Are Oncologists Leaving Smaller Practices over Time?

Abstract

Medicare and private payers have increasingly shifted their methods of reimbursing healthcare providers from fee-for-service to alternative payment models. During the same time, and some argue in response to, there is some evidence that hospitals and physicians have been coming together to form larger organizations. However, we know very little about how these national trends have affected consolidation among medical and radiation oncologists. For 2013 and 2017, we identified medical and radiation oncologists in Physician Compare tied to individual or group practices. Physicians in the database have submitted a Medicare claim within the prior year, have at least one specialty, and are associated with at least one practice. A group practice is defined by the number that the physician uses to submit claims (not by employment status) and the data include every group practice in which a physician has practiced during the previous twelve months. We identified providers who identified as medical or radiation oncologists. We calculated the size of each oncology group practice. We allowed oncologists to be counted in more than one practice. We used the number of oncologists within each group to estimate the proportion of total oncologists practicing in various group sizes (solo oncologist, 2-10, 11-50, 51-99, 100+). There were a total of 2,795 and 2,637 unique practices with 13,641 and 15,561 medical oncologists in 2013 and 2017. The mean number of medical oncologists per practice was 4.8 in 2013, rising to 5.8 in 2017. Practices with a single medical oncologist fell by 7% (1,173 to 1,086 practices) and those with 2-10 medical oncologists fell by 9% (1,370 to 1,242 practices). During the same period, practices with 11-50 and 51-100 medical oncologists increased by 40% (227 to 267 practices) and 14% (19 to 33 practices). There were a total of 1,620 and 1,603 unique practices with 5,556 and 6,222 radiation oncologists in 2013 and 2017. The mean number of radiation oncologists per practice was 3.4 in 2013 and 3.9 in 2017. Practices with a single radiation oncologist and 2-10 radiation oncologists decreased by 6% (600 to 563 practices) and 1% (945 to 933 practices). During the same period, practices with 11-50 and 51-100 radiation oncologists increased by 43% (73 to 104 practices) and 50% (2 to 3 practices). We found that the number of oncologists – both medical and radiation – practicing in small groups is declining over time. These findings suggest that the oncology community does not appear to be immune from the broader national trends toward greater physician consolidation. These findings raise important issues about the impact of rising consolidation on the quality and costs of oncology care. While larger practices may be providing better value, more empirical evidence is needed on the impact on patient care.