50 largest US medical group parents


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Oakland, Calif.-based Permanente Medical Groups ranked No. 1 in the nation’s 50 largest medical group parents, with over three times the number of unique physicians as the second ranked Veterans Health Administration, according to an annual report published by IQVIA.

The report uses data from OneKey, a database from IQVIA that includes nine million U.S. healthcare professionals and 680,000 organizations.

The report ranked these parent companies by total physician affiliations, unique physicians and medical group count. Total physician affiliations are defined as the number of physician bridges between providers and sites, unique physicians are defined as the number of unique physicians affiliated to an integrated delivery network and medical group count is defined as the number of physicians at the IDN’s outpatient center(s), which may be a single specialty or multispecialty business. Imaging centers and surgery centers are not included in this report.

Here are the 50 largest U.S. medical group parents, ranked according to total physician affiliations, unique physicians and medical group count.

No. 1 — Permanente Medical Groups (Oakland, Calif.)

  • Total physician affiliations: 19,179
  • Unique physicians: 14,757
  • Medical group count: 578

No. 2 — Veterans Health Administration (Washington, D.C.)

  • Total physician affiliations: 4,909
  • Unique physicians: 4,798
  • Medical group count: 690

No. 3 — Mayo Clinic (Rochester, Minn.)

  • Total physician affiliations: 5,137
  • Unique physicians: 4,733
  • Medical group count: 128

No. 4 — Ascension Health (St. Louis)

  • Total physician affiliations: 5,035
  • Unique physicians: 4,218
  • Medical group count: 1,136

No. 5 — UC Health (Oakland, Calif.)

  • Total physician affiliations: 4,797
  • Unique physicians: 4,124
  • Medical group count: 397

No. 6 — Fresenius Medical Care Holdings (Waltham, Mass.)

  • Total physician affiliations: 5,875
  • Unique physicians: 3,229
  • Medical group count: 2,479

No. 7 — Providence Saint Joseph Health (Renton, Wash.)

  • Total physician affiliations: 3,507
  • Unique physicians: 3,054
  • Medical group count: 573

No. 8 — DaVita (Denver)

  • Total physician affiliations: 3,676
  • Unique physicians: 2,737
  • Medical group count: 2,813

No. 9 — Trinity Health (Livonia, Mich.)

  • Total physician affiliations: 2,864
  • Unique physicians: 2,551
  • Medical group count: 607

No. 10 — Catholic Health Initiatives (Englewood, Colo.)

  • Total physician affiliations: 2,961
  • Unique physicians: 2,473
  • Medical group count: 766

No. 11 — Sutter Health (Sacramento, Calif.)

  • Total physician affiliations: 3,131
  • Unique physicians: 2,468
  • Medical group count: 436

No. 12 — HCA Healthcare (Nashville, Tenn.)

  • Total physician affiliations: 2,838
  • Unique physicians: 2,457
  • Medical group count: 641

No. 13 — Partners HealthCare System (Boston)

  • Total physician affiliations: 2,384
  • Unique physicians: 2,178
  • Medical group count: 218

No. 14 — UPMC (Pittsburgh)*

  • Total physician affiliations: 2,955
  • Unique physicians: 2,163
  • Medical group count: 642

No. 15 — Carolinas HealthCare System — now Atrium Health (Charlotte, N.C.)

  • Total physician affiliations: 2,235
  • Unique physicians: 1,885
  • Medical group count: 468

No. 16 — Cleveland Clinic

  • Total physician affiliations: 1,873
  • Unique physicians: 1,656
  • Medical group count: 195

No. 17 — Aurora Health Care (Milwaukee)

  • Total physician affiliations: 2,245
  • Unique physicians: 1,623
  • Medical group count: 258

No. 18 — Mercy Health (Chesterfield, Mo.)

  • Total physician affiliations: 1,840
  • Unique physicians: 1,570
  • Medical group count: 515

No. 19 —New York Presbyterian Healthcare System (New York City)

  • Total physician affiliations: 1,617
  • Unique physicians: 1,506
  • Medical group count: 168

No. 20 — NYU Langone Health (New York City)

  • Total physician affiliations: 1,743
  • Unique physicians: 1,500
  • Medical group count: 221

No. 21 — Indiana University Health (Indianapolis)

  • Total physician affiliations: 1,671
  • Unique physicians: 1,462
  • Medical group count: 244

No. 22 — SSM Health (Saint Louis)

  • Total physician affiliations: 1,824
  • Unique physicians: 1,455
  • Medical group count: 274

No. 23 — Penn Medicine (Philadelphia)

  • Total physician affiliations: 1,746
  • Unique physicians: 1,443
  • Medical group count: 210

No. 24 — Advocate Health Care (Downers Grove, Ill.)

