Does the Affordable Care Act hurt independent physicians?

AS everyone knows, the # of independent physicians is decreasing and # of employed physicians (hospital/academic or large groups) is increasing. The latest Physicians Foundation survey showed 44.8% employed by hospital/health system,  40.4% owner/partner of a practice and  14.8% employed with an 'independent' practice. In the same survey, 47% of physicians stated their practice had experienced no change since passage of the ACA (Obamacare). Almost 40% had experienced a problem ranging from payment issues to  being dropped by an insurance carrier.

A recent column in the WSJ by Dr.Gottlieb outlined what he saw as a threat to independent practices. See if you agree with his opinion. Here are his conclusions as seen by Shannon Barnet at Beckers:

"1. PPACA supporters endorse consolidating independent physicians because it enables payment provisions that shift the financial risk of delivering care onto providers as opposed to government programs like Medicare. Furthermore, he suggests the creators of the law assumed physicians could better bear financial risk if they're a part of a larger, well-capitalized institution.

2. Consolidated health systems eliminate competition between local providers for contracts with health plans, according to Dr. Gottlieb.

"Since all healthcare is local, the lack of competition will soon make it much harder to implement a market-based alternative to ObamaCare," he wrote. "The resulting medical monopolies will make more regulation the most obvious solution to the inevitable cost and quality problems."

3. PPACA payment reforms like accountable care organizations and bundled payment are biased in favor of engagements with hospital-owned entities and against less centralized engagements with independent physicians.

"These ObamaCare payment reforms are fashioned after 1990s-style health maintenance organizations, or HMOs, in which entities like hospitals would get a lump sum of money from Medicare (or now, ObamaCare) for taking on the risk of caring for a large pool of patients." wrote Dr. Gottlieb. "But right now all of these payment schemes are tilted far in favor of having hospitals pool that risk, and not looser networks of doctors."

4. PPACA biases against independent, private-practice physicians include requiring providers to control their own IT infrastructure, waiving anti-kickback provisions that many private practices are unable to qualify for and reimbursing hospital outpatient clinics for higher amounts than independently owned medical offices for the same procedures.

5. Many physicians, Republicans and Democrats alike, have expressed to Dr. Gottlieb that their professional strain would not be impacted by the PPACA.

"They are wrong," wrote Dr. Gottlieb. "ObamaCare has accelerated many of the detrimental trends doctors see in their profession, and introduced new ones."