In a year or two a part of Obamacare phases in that changes reimbursement structure from per-procedure payments to payments for overall effectiveness, whether it actually works is up in the air:
2015: "A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. "
Sounds like that will work out about as well as rewarding schools for performance. The doctors who treat the sickest patients who are likely to die anyway will get screwed.
Problem is that the doctor lobby is huge. If it results in them getting more money, they will push it through. If it results in them getting less money, they will stop it.
Doctor pay probably needs reform, but going head-to-head with the doctor's lobby is nuts.
Obamacare fixes this problem by getting everyone essentially closer to the medicare rate. Because I have high blood pressure, I cannot even get medical insurance which Obamacare will fix as well.
Edit: I worked for 5 years at a HMO in data analytics.