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Consolidation, in its many shapes, sizes and arrangements, appears to be accelerating as health care organizations look to achieve greater scale to address a dizzying array of market and government pressures.

Reimbursement policies, technology, regulations, capital needs, shifts in patient care and other factors have combined to create a state of flux in health care that is making organizational independence more and more difficult.

Earlier this decade, Medcenter One, based in Bismarck, N.(Full disclosure: Brainerd is the former chair of the board of directors for the Federal Reserve Bank of Minneapolis.) Specialists are also targets for vertical consolidation and integration.

But consolidation has also morphed into many different structural and legal forms that stop short of traditional mergers and acquisitions but achieve strategic objectives for both organizations.

That’s changing, as more hospital-centric health care systems add so-called hospital outpatient departments (HOPDs) that look and act much like traditional physician-owned clinics.

An Accenture report this year noted that “the era of the independent physician that many adults grew up with is swiftly coming to an end.” In 2000, 57 percent of physicians practiced independently, outside a larger health care system.

Many states do have their own fair housing laws which include additional protected classes such as marital status, sexual orientation and ancestry.

Under these laws, each state can also allow for age protection, which would begin at a defined age, but most do not prevent communities from being exclusive to older adults as they recognize the benefit of senior housing programs.

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