Mergers and acquisitions in the Physician Medical Group sector hit a record 119 transactions in 2016, up 19% over 2015’s previous record of 100 announced transactions. Consolidation was a big theme, as some of the top publicly traded companies either merged or were taken private.

Another factor driving independent physician practices to team up was MACRA (the Medicare Access & CHIP Reauthorization Act of 2015), which gave smaller physician practices the option to stay with fee-for-service Medicare reimbursement, or to switch to value-based payment for treating Medicare patients. The best option for many groups was to join a larger practice or the local hospital.

Despite the frenzy of M&A activity, combined spending on these transactions reached $13.3 billion, a 52% drop compared with the $27.4 billion spent in 2015. The two largest transactions in this sector, between Envision Healthcare (NYSE: EVHC) and AmSurg Corporation (NASDAQ: AMSG) for $6.7 billion, and between The Blackstone Group and Team Health (NYSE: TMH) for $6.1 billion, accounted for the vast majority of reported spending. The AmSurg deal accounted for more than 50% of dollars spent in Physician Medical Groups in 2016.

MEDNAX (NYSE: MD) was the only publicly traded physician management group that didn’t make a major deal. The company kept busy throughout the year with 14 announced transactions (but no disclosed prices).

Envision Healthcare is picking up the pace early in 2017, with three deals announced in the first week of January. The serial acquirer is keeping momentum in the Physician Medical Group sector.

As of January 7, Envision picked up Arizona-based Emergency Professional Services, Florida-based Sunshine Radiology LLC, and Arizona-based Oro Valley Anesthesia.

In the last month of 2016, the group acquired Arizona-based Desert Mountain Consultants in Anesthesia, Inc. and Alabama Neonatal Medicine, P.C., a total of five acquisitions since its takeover of AmSurg.