  • Total physician affiliations: 1,777
  • Unique physicians: 1,398
  • Medical group count: 284

No. 25 — Baylor Scott & White Health (Dallas)

  • Total physician affiliations: 1,596
  • Unique physicians: 1,362
  • Medical group count: 290

No. 26 — Dignity Health (San Francisco)

  • Total physician affiliations: 1,519
  • Unique physicians: 1,342
  • Medical group count: 396

No. 27 — Northwell Health (New Hyde Park, N.Y.)*

  • Total physician affiliations: 1,528
  • Unique physicians: 1,337
  • Medical group count: 308

No. 28 — Mount Sinai Health System (New York City)

  • Total physician affiliations: 1,522
  • Unique physicians: 1,326
  • Medical group count: 215

No. 29 — Community Health Systems (Franklin, Tenn.)

  • Total physician affiliations: 1,497
  • Unique physicians: 1,312
  • Medical group count: 586

No. 30 — Yale New Haven (Conn.) Health System

  • Total physician affiliations: 1,516
  • Unique physicians: 1,311
  • Medical group count: 202

No. 31 — Emory Healthcare (Atlanta)

  • Total physician affiliations: 1,523
  • Unique physicians: 1,282
  • Medical group count: 119

No. 32 — Stanford (Calif.) Health Care

  • Total physician affiliations: 1,403
  • Unique physicians: 1,254
  • Medical group count: 110

No. 33 — HealthPartners (Minneapolis)

  • Total physician affiliations: 1,508
  • Unique physicians: 1,254
  • Medical group count: 117

No. 34 — Johns Hopkins Health System (Baltimore)

  • Total physician affiliations: 1,515
  • Unique physicians: 1,251
  • Medical group count: 166

No. 35 — Vanderbilt University Medical Center (Nashville, Tenn.)

  • Total physician affiliations: 1,655
  • Unique physicians: 1,248
  • Medical group count: 109

No. 36 — Duke University Health System (Durham, N.C.)

  • Total physician affiliations: 1,549
  • Unique physicians: 1,229
  • Medical group count: 231

No. 37 — Intermountain Healthcare (Salt Lake City)

  • Total physician affiliations: 1,452
  • Unique physicians: 1,197
  • Medical group count: 241

No. 38 — Jefferson Health (Radnor, Pa.)

  • Total physician affiliations: 1,372
  • Unique physicians: 1,153
  • Medical group count: 173

No. 39 — UW Medicine (Seattle)

  • Total physician affiliations: 1,459
  • Unique physicians: 1,093
  • Medical group count: 178

No. 40 — Northwestern Medicine (Chicago)

  • Total physician affiliations: 1,370
  • Unique physicians: 1,083
  • Medical group count: 135

No. 41 — Fairview Health Services (Minneapolis)

  • Total physician affiliations: 1,291
  • Unique physicians: 1,070
  • Medical group count: 139

No. 42 — Novant Health (Winston-Salem, N.C.)

  • Total physician affiliations: 1,324
  • Unique physicians: 1,063
  • Medical group count: 305

No. 43 — Tenet Healthcare (Dallas)

  • Total physician affiliations: 1,161
  • Unique physicians: 1,052
  • Medical group count: 347

No. 44 — Banner Health (Phoenix)

  • Total physician affiliations: 1,303
  • Unique physicians: 1,043
  • Medical group count: 239

No. 45 — University of Michigan Health System (Ann Arbor)

  • Total physician affiliations: 1,285
  • Unique physicians: 1,039
  • Medical group count: 84

No. 46 — Adventist Health System (Altamonte Springs, Fla.)

  • Total physician affiliations: 1,180
  • Unique physicians: 1,033
  • Medical group count: 312

No. 47 — UNC Health Care System (Chapel Hill, N.C.)

  • Total physician affiliations: 1,162
  • Unique physicians: 1,013
  • Medical group count: 211

No. 48 — PeaceHealth (Vancouver, Wash.)

  • Total physician affiliations: 1,137
  • Unique physicians: 1,006
  • Medical group count: 165

No. 49 — Allina Health System (Minneapolis)

  • Total physician affiliations: 1,259
  • Unique physicians: 999
  • Medical group count: 120

No. 50 — Sanford Health (Sioux Falls, S.D.)

