A new study published in 2025 offers important insights into how physician affiliation influences where care is delivered and how much it costs. The findings show meaningful differences between hospital-employed physicians, private equity–affiliated groups, and independent or MSO-supported practices. These trends are particularly relevant for cardiovascular care, where the shift toward outpatient and ambulatory environments continues to accelerate. The following analysis is based on findings from the 2025 study, “Physician Affiliation and Site-of-Care Cost Variation in Outpatient Procedures,” available via the National Institutes of Health (NIH).
At Heart & Vascular Partners, we closely follow this type of research because it informs how we support our partner practices with strategic planning, operational execution, and long-term growth.
What the Study Found
The analysis identified clear distinctions in site of care patterns tied to different physician affiliation models.
- Hospital-affiliated physicians were the least likely to perform procedures in lower-cost outpatient settings.
- Private equity–affiliated physicians were more likely to deliver care in lower-cost outpatient and ambulatory settings.
- Independent and MSO-supported physicians demonstrated greater use of outpatient and ambulatory settings.
These patterns were consistent across both Medicare and commercial insurance claims, highlighting that site of care decisions, shaped in part by organizational structure, meaningfully influence total healthcare spending.
The study also reaffirmed a long-established trend: the site of care is a major driver of cost variation. Identical procedures can carry substantially higher prices when performed in hospital settings compared with outpatient or ambulatory environments.
Why These Findings Matter for Cardiovascular Practices
For cardiology groups navigating an increasingly complex reimbursement and regulatory environment, the study’s insights reinforce several strategic considerations.
- Outpatient and ambulatory settings are essential to long-term sustainability. Many cardiovascular procedures continue to shift toward minimally invasive approaches suitable for ASCs or office-based labs. Practices that have built, or plan to build, the infrastructure to support these settings are positioned to improve patient access, enhance efficiency, and reduce overall cost of care.
- Payers are prioritizing cost-effective care without compromising quality. The study’s findings align with broader national trends as commercial and government payers increasingly support lower-cost sites of service. Cardiovascular practices that proactively manage their site of care mix can strengthen their performance under emerging value-based and site-neutral payment models.
- Affiliation choices shape operational flexibility. The business model a practice aligns with (whether hospital employment, private equity investment, or an independent/MSO structure) has real implications for cost structure, site of care flexibility, and long-term operational resilience. Understanding these trade-offs is critical for sustainable growth.
How HVP Helps Practices Respond to These Trends
MSO partnerships offer physician-led groups a path to maintain autonomy while gaining the operational support needed to succeed in outpatient environments. At HVP, we work with cardiovascular practices to:
- Evaluate and optimize site-of-care strategies
- Expand or enhance ASC and office-based service lines
- Improve cost structure and operational efficiency
- Position the practice for long-term financial and clinical success
Our goal is to ensure practices can continue delivering high-quality cardiovascular care while adapting to the economic and structural realities highlighted in this research.
If your organization is evaluating affiliation models, growth strategies, or service-line expansion opportunities, our team can help translate these findings into informed, actionable decisions.
