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For W. Scott Brosche, MD, a senior partner at Fredericksburg Anesthesia Associates Inc., in Virginia, passage of the Affordable Care Act in 2010 was a cause for concern. How would the small, 16-physician practice, holding contracts with just two hospitals and one ambulatory surgery center, deal with the oncoming raft of legislated health care reforms, such as bundled payments, pay-for-performance, value-based purchasing and accountable care organizations? In addition to this uncertainty, “another hospital was moving into our area with a competing anesthesia group owned by a national corporation,” Dr. Brosche said. “So we began to think about our options.”

After considerable research and no small amount of soul searching, Dr. Brosche and his partners sold their practice last year to the national medical group MEDNAX Services Inc., and became part of the company’s American Anesthesiology division. “We had seen that small practices such as ours were increasingly being ousted from hospitals even though they had provided good care for many years,” Dr. Brosche said. “There was just no security.”

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