Radiology practices have been consolidating over the last decade, with the number of practices affiliated with radiologists decreasing, despite the number of radiologists increasing, a recent study found.

A new Harvey L. Neiman Health Policy Institute study, published in the American Journal of Roentgenology, looked at Centers for Medicare and Medicaid Services data from 2014 to 2023. The study found that the number of medical practices with affiliated radiologists decreased 14.7%, from 5,059 to 4,313, even though the number of radiologists increased 17.3%, from 30,723 to 36,024.

About half of radiologists are affiliated with radiology-only practices, with that number decreasing 12.8% over the time studied. The other half are affiliated with multispecialty practices, with that number increasing 47%, according to the study.

"Consolidation is understood to be occurring across the healthcare industry, with many examples among payers, hospitals and medical practices," Eric Christensen, research director at the Neiman Health Policy Institute, told HCB News. "Within radiology, there have been observations of consolidation and our goal was to determine whether there is a measurable consolidation, and to what extent."

The study did not determine the cause of the consolidation, but the researchers note that consolidation may have been caused by the Affordable Care Act (ACA), the Medicare Access and CHIP Reauthorization Act (MACRA) and the No Surprises Act.

“For example, in our recent study of clinician access to the No Surprises Act’s Independent Dispute Resolution process, we recognized that larger practices have more opportunity to use the IDR (independent dispute resolution) process, as larger practices have more potential to bundle claims, given higher practice volumes, and thus spread the costs of the IDR process across more claims,” Christensen said. “At the same time, incentives stemming from the ACA and MACRA favor larger practices, as larger practices can spread out the costs of EHR and IT infrastructure that are essential to responding to the ACA and MACRA incentives.

“In addition to these examples of legislative factors, consolidation among insurers and hospitals/health systems likely favors larger medical practices in contractual negotiations,” Christensen said.

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