Over 70% of physicians are now employed by a health care system or corporate entity, including publicly traded and private equity firms. Research to date shows that consolidation has increased health care prices with limited impact on quality or access to care. Yet the impact of consolidation is highly heterogeneous across market conditions. Research at CAHPR aims to inform policy by understanding this evolving landscape that has critical implications for competition, choice, access, and the structure of health care services.
Center for Advancing Health Policy through Research
Markets and Consolidation
While the health care industry has been consolidating for two decades, a number of trends are changing how physician markets are organized and how various stakeholders are impacted.
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Dr. Yashaswini Singh, Assistant Professor at Brown University, presented findings from a study on private equity (PE) in Maryland physician practices, mandated by Maryland’s 2024 legislation (HB 1388). The study analyzed PE trends, geographic penetration, affected communities, and PE-affiliated physicians' participation in payer networks and value-based programs. Erin Fuse Brown provided NASHP-based policy recommendations focused on enhancing oversight of healthcare transactions, protecting healthcare workers through stronger CPOM laws and limiting covenant restrictions, and increasing ownership transparency.
Recent News
The article investigates how major drugmakers like Pfizer and Eli Lilly are paying telehealth companies millions of dollars to connect patients to providers, raising concerns about potential conflicts of interest and violations of anti-kickback laws. While both companies deny influencing prescriptions, lawmakers and experts worry these partnerships may steer patients toward expensive branded drugs and allow pharma firms to collect detailed patient data.
Managed Healthcare Executive
Private Equity in Healthcare: Colonoscopy Prices Soar While Care Remains the Same
This article covers a study in JAMA Health Forum finds that private equity-acquired gastroenterology practices significantly raised colonoscopy prices without any improvement in quality of care. The rise in costs was especially steep in highly consolidated markets, where prices surged by 6.7%. With no measurable gains in patient outcomes, the findings raise broader concerns about the impact of PE’s profit-driven model on healthcare affordability, transparency, and value.
This article argues that despite Massachusetts’ recent reforms after the collapse of Steward Health Care, a major loophole still allows private equity to control medical practices through shell companies and “friendly physician” arrangements. Drawing on the century-old corporate practice of medicine (CPOM) doctrine, the article calls for stronger legal restrictions like those recently passed in Oregon to protect patient care from financial interests.
This article reports on a study by Daniel R. Arnold, and colleagues who find that private equity-acquired gastroenterology practices significantly increase colonoscopy prices—by 4.5% more than independent practices—without improving care quality. Despite claims that consolidation boosts efficiency, the analysis showed no statistical difference in quality measures, raising concerns about affordability and access.
Global Competition Review
FTC study supports scrutiny of physician mergers, economists say
This article reports on a FTC study highlighting how roll-up acquisitions of physician practices—often led by private equity firms—can harm competition, raise prices, and reduce care quality. The study calls for increased scrutiny of serial acquisitions that fall below federal reporting thresholds, and experts say it could lead to stronger antitrust enforcement in healthcare markets.
This article discusses how financial pressures, staffing shortages, and management decisions at Wisconsin’s Group Health Cooperative have led to a unionization effort by primary care providers, reflecting broader national challenges facing independent primary care.
Brown University
Market Power
Professors Erin Fuse Brown and Yashaswini Singh warn that private equity’s focus on short-term returns is reshaping healthcare at the expense of patients and providers. From overburdened hospitals to ethical dilemmas in mental health care, their insights expose how profit-driven ownership can undermine clinical priorities and public trust.
The Trump administration's push for deregulation threatens to accelerate vertical integration in healthcare. Brown University professor, Dr. Christopher Whaley warns from existing research how this may lead to referrals to more expensive hospitals ultimately leading to higher costs, reduced competition, and financial strain on independent hospitals, particularly in rural areas as the article discusses.
The article covers a study published in JAMA Health Forum by Yashaswini Singh and colleagues on the increasing affiliation of primary care physicians with hospitals and private equity firms, leading to higher patient costs without clear improvements in care quality or physician compensation.
This article discusses a study led by Dr. Yashaswini and published in JAMA Health Forum on trends in physician practice ownership, showing a significant shift from independent practices to corporate ownership, as well as the associated price increases, with hospital and PE-affiliated practices charging higher fees, and its implications for healthcare costs and quality.
This article highlights the study led by Dr. Yashaswini Singh on the growing affiliation of primary care physicians with hospitals and private equity firms along with increasing healthcare costs that come with these affiliations.
The Oregonian/OregonLive
Doctors unions, like the one on strike at Providence, are growing more common
Physicians, traditionally less unionized, are aligning with nurses and other healthcare workers due to shared grievances over understaffing, burnout, and corporate cost-cutting practices exacerbated by the pandemic. Hayden Rooke-Ley comments on this trend highlighting his study that found that the number of physician unions formed between January 2023 and May 2024 nearly equaled those established over the previous two decades (2000–2022).