How continued consolidation is affecting radiology practices in the US

Consolidation among radiology practices in the United States has been one of the industry’s biggest trends in recent years, as seen in the 2017 and 2018 Radiology 100 reports. According to a new study published in the Journal of the American College of Radiology, consolidation has led to larger group sizes and fewer groups that focus on a single specialty.

The study’s authors explored data from the Medicare Physician Compare database for 2014 and 2018 for their research. Fifteen groups from the 2014 dataset did not have size information available, so they were not included in the analysis.

Overall, declines were observed in the percentage of radiologists in groups with one or two members (from 3.2% to 2.1%), three to nine members (10.2% to 6.7%), 10 to 24 members (18.2% to 14.1%), 25 to 49 members (16.6% to 15.1%) and 50 to 99 members (13.3% to 11.5%). However, the percentage of radiologists in groups with 100 to 499 members increased from 15.7% to 21.8%. Likewise, the percentage of radiologists in groups with more than 500 members jumped from 22.9% to 28.7%.

As one might expect, similar dynamics were also found at the practice level. The percentage of radiology practices with one or two members decreased from 26.9% to 22.8%. Increases were noted in both the percentage of practices with 100 to 499 members (from 7.6% to 10.2%) and more than 500 members (2.5% to 4.1%).

In addition, there were 2,812 single-specialty practices in 2014, but 2,216 in 2018, a drop of 21.2%.

The authors noted that consolidation was consistent in the entire radiology workforce, but “somewhat more pronounced” among radiologists from single-specialty practices.

“One possible explanation is that radiology practices must invest large amounts of capital in expensive imaging equipment and IT resources, which may be increasingly difficult for small radiology practices,” wrote Andrew B. Rosenkrantz, MD, MPA, department of radiology at NYU Langone Medical Center in New York City, and colleagues. “In addition, the ubiquitous nature of digital imaging and remote image interpretation in today’s market may make it easier for radiology practices to span across geographic areas and practice locations. Also, as individual diagnostic radiologists do not typically have their own defined panel of patients, it may be easier for radiologists to seek a new practice when desired.”

Rosenkrantz et al. also noted that this trend “raises a number of potential concerns.” For instance, they explained, this push toward consolidation has not been tied to improvements in quality, patient access to care or cost savings. More research on this is required.

Also, the authors added, “dominant large practices” in certain markets may be able to make patient care more expensive by charging higher prices than they would if there was more competition.

“Such an effect could accelerate the cost that patients experience, particularly for radiologic services, given that deductibles and copays for radiology services tend to be higher than for many other health care categories,” Rosenkrantz and colleagues wrote.