Last year, the Centers for Medicare and Medicaid Services asked for comments and then rolled out the final rules on the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Many industry observers predicted the rules would drive the majority of independent physician practices “right into the arms” of a local hospital, health system or other entity. Those predictions appear to be true.
As of mid-March 2017, 46 acquisitions of physician practices have been announced, a 105% increase from the same period a year ago. Only one of the deals disclosed a price, Optum’s (NYSE: UNH) $3.3 billion acquisition of Surgical Care Affiliates Inc. (NASDAQ: SCAI).
The most active acquirers this year are the usual suspects: Mednax, Inc. (NYSE: MD) with five deals, and Envision Healthcare Corporation (NYSE: EVHC), with four. Envision’s targets were two radiology practices in Florida and California, as well as an anesthesiology practice and an emergency physician practice, both in Arizona. Mednax acquired three neonatology practices in Kansas, Texas and Utah and, in Tennessee, a pediatric ophthalmology practice, and its first, on-site radiology practice, a new line of business the company is pursuing, following its May 2015 acquisition of Virtual Radiologic Corporation for $500 million.
Beyond these serial acquirers, the influx of PMG deals can be attributed to a combination of private equity deals and PE-backed add-on acquisitions. Eighteen of the the 45 deals were announced by private equity firms or PE-backed physician medical groups. The majority targeted specialty practices.
Dermatology Associates, a portfolio company of ABRY Partners, announced three dermatology deals based in Texas in 2017. CI Capital-backed Epiphany Dermatology announced three dermatology deals of its own in New Mexico and Texas. And U.S. Anesthesia Partners (USAP), a portfolio company of Welsh, Carson, Anderson & Stowe, picked up two anesthesiology practices in Texas and Washington.
Of the six deals effected directly by the PE-firm, three eye-care practices, two primary care practices and one dermatology practice. The acquirers include Chicago Pacific Founders, Comvest Partners, Flexpoint Ford, InTandem Capital Partners, Sterling Partners, and Waud Capital Partners.
Seven of the 46 deals were announced by hospitals or health systems. Five of their targets were primary care groups and the remaining two were cardiology groups.