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The Coming Wave of Physician-Hospital Alignment: What the Antitrust Laws Have to Say About It

AHLA thanks the leaders of the Antitrust Practice Group for contributing this feature article.
  • August 01, 2020
  • Herbert F. Allen , Polsinelli PC
  • Matthew C. Hans , Polsinelli PC

A great realignment is underway among America’s doctors. Over the last decade, physicians have been moving in ever-greater numbers away from independent practice towards full hospital employment or affiliation with a hospital system.

The shift has been motivated by several national trends. Independent physician practices have faced growing administrative and staffing costs, as well as new demands for capital investment in things like electronic medical records systems. A physician shortage has pushed physician salaries higher, making it increasingly difficult for independent practices to recruit and retain physicians. By 2033, the United States is expected to have an unmet need for between 54,100 and 139,000 physicians.1 In the face of these rising costs, reimbursement rates have declined or remained flat. An aging population and the expansion of Medicaid under the Affordable Care Act has led to a lower-reimbursing payer mix for many practices.

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