Introduction
Over the previous decade, personal fairness companies and different well-funded company entities together with hospitals and insurers have expanded their presence in doctor practices throughout the nation. In 2024, hospitals and company entities employed nearly 80% of physicians. A rising physique of proof means that company possession buildings prioritize monetary positive factors over affected person care, undermine doctor autonomy, and improve well being care spending. Policymakers are more and more grappling with find out how to regulate the rising company funding in doctor practices.
Oregon has emerged as an early instance of how states can confront this problem. Lately, the state has enacted reforms focusing on each the company observe of drugs and oversight of well being care transactions. Collectively, these insurance policies type a multi-pronged technique to restrict company affect over doctor practices and defend sufferers from the potential harms of consolidation.
Strengthening Company Observe of Drugs Legal guidelines
Company observe of drugs (CPOM) is a authorized doctrine primarily codified in statute, requiring that licensed physicians and different clinicians personal for-profit medical practices. Its function is to make sure that licensed clinicians—not company actors—retain final authority over medical and operational selections affecting affected person care. The doctrine displays issues that company revenue motives could battle with clinicians’ moral responsibility to prioritize affected person care.
Extra not too long ago, companies have developed workarounds that allow de facto management over doctor practices, most notably by means of the “pleasant doctor mannequin.” Below this strategy, a lay company—resembling a personal equity-owned firm—creates a separate entity generally known as a administration providers group (MSO) that positive factors management over the doctor observe’s property and installs an affiliated doctor because the nominal proprietor of the observe. The MSO-affiliated doctor could haven’t any lively medical position on the observe or dwell out of state. The MSO then enters administration providers preparations with the observe to successfully acquire full operational and administrative management.
These preparations invert CPOM’s meant relationship between the observe and the MSO. Slightly than functioning as a vendor supporting a physician-owned observe, the MSO has full management over the observe. This dynamic dangers undermining doctor autonomy and limiting physicians’ potential to boost issues about administration selections affecting affected person care. Consequently, researchers have more and more scrutinized the pleasant doctor mannequin as a mechanism for oblique company management, and state curiosity round amending CPOM legal guidelines to control the pleasant doctor mannequin have additionally grown.
In 2025, Oregon handed one of many most complete CPOM legal guidelines within the nation by prohibiting the “pleasant doctor” mannequin. The regulation bans MSOs or anybody they contract with from having majority management or possession over a observe or exercising final management within the doctor observe. The statute additionally bars inventory restriction agreements and renders many noncompete, nondisclosure, and nondisparagement clauses unenforceable. By combining these possession and contractual restrictions, Oregon’s regulation restrains MSOs and goals to revive the spirit of CPOM. Nevertheless, the regulation didn’t create an enforcement authority inside state companies and may solely be enforced by means of personal proper of motion.
Transaction Oversight
Transaction oversight permits states to observe and evaluation mergers, acquisitions, and different possession modifications amongst well being care entities. States vary from having no oversight authority or pre-transaction evaluation authority to having complete oversight frameworks that embody transaction approval and post-transaction monitoring to guard sufferers and communities. Not too long ago, states have expanded their oversight authority. A 2024 publication discovered that 13 states had transaction approval authority. By late 2025, that quantity had grown to 32. These mechanisms are meant to make sure that consolidation and funding don’t undermine affordability, high quality, or entry to care.
In 2021, Oregon handed probably the most complete transaction oversight frameworks within the nation. Not like most states, Oregon requires pre-transaction notification and approval for sure transactions involving doctor practices that exceed a specified income threshold. Regulators evaluation the potential affect of those proposed transactions on client prices, high quality, entry, and fairness. The regulation additionally offers regulators post-transaction oversight authority, permitting the state to observe transactions after they shut and implement situations designed to guard affordability, entry, high quality, and fairness. If the entities are discovered to be out of compliance with any situations of approval, regulators can pursue authorized treatments.
Oregon’s CPOM reforms work along with the state’s transaction oversight authority, forming a multi-pronged technique to restrict company affect within the supply of well being care providers. Below the state’s transaction oversight framework, the Well being Care Market Oversight (HCMO) program could deny a fabric change transaction topic to evaluation if there’s a substantial chance it could violate the regulation. Accordingly, if a transaction includes a pleasant doctor association that violates the strengthened CPOM regulation, HCMO has the authority to disclaim approval.
Wanting Ahead
Oregon’s strengthened CPOM provisions take impact on a staggered timeline. The regulation grew to become efficient in January 2026 for MSOs and doctor practices shaped after June 2025. Current MSOs and doctor practices shaped earlier than June 2025 should comply starting in 2029.
Early trade actions are testing how the brand new regulation is interpreted. For instance, PeaceHealth not too long ago determined to exchange its long-standing emergency division doctor group, Eugene Emergency Physicians, with Lane Emergency Physicians. The brand new observe is solely owned by an Illinois doctor affiliated with ApolloMD, a Georgia-based MSO that additionally serves as Lane Emergency Doctor’s MSO. Legislative and gubernatorial scrutiny have adopted. Oregon lawmakers have requested for data to find out whether or not the association complies with the strengthened CPOM regulation and requested the events submit the transaction for evaluation. On the identical time, Eugene Emergency Physicians filed a lawsuit in opposition to PeaceHealth, ApolloMD, and Lane Emergency Physicians, alleging the brand new association depends on the pleasant doctor mannequin that the up to date CPOM regulation prohibits.
Oregon’s expertise might present vital insights for different states looking for to curb company affect in well being care. Particularly, monitoring how the CPOM reforms work together with the state’s transaction oversight framework will assist assess whether or not these insurance policies safeguard doctor autonomy, restrain prices, and defend sufferers.