Docs on the block: seeing a physician could get more costly as more sell their practices to health-care systems.

• Author: Weisbecker, Lee
• Position: Statewide: BUSINESS NEWS FROM ACROSS NORTH CAROLINA

In 2009, a group of doctors formed Independent Physicians of the Carolinas, a Charlotte-based nonprofit. During periodic meetings, doctors from about 50 practices, most in the Charlotte region, discuss topics ranging from health-care reform to back-office operations. With more physicians selling their practices to hospital systems, says board member and Charlotte pain specialist Ratko Vujicic, the gatherings can sometimes feel like a support group for beleaguered holdouts.

Half of U.S. doctors will work for hospitals or their physician networks by the end of the year, according to Scott Gottlieb, a fellow at the American Enterprise Institute, a Washington, D.C.-based research group that promotes free markets. The Raleigh-based North Carolina Medical Society doesn't track how many of the state's approximately 30,000 licensed doctors work for hospitals, but Charlotte-based Carolinas Healthcare System, the largest health system in the state, has increased its stable of practices 50% to 227 since 2010. The trend also is evident at other large systems, including Winston-Salem-based Novant Health, Durham-based Duke University Health Care, Chapel Hill-based UNC Health Care, Winston-Salem-based Wake Forest Baptist Health and Raleigh-based WakeMed Health and Hospitals.

Hospitals began buying up independents 15 to 20 years ago, believing they could treat more patients at a lower cost on an outpatient basis, says Duke University professor Chris Conover, a health-policy specialist. The spending spree stalled when practices didn't prove to be as profitable as predicted, but health-care reform has revived it as systems prepare for a post-Obamacare market. "Hospitals are finding that the easiest way to comply with all the new regulations is simply to employ the physicians," says Bill Pully, president of the North Carolina Hospital Association. "Is that good or bad? I don't know, it just is."

Many predict that Obamacare will morph into a system that resembles accountable-care organizations --provider partnerships that are paid based on patient outcomes instead of by the number of tests and procedures they perform. Medicare uses a formula to calculate savings, giving half to the partnerships. Consolidation, Pully maintains, prepares hospitals for the changes by coordinating treatment among practices.

Independent physicians find selling out attractive because, in part, the Affordable Care Act demands upgraded office technology such as electronic patient...