With hospitals receiving higher Medicare payments for specialty services than independent doctors, who have seen reimbursements repeatedly cut, many physicians must sell their practices. The shift helps doctors maintain a stable income, but it forces them to adhere to institutional guidelines that may hamper their practice. Consolidation has hit a boiling point in Boise, Idaho, as the area's largest health system is accused of having too much market control. While some policy experts say moving away from independent practices makes health care less fragmented and costly, some physicians say hospitals are pressuring them to admit more patients to meet financial targets.
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