  • Total physician affiliations: 1,212
  • Unique physicians: 964
  • Medical group count: 198

To download IQVIA’s full report, click here.

Trinity Health in talks to sell New Jersey assets to Virtua Health 3 months after failed merger


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Carbondale, Pa.-based Maxis Health reportedly entered into a nonbinding agreement March 8 to sell Lourdes Health System, a two-hospital system in Camden, N.J., to Virtua Health.

Under the letter of intent agreement, Marlton, N.J.-based Virtua Health will purchase Lourdes Health System’s two hospitals from Maxis Health, an entity of Livonia, Mich.-based Trinity Health.

“The parties hope that they will be able to complete this transaction, which has the potential to achieve great benefits for healthcare in South Jersey. Further review is underway; there is no final agreement,” Lourdes Health System officials said in a news release. “Because we are very early in the due diligence process, the parties have no other information to provide at this time.”

The decision comes roughly three months after Camden-based Cooper University Health Care axed its plans to acquire Lourdes Health System and Trenton, N.J.-based St. Francis Medical Center.


Operator to bar New York hospital CEO, CFO and COO from expensing bi-yearly trips to Cayman Islands


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East Meadow, N.Y.-based Nassau Health Care Corp. officials expect to pass a resolution March 8 barring East Meadow-based Nassau University Medical Center officials from traveling to the Cayman Islands twice a year and charging the hospital for expenses incurred on the trip, according to Newsday.

George Tsunis, chairman of the board of Nassau Health Care Corp., which operates NUMC, told the publication the proposal is part of a series of resolutions to cut costs at NUMC, prevent corruption and make the public more aware of executives’ actions.

Nassau Health Care Corp. created a limited liability company, called NHCC LTD, in the Cayman Islands for tax purposes to self-insure for malpractice and general liability claims, according to the report. Company officials must meet outside the U.S. at least once a year to maintain the Cayman Islands location. NUMC’s CEO, COO, and CFO were all named to NHCC LTD’s board, and previously traveled to the islands for two weeks out of the fiscal year to discuss the company’s financial and operational activities.

Under the proposal, two NUMC executives will meet once a year for one day at an offshore location, such as a Canadian airport, to discuss the company’s activities.

The series of resolutions also calls for a reduction in the use of outside legal firms to handle internal legal issues, and to enact anti-nepotism disclosure requirements for hospital trustees, among other initiatives.

Nassau Health Care Corp. officials did not disclose how much the organization would save as a result of the proposed changes, Newsday reports.

Mr. Tsunis said as a safety-net hospital, NUMC should adhere to federal expense guidelines and not use taxpayer money to fund executives’ trips.

“[The proposed resolutions are] essential for credibility. The taxpayers of Nassau County need to be assured that we are protecting their tax dollars and operating at the highest ethical levels,” Mr. Tsunis told Newsday.


Moody’s: Nursing shortage will pressure hospital margins for years


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U.S. nonprofit hospital margins will be negatively affected by an extreme nursing shortage for at least the next three to four years, according to a new report from Moody’s Investors Service.

To attract and retain nursing talent, many hospitals are increasing compensation and offering sign-on bonuses and attractive fringe benefits. However, these incentives are putting expense pressure on hospitals.

“Labor is the largest hospital expense and is increasing faster than total expense growth while outpacing revenue growth,” Safat Hannan, a Moody’s analyst, said. “The lack of qualified nurses will compound these expense pressures and negatively affect hospital margins.”

The nursing shortage is most prevalent in Florida, Georgia, Texas, California, Louisiana, Mississippi, Alabama and West Virginia, according to the report.

Orthopedic Urgent Care Franchising is THE Opportunity of 2018


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Healthcare Executives, Physicians, and Healthpreneurs dealing with hospital spending cuts, reduced insurance reimbursements, and reduced market share are looking for solutions to earnings loss which is giving rise to the innovations in specialized focused urgent care.

The economic pressures coupled with the need for lifestyle balance cause many in the healthcare industry to look for alternatives and franchising is leading this nationwide healthcare overhaul.

With approximately 9,000 urgent care centers in the United States offering generalized care, OrthoNOW is the only franchised care center of its kind in the United States — a unique position to gain market share in this highly fragmented industry.

OrthoNOW’s focus is on sports medicine and the treatment and prevention of the full range of orthopedic injuries, all on a walk-in basis. Services include treatment of injuries to the hand, wrist, foot, ankle, knee, spine and shoulder, as well as preventative consultation and regimens by experts in orthopedics.

