Between 2012 and 2020, the number of GI practices decreased by more than 650, 14%, even as the total number of gastroenterologists grew, according to a new study published February in Clinical Gastroenterology and Hepatology.
The authors – Jonathan Busam, MD, general medicine physician at Los Angeles-based Cedars-Sinai Medical Center and Eric Shah, MD, gastroenterologist at Ann Arbor-based Michigan Medicine — argue that payment reform, stronger physician networks and better-positioned physician leaders are needed to preserve independent practice viability.
Here are eight more things to know:
1. Physicians practicing in groups of fewer than 10 dropped by nearly 1,500, a 35% decline over that same period.
2. Physician-hospital employment increased by over 70% from 2008 to 2016, showing consolidation accelerated well before the most recent decade.
3. Consolidation trends are not unique to gastroenterology and have drawn regulatory scrutiny due to concerns about increased costs and reduced care quality, according to the report. Practices most often cite financial uncertainty, including increased costs, decreased revenues, and regulatory pressures, as the primary drivers of consolidation decisions, along with personal financial incentives.
4. Medicare reimbursement for office visits fell 5% from 2007 to 2022. Reimbursement for colonoscopy and EGD procedures dropped roughly 20% from 2018 to 2022.
5. From 2014 to 2024, mean reimbursement per procedure declined by $56, or 38%, across the 10 most common GI procedures.
6. When adjusted for efficiency, mean reimbursement fell from $1.92 per minute in 2014 to $1.51 per minute in 2024, a 21% drop. Most procedures saw a 30-40% reduction in revenue per procedure over the decade.
7. Pharmacy benefit manager profits rose approximately 80% over the same period.
Drug prices, overall US health expenditures, facility revenues, and case complexity all increased while GI physician revenue fell.
8. According to the report, growing evidence suggests healthcare consolidation is linked to higher spending without commensurate improvements in care quality. If financial pressures continue pushing independent practices into larger groups, patients are considered the most likely to suffer the consequences.
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