As the Affordable Care Act continues through it’s implementation benchmarks, it would be naive to believe that the culture of healthcare will not be changed forever as we have known it in our generation.  For better or worse, Adam Smith’s  “invisible hand” metaphor for the marketplace will move the provider of goods and services in a manner that maximizes self-interest.  The delivery of healthcare is not immune to this theory.  

Before the Affordable Care Act became a legislative priority in Obama’s first term, hospital systems across the country were buying local physician practices and increasing the number of physicians on their payroll. From a strategic view, that initiative served not only to increase market share, but also to provide greater control in all aspects of patient care, with cost of service not the least of concerns.

Now that the Affordable Care Act is moving closer to full execution, it seems there are some aspects of the plan that may accelerate the push for physicians to become hospital employees. Some of the reimbursement figures for office-based specialists seem to be less than what similar care would be in the hospital setting.  This alone does not portend a positive outlook for the entrepreneurial physician wishing to establish their own personal service coporation independent of the financial resources in the hospital sector.  

Whatever the outcome, we probably wouldn’t recognize the deliver of healthcare in the US 20 years from now.