If my memory of Obamacare is correct, the goal is for the Medical Home model, everyone works for the hospital, which takes responsibility for setting the priorities and guidelines for local healthcare.
The hospitals see that they need to start buying up a critical mass of the providers now to get market share compared to other hospitals.
If there is no competition between hospitals and your practice is dependent on hospital access/referrals/procedures, then your practice might not be worth as much later on.
Much of this is based on the ACO, or accountable care organization model. It has been undergoing a lot of revisions as they try to implement it. One of my hospitals has started to implement it and they are NOT buying practices, but they are trying to tie the physicians in tightly around the PHO. The concept ultimately is to get away from a fee for service to a more wholistic, almost true HMO model where you provide optimum care for the patient proactively to prevent spending money on inevitable complications and deterioration. Interestingly, the model calls for keeping patients out of the hospital because that is the largest cost center. I'm not giving away secrets, this is common knowledge. Eventually they will have to see whether this model will be sustainable on a hospital side.
It would appear we are going into another cycle of hospitals buying physicians practices. It's happened before but employed physicians usually are not as efficient as private practitioners. An advantage of a large system is that it can afford infrastructure to follow and bind both patients and their book of business. The disadvantage is that many of us are in private practice after training in large institutions because we saw that the bureaucracies do not work efficiently and we preferred to work for a system we more control.
It will be interesting to see how this all plays out. I do admit that health care costs have spiraled out of control for almost a quarter of a century. But, physicians have not seen much of that increase.
While we are the ones to order the care plan, we follow carefully scripted algorithms (some of the time) that are unlikely to change. Our patterns of care in this litigious society will not deviate without changes beyond the control of the physician. Increasing the responsibility of the patient, decreasing the barriers to health care, decreasing the likelihood of being sued will have far greater impact than hospitals controlling the practices.
