New ObamaCare rules will essentially make it impossible for future doctors to create innovative organizations like the Mayo Clinic or Cleveland Clinic.
Here's an extended excerpt
The Affordable Care Act (ACA) ends local-regional physician and patient control of medical decision making by shifting them to bureaucrats in Washington while fundamentally changing healthcare delivery models and reimbursement. Hospitals are the major beneficiaries of these changes- a requirement necessary for the American Hospital Association to support this law.
The law stipulates that physicians can no longer own hospitals. It also creates a new payment model for medical services which favors hospitals. The Accountable Care Organization (ACO), is an integrated healthcare delivery model devised to control costs by issuing a single payment for an episode of care for a patient. The ACO then divides the payment "fairly" among those involved in this episode. This payment model was unsuccessful in recent trials, but was so well supported by non-clinical health care planners who had the ear of the administration, that it was included in the law. Hospitals will typically be in charge of these ACO arrangements, because they already have the infrastructure required by the government for implementation.
In anticipation of this sea change, hospitals are engaged in a "feeding frenzy", buying up predominantly primary care practices, but specialty practices too. In many cities, hospitals compete for these practices, vying for control of as many patients as possible in a community. Once achieving "critical mass", with enough primary care practices, hospitals can approach a specialty group with a Mafia style "offer that they can't refuse". They make it clear to the specialty practice that the doctors who previously sent them patients are now controlled by them. They can either take the hospital’s offer for their practice or go out of business.
The end of private practice is imminent in an ACO world. Small practices will be unable to survive. What is not advertised is that in such a system, doctors become employees. Their allegiance is no longer to their patients, but to their boss, who is interested not in treating infections, or replacing hips, but in balance sheets, and return on investment.