors are selling or leasing to hospitals for many of the same reasons as other specialists: Cardiologists are looking for the arrangements to provide financial stability, said Suzette Jaskie, MedAxiom Consulting's president and CEO.

“Integration allows them to shift risk to hospitals,” she said.

An Accenture analysis of data from the American Medical Association and MGMA-ACMPE, the medical practice manager association, found that only 36% of practicing physicians will hold a practice ownership stake by the end of the 2013, a decline from 57% in 2000.

Practice expenses big reason for selling

In an accompanying survey of 204 physicians, Accenture found that 87% of doctors cited business expenses as a top concern influencing their decision to seek an employed situation. That was the reason given most often.

The MedAxiom report said cardiologists have been affected by the trend toward physician employment for reasons that have to do with the speciality. MedAxiom cited cardiology's hospital-based nature, hospitals' economic dependence on cardiology, and hospital payment incentives focusing on cardiovascular incentives.

For cardiologists, integration “gives them opportunities to manage and create cardiology programs on a bigger stage,” Jaskie said.

The number of cardiologists who will sell or lease their practices to hospitals is going up, according to MedAxiom. Fourteen percent of practices were integrating, and 11% were thinking about it.

The survey said 19% were not considering selling or leasing their practices to hospitals, but they wouldn't rule it out in the future. Only 3% said they would never consider integration.