34% more cardiology practices have become integrated since 2007

The proportion of cardiology practices that are integrated with a hospital or health system has grown by 34 percent in the last decade—matching the most dramatic growth of any specialty, according to a study in the July edition of Health Affairs.

This vertical integration in healthcare has come under scrutiny, the authors said, as policymakers consider imposing measures to prevent or slow consolidation.

“Vertical integration could result in greater coordination between physicians and hospitals, saving costs and improving the quality of care,” wrote Sayeh S. Nikpay, PhD, MPH, and two other colleagues with Vanderbilt University Medical Center. “But a growing body of evidence suggests that vertical integration instead increases costs, with no discernible impact on quality.”

To measure the extent of vertical integration by specialty, Nikpay et al. used SK&A surveys in odd-numbered years from 2007 through 2017 to determine if a physician practice was either owned by a hospital or a member of a hospital system. The surveys are among the most comprehensive for physician practices, covering 75 percent of all U.S. office-based physicians.

The percentage of cardiology practices that reported either being owned by a hospital or a member of a health system increased from 10 percent in 2007 to 44 percent in 2017. That 34 percent jump matched oncology for the highest among 21 practice types studied, with dermatology’s 4 percent increase over 10 years representing the lowest increase.

“The average number of practices that were vertically integrated with a hospital grew more among cardiology and medical multispecialty practices than among surgical multispecialty practices or oncology practices,” Nikpay and colleagues noted. “Over our 10-year study period, hospitals integrated with roughly three more cardiology practices, but with only one more oncology or surgical multispecialty practice, on average.”

Although each specialty saw an increase in consolidation, the authors said the relatively modest addition of practices from the hospitals’ perspective “suggests a more nuanced story, on average, than that portrayed in media reports of hospitals ‘gobbling up’ physician practices.” Additional studies are needed to fully understand the impact of vertical integration on care quality and access to services, they wrote.