Tom,
For the first time, we had clients leave AC last year, and the two main drivers were selling to the hospital, or retiring.
We have also seen more Physicians go non-par or even stop taking Govertment payer programs.
Several practices are getting off the Meaningless Use bus, they have just become too burdensome to jsutify compliance.
Everyone's situations is different, but Physicians and Providers are increasingly changing tack and lightening ship. (To stay with the nautical theme)
Some practices are changing their offerings/payers, some are offering services outside of what payers cover. Several have found that once you aren't taking government money, your population changes to more compliant patients, and you have the freedom to be more flexible in what payments you take, and their structure.
We end up talking about this at every Meetup we have, so you are welcome to facilitate the subject when we get together in Laramie this summer.
The TL;DR is that Physicians and Providers continued to get pushed further into the corner, and they are smart people being badgered by mid-wits. Push them hard enough, long enough, and they begin to find ways out of the corner.
