Value-Based Payment and Vanishing Small Independent Practices (JAMA Network)

An estimated 80% of physicians are now employed by larger entities like hospitals and health systems, driven by factors such as administrative burdens, capital demands, and financial incentives. A key yet underappreciated factor is the shift from fee-for-service to value-based payment models, which require significant resources for small independent practices. The need for investments in technology and regulatory expertise to participate in these models is accelerating corporate consolidation, a trend that policymakers should consider as they promote value-based care.