I recently had breakfast with a physician who is part of a reasonably large single specialty group.  The group is in integration discussions with one of the hospital systems in their town.  The good news for the group is that the framework of the deal allows them to align and integrate while remaining independent.  There is even an escape hatch if things don't go well.

I sat there and nodded that nod that you get when your skepticism is pleasantly surprised, sort of like when your kids clean the kitchen after dinner without being asked.  Maybe, just maybe, the hospital folks are beginning to see that the relationship discussion is not binary: employed or not.

Then he told me that at the last minute the system showed up with their IT guys and said it would be really, really good if the group would get on the ambulatory module of their enterprise system.  Integration would just be easier, after all.

Easier on who?  The hospital's IT staff?  Exactly.

Not so much on the physicians who want to align and cooperate and share risk and financial up and downsides, physicians to whom that escape hatch really matters since there are more than a few historical reasons for them to not completely trust the hospital.

'If you do it,' I told him, 'you just sold your practice.  You just deferred the price discussion until later when you have no leverage.'

This does not have to be this hard.