When we first started MedResolutions, our goal was simple: to talk with billing managers and physicians who were struggling with out-of-network payments and get a clear sense of the market. Connecting with doctors wasn't hard. Within a few weeks, we were able to line up more than 20 introductions to physicians across multiple specialties.
Unfortunately, we were often too late.
Many of the doctors we spoke with had already been acquired by health systems like Northwell, Mount Sinai, or larger corporate groups—some as recently as within the past year. These weren't isolated examples; they reflected a broader trend we were seeing across the country: the rapid disappearance of the independent physician practice.
Private Practice Isn't the Default Anymore
According to the American Medical Association (AMA) as of 2024 only 42.2% of physicians work in practices wholly owned by physicians which is down 18 percentage points from 2012. Meanwhile, more than 77% of U.S. physicians are now employed by hospitals, health systems, or other corporate entities, and roughly 58.5% of all physician practices are owned by non-physician organizations. The share of doctors who personally hold an ownership stake in their practice has also fallen sharply, dropping to 35.4% in 2024, down from 53.2% in 2012.
These numbers tell a clear story: Independence is shrinking. For decades, private practice offered physicians three critical advantages: autonomy in care decisions, freedom to choose payer contracts (or none at all), and the ability to set or negotiate rates that reflected the value of specialized, high-acuity care. But underpayment pressures, administrative burdens amplified by the No Surprises Act (NSA), and the rise of opaque payer reimbursement algorithms have eroded that freedom. Many physicians are making a rational economic choice: sell the practice or join a health system rather than continue battling unpredictable reimbursements and rising overhead.
How the NSA & Payer Dynamics Play Out in Practice Strategy
The No Surprises Act changed the rules of out-of-network billing: it limited balance billing, mandated eligibility checks, and funnelled eligible disputes into the Independent Dispute Resolution (IDR) process. While the IDR process has been a powerful tool for providers, it also raised the operational bar adding to the growing list of duties for engaging with insurance companies. IDR requires specialized documentation, data analytics, and either internal or vendor support.
For independent practices this means: more investment in billing infrastructure, exposure to cash-flow risk if cases aren't filed optimally, and reduced margin for error. At the same time, large systems and hospital-owned practices could spread that burden across larger infrastructure and captive contracting leverage. The result? Smaller, independent groups face higher overhead and more uncertainty.
Why This Shift Matters for Reimbursement Strategy
Leverage changes: Independent practices formerly historically had more room to negotiate out-of-network rates, or to walk away from low-value payer contracts. With the introduction of the NSA, the high barrier of entry to the IDR process favors insurers, eroding provider leverage.
Operational cost increases: Compliance with the NSA/IDR, payer analytics, and documentation demands raise costs which smaller practices feel more severely.
Revenue volatility increases: Without the buffer of scale or system support, single-specialty or small multi-specialty groups face sharper swings in payment outcomes.
Choice narrows: When practice owners sell out or join systems, the number of independent entities that can truly pursue out-of-network reimbursement strategy shrinks competition and bargaining power in the market.
Reclaiming Independence Through Strategy, Not Status Quo
Independence doesn't necessarily mean solo. It means strategic autonomy and value-based positioning. Here are three actionable levers for independent or emerging practices:
| Lever | Action | Outcome |
|---|---|---|
| Data-Driven Out-of-Network | Use benchmark analytics (e.g., FMV, QPA modelling) to support higher reimbursement offers and better contract negotiation strategy | Elevates bargaining power, improves expected value of IDR cases and in-network contract offers. |
| Selective Contracting | Don't become network-dependent just for convenience—maintain meaningful out-of-network capability. | Preserves leverage and alternative revenue streams. |
| Operational Scalability | Invest in documentation/workflow processes that support high-acuity, complex care billing. | Reduces overhead risk and improves profitability per case. |
The Takeaway
The No Surprises Act and the broader payer/reimbursement dynamics haven't just changed how providers get paid they've changed something much deeper: who controls the practice.
"For physicians committed to independence, partnering with the right vendors, or hiring the right staff is no longer helpful but rather a necessity. Independence is built on strategy not legacy."
In an ever changing legal landscape, having a reputation for quality care is just the start. In today's environment, strategy means leveraging data, selectively engaging payers, and investing in systems that scale. If private practice is going to survive, it has to tilt the odds in its favor.
Next steps
Turn the analysis into a recovery path.
Open negotiation, evidence development, filing support, arbitration, and payer follow-up.
IDR eligibility guidelinesScreen plan type, service category, facility context, timing, and federal versus state routing.
Rate transparency analysisUse payer data and market benchmarks to support reimbursement strategy.
Send a claim sampleAsk MedRes to review an underpaid claim and identify the right recovery route.
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