More is apparently better when it comes to the consolidation of area medical practices.

Such consolidations in recent years give a glimpse into the strategic vision of regional hospitals and medical groups.

A number of private practices and medical groups have affiliated with the major players in the local health care scene. New Hanover Regional Medical Center, Novant Health and Wilmington Health have all added new services and physicians to its stable of providers in recent years.

“For us, the consolidation of medical practices has not affected the way we do business. We have always been in the physician business, and so physician growth is simply an extension of what we do,” Jeff James, Wilmington Health CEO, said recently.

With that growth comes “both challenge and opportunity,” James said.

“The challenge is how best to meld different temperaments, talents and convictions into one cohesive culture. In fact, that’s the challenge for the physician corps in the community, not just at Wilmington Health,” James said. “The opportunity comes from our increased ability to promote efficiency, demonstrate quality, reduce the cost of care and improve the patient experience.”

In the past five years, eight practices, including Riverside Family Medicine, HMS Endocrinology and Azalea Coast Plastic Surgery, have joined Wilmington Health, said Chasity Chace, Wilmington Health’s chief financial officer.

That brought over about 14 providers, she said, adding that another handful of providers migrated to Wilmington Health from other practices. Prior to recent years, two larger practices – The Children’s Clinic and Carolina Ob/Gyn – became part of Wilmington Health, she said.

New Hanover Regional has been an aggressive participant in consolidation. There are more than 200 providers in the NHRMC Physician Group, New Hanover Regional spokeswoman Claire Parker said.

The trend of consolidation “has been very common across the United States for a long time,” Parker said.

The NHRMC Physician Group began in March 2009. It was formed, in part, because of “a number of factors driving the increased collaboration between hospitals and physicians,” Parker said.

“Most important is the opportunity to work together to improve quality. Through integration we can set measurable quality standards that extend into the ambulatory setting and align our collective efforts toward more preventative medicine,” she said. “With the advent of [accountable care organizations] and population health, we are also seeing the need to work together to ensure care is coordinated before, during and after a hospitalization.”

Economic factors also enter into the consolidation equation.

“The need to control costs is also a big driver toward consolidation. Medical technology and electronic medical records are big investments and can be out of reach for smaller practices,” Parker said. “By sharing technology and business functions, we can put more resources toward direct patient care.”

Careful planning went into the decision to add new providers under the NHRMC umbrella, Parker said.

“We monitor the needs of the community, and we strategically align those patient needs with our growth plans. This may be adding another group to the NHRMC Physician Group, partnering with providers or hiring primary care and specialty providers,” she said.

Novant Health is a not-for-profit integrated system of 15 medical centers and 1,123 doctors in 343 clinic locations, in addition to numerous outpatient surgery centers, medical plazas, rehabilitation programs, diagnostic imaging centers and community health outreach programs.

It has operated Novant Health Brunswick Medical Center in Brunswick County since 2006.

From January 2009 to March of next year, there are expected to be a total of 271 new clinics or affiliations within Winston-Salem-based Novant Health’s entire system, said health care system spokeswoman Ashton Miller.

In March 2006, Brunswick Community Hospital, now Novant Health Brunswick Medical Center, joined Novant Health. At that time, two physician practices transitioned from management by the hospital’s prior owner, HCA, to Novant Health.

Those two practices each had one location on the hospital campus, including four doctors, Miller said.

Today, there are nine practices with a total of 26 providers and 16 locations in Brunswick County that have become part of Novant Health’s medical group, she said.

John Phipps, executive vice president and president of the Novant Health Medical Group, said medical group-hospital system consolidation has been an ongoing process.

“The trend to integrate medical groups within hospital systems has actually been occurring for about 15 to 20 years. There are many reasons for this trend,” Phipps said.

“One is that independent practitioners face mounting pressures and complexities when it comes to running the business of their clinic,” he said, “for example, trying to implement electronic health records, complying with CMS [Centers for Medicare & Medicaid Services] and other payer demands for submission of quality and claims information, as well as complying with the recent ICD-10 [diagnostic codes] transition.”

Shelbourn Stevens, president of Novant Health Brunswick Medical Center, added that Brunswick County is considered to be a medically underserved area, having 1,578 people per physician, versus the 859 per physician state average and 631 national average.

“Recruiting more physicians to the area has been a key strategy for Novant Health since 2006 with a goal of providing care close to home for local residents,” Stevens said.

Still, the consolidation trend in general needs to be carefully monitored, said Robert W. Seligson, CEO and executive vice president of the N.C. Medical Society.

“We have heard of pressure being put on employed or affiliated physicians to limit referrals within the system regardless of the quality or cost of that care,” Seligson said. “This runs completely counter to a value-based health care system and the three goals of such a system: improving the patient experience of care, improving the health of the defined population of patients and reducing the per capita cost.”

Seligson said that form of control by the large health systems “strengthens the hospitals’ negotiating position and has the potential to drive up costs, while the independent physician practices are possibly squeezed further because they lack leverage.”

Consolidation will likely be a continuing trend, said Scott Whisnant, community relations administrator of NHRMC.

“With the way our country’s health care system continues to evolve, physicians and hospitals will increasingly find advantages to working together,” Whisnant said. “We collaborate on setting standard protocols for care, quality metrics and methods of managing a patient’s various conditions.”