For what it's worth, most of the physicians I know presume that this was set up expressly to incentivize physicians to become hospital employess. The thought is that when the time comes to ratchet down reimbursements, the hospitals have no choice, while independent physicians vote with their feet by choosing not to participate. There are already a few internists I know who will not take new Medicare patients, even though that's not supposed to be charity reimbursement.