In January 2009, Barack Obama was inaugurated as the 44th President of the United States. With healthcare reform as one of his major initiatives, the Affordable Care Act, also known as Obamacare, became law in 2010. Among the many levers embedded in this massive and ambitious legislation are incentive programs designed to completely shift the focus of the American healthcare system, from disease management to population health management.

While the underlying theories driving this shift may be based on sound principles, implementation of these programs has created unmanageable layers of complexity for physicians. Small, private, independent practices are among those that struggle the most to participate in the alphabet soup of incentive programs promulgated by both the Federal and State government.

Unfortunately, physicians have few options.

They either invest significant resources in the technology and human resources required to participate in MACRA, MIPS, PCMH, and a host of other incentive programs; sell their practices to large, corporate health systems which have the infrastructure to handle the data collection and reporting required to participate; or close shop and become employees of large practices or health networks.

And that is exactly what we have seen over the past eight years. Small, independent practices are vanishing, leaving many patients without access to neighborhood-based healthcare providers who know them, understand and share their culture and language preferences, and may have taken care of generations of their family members.

In their place are large, corporate practices, often owned by monolithic health systems headquartered far from the communities they serve.

What is the answer?

Is it possible to achieve meaningful reform, to control costs, ensure access to care for all who need it, and protect providers?

We will continue to examine these issues and others that affect independent physicians in the U.S. Please join this dialogue and share your opinion. We look forward to engaging with individuals on all sides of this debate.