Vertical integration—hospitals buying medical practices—is changing the U.S. healthcare system. Integration improves care coordination but may change delivery patterns. Vertical integration in gastroenterology offices increases deep sedation use and post-procedure problems, according to research. These changes are driven by financial incentives since integrated processes favor profitability over resource allocation. Vertical integration reduces quality and healthcare spending despite enhancing efficiency. To reduce these effects, policymakers could seek mitigation.