But measuring small-practice quality will become a more significant change if one of these payment pilot projects evolves into a full-fledged quality-based reimbursement system.
Given the general direction healthcare is heading and the financial pressures physicians face, it's likely that the proportion of doctors in small practices will continue to drop over the next couple of decades.
There are some options for the little guys, though. An independent practice can have a managed service organization run by a hospital or other entity handle human resources and administrative tasks, or a physician-hospital organization, where money matters are handled jointly. Some physicians may also look at limited or divisional mergers, where a small practice retains its individual identity but joins other practices to form a corporation.
To stay small, many practices will have to find help, and perhaps give up some of their autonomy. But that may be the only way to resist the tide of consolidation.