2018 Physician Practice Consolidation: A Year in Review

February 8, 2019

2018 continued many of the 2017 trends of consolidation among physician practices, with practices merging with other practices or entering into acquisition deals with other practices, hospitals and health systems or private equity groups.

The fragmented nature of the physician practice industry and the challenges facing small practices continue to drive this consolidation movement. Factors such as the changing reimbursement and regulatory landscape, the appeal of economies of scale for activities like billing, and greater access to information technology and general technology infrastructure provide strong motivation to consolidate.

This article acts as a snapshot of some of the notable deals that closed or were announced in 2018. The fields of dermatology, eye health (i.e., optometry and ophthalmology), and orthopedics continue to be areas of high activity, with multiple acquisitions and other activities to report. Finally, 2018 saw increased activity in other medical fields such as anesthesia and emergency medicine practices.

Dermatology

Dermatology, as a practice area, was particularly active in 2018 and continues to see significant private equity involvement.

In May 2018, Schweiger Dermatology Group (SDG), a large and fast-growing dermatology practice management company in the Northeast, received an investment of $100 million from LNK Partners, a private equity firm, which will hold a minority stake in the company. Dr. Eric Schweiger, founder and CEO, will continue to lead SDG to expand in in the Northeast. Similarly, SDG announced on Sept. 4, 2018, its merger with Pennsylvania Centre for Dermatology (PCD), located in Center City, Pennsylvania. This is SDG's first location in that state and SDG said the transaction was intended to expand its services throughout the region.

On June 7, 2018, Pinnacle Dermatology, a multisite dermatology practice, announced its expansion from Illinois into the Indiana market with its acquisition of Skin, Vein, & Cosmetic Clinic in Munster, Indiana, for an undisclosed amount. Pinnacle continued to expand in Illinois throughout 2018, opening an office in the Chicago suburb of Naperville in July 2018.

On April 2, 2018, U.S. Dermatology Partners — a physician-owned, dermatology-focused practice management group — announced continued expansion in the state of Colorado with its acquisition, for an undisclosed amount, of Apex Dermatology Group, which has locations in Denver and Littleton, Colorado.

Optometry and Ophthalmology

Optometry and ophthalmology continue their 2017 trend as a popular source of consolidation and acquisitions, with deals driven by sources ranging from small and mid-size practices to private equity firms.

On April 5, 2015, Omni Eye Service, a portfolio company of NMS Capital, acquired Kremer Eye Center for an undisclosed amount. Kremer is a regional provider of medical and surgical eye care services, including ophthalmologic services and LASIK surgery, in the Mid-Atlantic region.

On Sept. 4, 2018, EyeSouth Partners, an eye-care-focused physician services organization formed by Shore Capital Partners, announced a strategic partnership with Florida Eye Microsurgical Institute (FEMI) and Boynton Beach ASC for an undisclosed amount. This expands EyeSouth’s presence into the south Florida region. FEMI consists of five ophthalmologists, one optometrist and approximately 75 support staff.

On Aug. 3, 2018, Eye Health America (EHA), an eye care practice management company, announced its acquisition of Montgomery & Riddle Eyecare and the Surgery & Laser Center at Professional Park. EHA has stated its desire to expand its reach of owning and managing eye care practices across the Southeast. The acquired practices offer advanced eye care treatments, including blade-free laser cataract surgery, corneal transplantation, LASIK/PRK surgery, advanced glaucoma treatments, oculoplastic procedures, and diabetic eye care.

Orthopedics

In 2018, orthopedics continued to be a field of much activity, with consolidations between orthopedic practices as well as private equity investors.

On Sept. 5, 2018, Atlantic Street Capital acquired Ortho Bethesda for an undisclosed amount. Ortho Bethesda is an orthopedic provider in the greater Washington, D.C., area specializing in musculoskeletal care and operating four centers that focus on arthritic joint, shoulder and spinal trauma conditions. Atlantic Street Capital is a private equity firm that generally invests in companies with an EBITDA between $4 million and $15 million.

In May 2018, PhysioFocus Orthopedic and Sports Therapy announced a partnership with Ivy Rehab, which marked Ivy Rehab’s entry into the state of North Carolina. Ivy Rehab is a network of physical therapy clinics that already had a footprint in the East and Midwest prior to its entry into North Carolina.

Also in May 2018, The Orthopaedic Institute (TOI) announced changes to its executive leadership team, which are reflective of TOI’s recent growth and partnership with Varsity Healthcare Partners, a private equity investment firm that focuses on healthcare services companies. TOI is a provider of integrated orthopedic surgical care and ancillary patient treatment services in North Central Florida.

Radiology

Radiology experienced a high amount of deal activity in 2017 and continued its consolidation trend in 2018.

On Oct. 30, 2018, Radiology Partners — which offers services in more than 750 hospitals, imaging centers and clinics in 17 states — announced growth in Arizona, California, Florida, Hawaii, New Mexico, North Carolina, Ohio and Texas. Radiology Partners also announced a new partnership with Gulf Imaging Associates in Houston, Texas, in September and an acquisition of Radiology Associates of Florida, a Tampa-based private practice in April.

On Feb. 28, 2018, Chandler Radiology Associates (CRA) finalized the sale of its company to Envision Healthcare Corporation. CRA employed 15 physicians and staffed two of the most active radiology departments in Phoenix, Arizona. Envision Healthcare Corporation is a national hospital-based physician group.

On Aug. 8, 2018, the teleradiology firm REAL Radiology LLC (REAL) acquired Argus Radiology Consultants, which is a provider of 24/7 teleradiology services. Both REAL and Argus are completely owned and operated by radiologists.

Anesthesia/Pain ManagementThe area of anesthesia practices saw new deal activity in 2018. On July 26, CRH Medical Corporation announced its acquisition of 51 percent of the interests in Lake Washington, a gastroenterology anesthesia practice in the state of Washington. CRH also announced its acquisition of Western Ohio, a gastroenterology anesthesia practice in Dayton, Ohio. CRH is a medical corporation that focuses on providing gastroenterologists throughout the United States with services and products for the treatment of gastrointestinal diseases.

Emergency Medicine

Emergency medicine practices saw increased activity in 2018, with deals between practices and larger emergency medicine and urgent care companies.

In March 2018, American Physician Partners, a Brentwood-based company that employs approximately 850 providers and was recapitalized in 2017 by Brown Brothers Harriman Capital, acquired Northeast Tennessee Emergency Physicians (NETEP) for an undisclosed amount. NETEP manages emergency departments in seven hospitals in Northeast Tennessee and Southwest Virginia.

On June 26, 2018, US Acute Care Solutions (USACS) announced that three emergency physician groups would be joining USACS — Front Range Emergency Specialists of Colorado Springs, Southwest Emergency Physicians of Durango, and Southern Colorado Emergency Specialists of Pueblo. The three practices provide care to approximately 175,000 patients annually in Colorado. USACS was founded by emergency medicine physician groups across multiple states.

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