Consolidation in the health care market isn’t a new trend, but the frenzy of mergers and acquisitions in the emergency medicine space make this a top concern for practicing emergency physicians and EM administrators. Over the next few months, ACEP Now will feature a series of articles exploring the effects—both positive and negative—that consolidation may have on emergency medicine.

To start the discussion, ACEP Now editorial board member Ricardo Martinez, MD, FACEP, chief medical officer for North Highland Worldwide Consulting and assistant professor of emergency medicine at Emory University in Atlanta, recently sat down with Jeff Swearingen, managing director and cofounder of Edgemont Capital Partners in New York City, to explore some of the forces driving mergers and acquisitions in emergency medicine. Next month, we’ll highlight some of the mergers and acquisitions topics discussed at the ACEP15 Council Town Hall meeting held Oct. 25, 2015, in Boston.

RM: We’re seeing a lot of activity and tremendous interest in mergers and acquisitions in emergency medicine. What do you see as the main driving forces behind this?

JS: First and foremost, there’s a lot of mergers and acquisitions activity throughout health care right now. There is consolidation happening in all four of the main hospital-based specialties: emergency medicine, anesthesia, hospitalist medicine, and radiology. Anesthesia is even more active than emergency medicine in terms of the number of transactions at the moment, if you can believe that. Consolidation is resulting from different types of provider organizations jockeying for position and negotiating leverage as people look to negotiate a larger share of a bundled payment that may be bundled across both the facility and the provider in the future. I think the second reason for consolidation is access to capital. Many of the consolidators that are driving mergers and acquisitions in emergency medicine have far greater access to both debt and equity capital than even a midsized regional group might have. Investment in information technology and other capabilities will be important going forward, especially the ability to capture data beyond just the three hours in the emergency room episode of care. Emergency physicians in the future may be able to capture data via call center follow-up with patients to make sure that they’re following their discharge instructions and that they’re making follow-up appointments with their office-based providers. Envision, the EmCare business, also owns the large ambulance company American Medical Response, and they are using the trained paramedics to make follow-up house calls to patients discharged from their EmCare-staffed emergency rooms. They’re doing this on a test basis in some markets, as I understand it. Envision is using those resources to try to reduce readmission cases. That is just one example of what may be required of emergency medicine providers in the future. To meet these potential requirements, groups will need expertise beyond emergency medicine, information technology resources, and access to capital to make those types of investments.