title: The dynamics of community health care consolidation: acquisition of physician practices.
abstract: BACKGROUND
  Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems.
  
  
  METHODS
  We used key informant interviews, supplemented by document analysis.
  
  
  RESULTS
  The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future.
  
  
  CONCLUSIONS
  In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices.
authors.affiliation: University of Minnesota School of Public Health.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Christianson
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Carlin
authors.forename: Louise H
authors.initials: LH
authors.lastname: Warrick
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003363:Cost Control / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D006273:Health Facility Merger / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008910:Minnesota; D010820:Physicians / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D011331:Private Practice / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration
keywords: community health systems; health facility merger; integrated health care system