Becker's ASC Review

5 ASC MANAGEMENT The battle for physician autonomy: 5 trends By Francesca Mathewes A utonomy remains a central concern for physicians as declining reimbursement rates, soaring operational costs and other financial burdens force them into increasingly consolidated practice models. Here are five notes on the state of physician autonomy: 1. Corporate consolidation in healthcare is at an all-time high, which many associate with a decrease in physician autonomy. Only 42.2% of physicians were working in private practice in 2024, a dramatic decline from 60.1% in 2012, according to the American Medical Association's Physician Practice Benchmark Report, published May 29. Private practice has slipped below 50% representation in most medical specialties. Participation ranges from just 30.7% in cardiology to 46.9% in radiology. 2. Private equity ownership continues to rise. In 2024, 6.5% of physicians reported working in private equity-owned practices, up from around 4.5% in both 2020 and 2022, according to the AMA report. 3. Hospital employment is growing at twice the rate of private practice. e number of hospital-employed physicians rose by 33% between 2013 and 2022 — from around 157,000 to more than 205,000 — while private practices grew by 17%, according to a report published May 13 in the Journal of the Society of Laparoscopic and Robotic Surgeons. 4. Physician-led practices report higher satisfaction. Consulting firm Bain & Co. released its Frontline of Health Survey in October 2024, revealing that nearly 25% of physicians in health system-led organizations were considering changing employers, compared to 14% in physician-led practices. Among those in physician-led models, 81% said they were satisfied with their involvement in strategic decision-making, compared to just 50% in hospital-led practices. 5. Signs point to renewed interest in independence. Anecdotally, some physicians and healthcare leaders say a growing desire for autonomy may lead to a shi back toward independent practice — especially in outpatient care and certain subspecialties. "As we see site-of-service differential go away in diagnostic imaging between the HOPD rates and the outpatient world, and as Medicare continues to shi its focus on cardiovascular care being treated more in the outpatient arena than the inpatient arena, we're going to see more and more hospitals looking for alternatives to how they're going to deal with their cardiology programs," said David Konur, CEO of Cardiovascular Logistics, in an interview with Becker's. "If site-of- service differential goes away, there is going to be a huge influx of cardiologists looking to join platforms like ours, and we're already talking to almost a dozen groups that are very interested in what that would look like, because as they read the tea leaves, they see that coming as well." "at pendulum that swung all the way over to hospital employment, we see that starting to swing back the other way," he continued. "I would expect to see an increase in consolidation in the specialty. I think this partnership is a great example of the leaders within cardiovascular medicine coming together. Our platform is not a roll- up play where we're trying to roll up a bunch of small practices from all over the place. We're bringing together the true thought leaders that have been thought leaders for decades to fundamentally change how we deliver care in our country." n Inside the state seeing rapid ASC growth By Patsy Newitt N orth Carolina has seen some of the ASC activity so far in 2025, with more than eight new centers opened or announced. Fueling this boom is a major reform to the state's certificate-of-need laws, set to take effect by the end of 2025. The legislation will repeal CON requirements for ASCs in counties with populations exceeding 125,000, starting Nov. 21, 2025. While affected centers will still need to meet charity care obligations and submit annual data reports, the loosening of regulatory barriers is expected to spur significant growth. Experts suggest that the regulatory shift will intensify competition across the state's healthcare market. "This may vary region by region," said Richard Saver, a professor of law at the University of North Carolina at Chapel Hill who also works in the university's social medicine, medical, and public health departments. "In highly competitive markets like the Research Triangle or other parts of the state, major health systems will continue to compete with one another. If CON is overturned, it could create competitive pressure to lower barriers to entry." Leo Spector, MD, CEO of Charlotte, N.C.-based OrthoCarolina, echoed this sentiment, emphasizing the potential for cost savings. CON reform will "help lower costs because essentially MRIs and ASCs are a commodity, but they are ones that have been protected by CON. As a result, prices on them have stayed higher than they would in an open market," Leo Spector, MD, CEO of Charlotte, N.C.-based OrthoCarolina, told Becker's. "With the removal of CON and the ability to have surgeons open up those ASCs, we know that it's going to lower costs at those ASCs because they will no longer be controlled in the way they were previously," he said. North Carolina's ASC surge mirrors broader trends across the Southeastern U.S., where outpatient care is growing rapidly. A July report from Research and Markets identified the Southeast as holding the most substantial share of the national ASC market. This growth is driven by an increasing preference for outpatient procedures and a high volume of physician-owned centers. n

• Cover