Mitchell JM, DeLeire T. Vertical Integration Versus Physician Owners: Trends in Practice Structure Among Breast Cancer Surgeons.
Med Care 2022;
60:206-211. [PMID:
35157620 PMCID:
PMC8869847 DOI:
10.1097/mlr.0000000000001687]
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Abstract
OBJECTIVE
The objective of this study was to document changes in physician practice structure among surgeons who treat women with breast cancer.
DESIGN
We merged cancer registry records from 5 large states with Medicare Part B claims to identify each surgeon who treated women with breast cancer. We added information from SK&A surveys and extensive internet searches. We analyzed changes in breast surgeons' practice structure over time.
MEASURES
We assigned each surgeon-year a practice structure type: (1) small single-specialty practice; (2) single-specialty surgery or multispecialty practice with ownership in an ambulatory surgery center (ASC); (3) physician-owned hospital; (4) multispecialty; (5) employed.
RESULTS
In 2003, nearly 74% of breast cancer surgeons belonged to small single-specialty practices. By 2014, this percentage fell to 51%. A shift to being employed (vertical integration) accounted for only a portion of this decline; between 2003 and 2014, the percentage of surgeons who were employed increased from 10% to 20%. The remainder of this decline is due to surgeons opting to acquire ownership in an ASC or a specialty hospital. Between 2003 and 2014, the percentage of surgeons with ownership in an ASC or specialty hospital increased from 4% to 17%.
CONCLUSIONS
Dramatic changes in surgeon practice structure occurred between 2003 and 2014 across the 5 states we examined. The most notable was the sharp decline in the prevalence of the small single-specialty practice and large increases in the proportion of surgeons either employed or with ownership in ACSs or hospitals.
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