News | Published: Saturday, October 18, 2025
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As the business of cardiovascular care evolves rapidly, cardiologists have a number of options for structuring their practices and engaging in strategic partnerships. At a packed mini-intensive session, physicians, legal experts and practice leaders shared candid insights into how hospital employment, capital-backed platforms and management services organizations (MSOs) are reshaping independent cardiology practices. The three-part session, part of CV Transforum Fall’25 in Austin, TX, explored practice model choices, key legal protections in strategic partnerships, and what it’s really like to work in a private equity (PE)-backed cardiology group.
Moderator Dana Jacoby, MHS, president and CEO of Vector Medical Group, opened the discussion by emphasizing that “these models are in flux right now.” Fahad Gilani, MD, FACC, FSCAI, founding partner of Cardiovascular Specialists of New England, described his former group’s decision to leave a hospital-employed model and build Cardiovascular Specialists of New England, from the ground up, ultimately partnering with CardioOne for operational support. Weekly meetings, pro forma accountability, and guidance on billing, coding and revenue cycle management allowed his team to maintain ownership while accessing national-scale expertise. That balance of autonomy and infrastructure was a recurring theme throughout the day, as physicians compared how different structures shape practice control, physician compensation and program growth.
For David Wohns, MD, division chief of Cardiology at Corewell Health West, a long-standing partnership with a physician-led health system offered a different kind of independence. His group receives funding from the system but determines how to distribute revenue internally, relying on a team-based decision-making model rather than top-down directives. “Autonomy is in the eye of the beholder,” he said. Panelists repeatedly returned to this idea of what autonomy means to the individual organization based on several factors, such as operations, culture, volumes and finances, that can be used to evaluate the value of potential partnerships.
John Mehall, MD, senior vice president of Strategy and Development at Heart and Vascular Partners, discussed the key considerations for practices seeking PE support. Mehall cited the mounting challenges for cardiology practices as rapid changes in reimbursement, technology and care delivery. To remain competitive, groups need to anticipate shifts such as new procedural codes, expand their presence in key markets, and invest in capabilities like device and chronic care management. PE platforms can help accelerate this process by providing capital, operational infrastructure, and access to platform-wide initiatives. This kind of support allows practices to scale strategically, can enhance revenue streams, and position themselves for long-term sustainability in an increasingly complex healthcare environment – if PE aligns with their program needs and culture.
The conversation then shifted to legal considerations. Attorney Anjana Patel, JD, shareholder, and Glenn Prives, JD, healthcare and corporate partner attorney at Baker Donelson, underscored that no matter which strategic model physicians choose, the legal protections negotiated at the outset can determine how much autonomy they retain over time. Critical elements include governance rights, fair compensation structures, income protection and noncompete carveouts. They explained that while state laws often protect clinical autonomy, operational and governance authority depends on what is written in the contract. In private equity partnerships and MSO models, securing board seats or observer roles can give physicians visibility and influence over strategic decisions. They also noted that “supergroups” – alliances of independent practices – can offer scale and leverage without an immediate sale, but require careful alignment of culture and compensation structures across multiple legacy groups.
Cultural alignment emerged as one of the most decisive factors in whether these transactions succeed. Panelists emphasized that while financial terms can be negotiated, misalignment in values or vision is far harder to fix. Legal experts also highlighted the growing importance of restrictive covenant negotiations, noting that although the Federal Trade Commission’s proposed noncompete rule is no longer moving forward, state laws vary widely and can significantly impact a physician’s future flexibility.
The final portion of the session turned to real-world experiences from physicians working within private equity-backed cardiology practices. Kartik Giri, MD, FACC, partner at Cardiovascular Associates of the Delaware Valley, who leads one of New Jersey’s largest independent groups, described his team’s initial resistance to consolidation and their eventual decision to partner with CVAUSA. “We wanted to remain independent,” he said, “but by 2020, we realized we couldn’t sustain a long-term independent future alone.” Partnering with PE allowed them to retain clinical control while gaining the resources necessary to compete in value-based care arrangements and invest in growth. Mike Plantz, senior vice president of Operations at US Heart and Vascular, explained that the operational benefits of engaging with PE have been substantial. Access to specialized subject matter experts has enabled their practice to operate more efficiently and freed physicians to focus on patient care rather than administrative burdens.
Both emphasized that PE partnerships are not without trade-offs. Physician income typically normalizes to market rates after a transaction to create EBITDA, with potential upside through equity participation and future “second bites.” Transparency, particularly in how equity is structured and how newer physicians are brought in, is critical to maintaining trust and stability. Kartik noted that their group eliminated traditional physician buy-ins to make recruitment easier and equity more accessible to new hires. Plantz added that the difference now is the depth and breadth of resources: “There’s just a greater volume of specialized support. It allows us to do more and be smarter about how we grow.”
Throughout the session, a few common threads stood out. Autonomy is not fixed but negotiated, shaped by governance structures, contract language and partner alignment. Financial priorities differ across career stages, and legal details – particularly around governance rights, equity terms and noncompete clauses – can shape a physician’s options for years to come. Many practices are realizing that growth increasingly requires scale, whether through PE, MSOs or supergroup formation, as independent groups face mounting reimbursement pressures and regulatory change. As Centers for Medicare & Medicaid Services reimbursement updates loom in 2026 and financial pressures intensify, speakers agreed that strategic positioning – not just clinical excellence – will define the future of cardiology.
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