An article in Health Affairs looks at the MACRA and the “corporate transformation of American medicine.”

Among its observations:

”There is surprisingly little evidence about the performance of different forms of physician practice. Several recent studies suggest that, on average, larger practices and practices owned by hospitals charge higher prices, generate higher total costs of care per patient, and do not provide better quality. However, the available evidence is far from definitive. It is possible that if payment incentives to improve quality and control costs become stronger over time, large organizations will gradually develop superior capabilities to improve the care they provide.”

The article ends with this:

“Meanwhile, the corporate transformation of American medicine proceeds. Once independent practices become owned by a corporation, it is very difficult for them to disengage themselves and re-create a functional practice. Given the limited research to date about higher prices, higher costs, and at best equivalent quality for patients of physicians employed by hospitals, there is an urgent need for more evidence on the impact of different types of provider organization on the quality and cost of care, and on patient, physician, and staff experience.”