A few excerpts from the article:
During a hearing before the House Small Business Committee on Thursday, health-care professionals explained that the shift has already been picking up momentum in recent years, driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers -- all of which they say have hit small practices especially hard. Consequently, doctors are shying away from the traditional solo practitioner model in favor of employment at large hospitals...
Now there's an additional catalyst physicians say may expedite the decline of small practices -- the Patient Protection and Affordable Care Act, passed in 2010 and recently approved by the Supreme Court.
For starters, PPACA made Accountable Care Organizations -- referring to groups of providers that take responsibility for the care for an entire patient group -- an official part of the Medicare program this year, giving hospitals added incentive to scoop up physician partners.
"Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary care physicians, particularly, as well as specialists that they can have in their Accountable Care Organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.
But the law also comes with new regulations and non-compliance penalties that could further deter doctors from self-employment...Bear in mind, this is not some "unintended consequence". From my July 2011 PJMedia piece, "The Coming Collectivization of American Health Care":
The Obama administration regards this collectivization of medical providers as a desirable outcome, not merely some “unintended consequence.”
As Obama health advisor Nancy-Ann DeParle wrote last year in the Annals of Internal Medicine, the new law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and “physicians will need to embrace rather than resist change.”
Translation: “Doctors should get with the program — or else!”
Furthermore, such collectivization is merely a continuation of a much older strategy.
Jonah Goldberg’s book Liberal Fascism described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal. As Goldberg noted:If a physician freely decides to join a large multispecialty group practice (or become a hospital employee) based on his own best professional judgment and individual practice preferences, this is not necessarily bad.
[If] you want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What’s easier, strapping five thousand cats to a wagon or a couple of giant oxen?Similarly, it will be much easier for the federal government to regulate 100 large ACOs than 10,000 small private practices.
Once doctors are herded into ACOs, they will become increasingly accustomed to simply following orders from ACO administrators (who in turn will be proxies for government health bureaucrats).
The New York Times recently reported that after physicians became hospital employees, they became much more accepting of government controls over health care than their counterparts in private practice...
But when the government tilts the playing field to drive doctors out of small private practices into these more easily-regulated large entities, that's a different matter altogether.
As Dr. Jay Parkinson observes, this really means that "bureaucrats determine the business model of a doctor’s practice".
Under such a system, doctors lose the freedom to practice how they best see fit. When that happens, patients lose the freedom to receive the care their doctors deems most appropriate.
Do we want that kind of medical system?