Strong interest in the brand is being fueled by CDC estimates that injuries have a $671 billion annual impact on the U.S. economy — orthopedic medicine contributes $48 billion to the GDP and urgent care centers produce an additional $30 billion in revenue. Further, 160 million patients seek out urgent care each year; 48 million of those patients will require orthopedic care who, without access to, are referred to the local emergency room only to be redirected to a specialist following a long and expensive visit.

“OrthoNOW offers an innovative turn-key solution with a comprehensive support system built in. Our corporate staff consists of veteran business, medical and franchise professionals who work closely with our franchisees and provide ongoing support. Thus, our operations are efficient and effective,” says Christine Dura, Chief Development Officer. “We have more than 1,000 territories available, and we are aggressively targeting proven multi-unit operators and Regional Developers who understand the power of scalability.”

Have you ever wondered how owning a proven franchise model in healthcare could change your financial future? OrthoNOW’s power-packed 30 minute webinar is the place to start. Get expert answers to your most pressing questions. Some will watch and miss the opportunity. Some may even try a solution on their own. Regardless, their proven model leads the charge in delivering the healthcare solutions many Americans need NOW.

Answer the call of millions of Americans in need of expert and affordable healthcare. Join OrthoNOW’s webinar on February 28, 2018, which covers the four big questions in franchising:

  • Am I the right fit?
  • What is my investment?
  • How much money can I make?
  • Why OrthoNOW?

Tenet eliminates poison pill, adopts governance changes


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Dallas-based Tenet Healthcare announced March 5 that its board of directors has approved several changes to the company’s corporate governance.

Here are five things to know about the changes.

1. The board approved changes to Tenet’s bylaws that allow shareholders with a 25 percent stake in the company to request a special meeting. The move comes after the board approved amendments to the company’s bylaws in January that allowed majority shareholders to request special meetings.

2. Tenet approved a short-term shareholder rights plan in August 2017, which was designed to protect $1.7 billion in net operating loss carryforwards and ensure the board could protect all shareholder interests as it executed CEO and board changes. Under the poison pill, if any person or entity acquired 4.9 percent or more of Tenet stock, all holders of rights issued under the plan are entitled to acquire shares of common stock with a 50 percent discount.

3. Tenet terminated the poison pill March 5. “The board made this decision based upon the reduced value of the NOL shareholder rights plan following recent tax law changes and an increase in the company’s stock price since the NOL shareholder rights plan was adopted, as well as shareholder feedback,” Tenet said in a statement. The poison pill was originally slated to expire following Tenet’s 2018 annual meeting of stockholders, which is typically held in May.

4. Tenet announced March 5 that it also eliminated the executive committee as a standing committee of the company’s board of directors.

5. “The board of directors and management have spent considerable time in recent weeks engaging with shareholders representing a majority of our outstanding stock and we received constructive input regarding Tenet and our objective to lead with best corporate governance practices,” said Ronald A. Rittenmeyer, executive chairman and CEO of Tenet. “We believe the actions which we are taking today demonstrate our continued commitment to being responsive in a timely manner to shareholder feedback and to implementing measures that increase transparency and accountability.”


Moody’s: Nonprofit hospital rating downgrades rose sharply in 2017


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Despite a strong economy and low uninsured population, nonprofit hospital rating downgrades sharply outpaced upgrades throughout 2017 — creating a downgrade-to-upgrade ratio of 3.4 to 1.0, which is more than double the 2016 ratio of 1.5 to 1.0, according to a new report by Moody’s Investors Service.

In 2017, there were 41 credit downgrades and 12 credit upgrades for nonprofit hospitals, compared to 32 credit downgrades and 21 credit upgrades in 2016.

Moody’s attributed the credit stress in 2017 to rising labor and supply costs coupled with a low revenue growth environment.

“An acute nursing shortage in many markets, along with rising supply and pharmaceutical costs, resulted in expense growth outpacing revenue growth for many hospitals and health systems,” the Moody’s report reads.

While hospitals of all sizes were downgraded, 60 percent of the downgrades in 2017 affected smaller health systems with less than $1 billion in total operating revenue. In addition, 12 of the downgrades occurred in Pennsylvania and Ohio, reflecting the lagging economy, aging demographics, competitive service area and commercial payer challenges in the Rust Belt area.

Although downgrades outpaced upgrades in 2017, Moody’s affirmed the vast majority of ratings in 2017, which is in line with historical trends.