[mikeyouse]

Private insurance actually started a lot of these initiatives. If you're a physician with a busy practice, at the end of the month, you'll get a check from all of the big insurance companies detailing how much they're paying you.

It doesn't read, "You saw 100 patients at $100/patient, here's $10,000."

It's more like, "You saw 100 patients, here's your per-patient fee of $50. You prescribed 87% generic medicines, which for a doctor with your patient population in your area underperforms by 2 percentage points, this equates to a $1,400 bonus -- if you prescribed 91% generics, this bonus would be $2,500. Only one of your patients required an off-formulary medcine, your bonus here is $500."

There are a lot of competing interests right now, the formerly independent doctor groups are all merging together, insurance companies are merging, hospitals are merging. There's also a big push for risk-based reimbursement:

http://www.mckesson.com/bps/blog/riding-the-shifting-landsca...

[azernik]

I can second the testimony about lots of upheaval and consolidation in the industry. A family member recently worked at a Big Law firm on antitrust cases, and a large portion of them had to do when recent M&A activity among hospitals, specialty clinics, and small practices. The days of the doctor as small-business proprietor are waning.

[leekyle]

One interesting aspect with the consolidation of hospitals is that they are generally buying smaller hospitals, it isn't some massive merger which gives them immunity from anti-trust cases.