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Comment by delfinom | Hacker News Reader

Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration. The era of independent doctors is basically coming to a very fast end.

Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now.

Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.

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There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3].

In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4].

[1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/h...

[2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.99820...

[3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health...

[4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....

> Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech.

Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.

My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.

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