Annals: Fewer Than Half of ED Visits Staffed by Majority Physician-Owned Practices

Most emergency department (ED) visits are staffed by physicians employed by health systems or private equity-owned staffing groups, according to a first-of-its-kind analysis of physician group market share by ownership structure published in Annals of Emergency Medicine.

“The rapid pace of consolidation across emergency medicine raises critical questions about care quality and physician employment,” said Angela G. Cai, MD, MBA, study author, emergency physician at Penn Medicine, and assistant professor of clinical emergency medicine at the University of Pennsylvania.

Health system-owned groups staffed one-third (33 percent) of all emergency visits. Nearly one in four (24.7 percent) of visits were staffed by physicians in private equity-owned groups.

Regional clinician partnership-owned groups accounted for 20.8 percent of visits, national clinician-owned partnerships groups were 13.4 percent of visits, and single-site clinician partnership-owned groups staffed 8.1 percent of visits. These findings showed that fewer than half of emergency visits are staffed by majority physician-owned employers.

The study sample included 3,998 hospital-based EDs accounting for 109.7 million visits.

The study also revealed trends of market concentration within ownership categories and within geographic regions. In the private equity ownership category, 93 percent of all ED visits were seen by physicians under three employers.

Regional concentration is high; of 306 hospital referral regions across the country, 84 percent qualified as highly concentrated.

A lack of transparency in practice ownership has impaired the ability to understand market trends and health outcomes, the authors wrote. At the same time, emergency physicians continue to raise strong concerns about care quality and workplace satisfaction.

“This study does the foundational work to define market trends, that non-physician owned groups staff most ED visits and the emergency physician employer market is highly concentrated,” Dr. Cai said. “Researchers and policymakers have a critical opportunity to connect these trends to patient outcomes and physician employment.”

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