We seem to be in another cycle of practice sales as hospitals, health care systems and even large physician groups work to accumulate the pieces of their own accountable care organizations (ACOs). Many are betting that ACOs will become the basic building blocks of the health care system as envisioned in the Patient Protection and Affordable Care Act, a.k.a. health care reform – or Obamacare, depending on your political leaning.

As in the managed care boom of the early 1990s, independent physicians may get tempting offers for their practices, since the ACO builders are in a rush to snap up the resources they need before a competitor does. Of course, some who sold during the boom years ended up with their practices dumped back in their lap, perhaps somewhat battered by hospital management or mismanagement, during the managed care bust of the late 1990s. As any of them can tell you, the future direction of health care may not be what it seems.

Although history has a way of finding new and surprising ways to repeat itself, the experience of the early 1990s has plenty of other lessons to teach us about practice sales, most of which are probably applicable today. One of them is succinctly outlined in Donna G. Izor's article in this issue: “Why Did Your Productivity Decrease When We Hired You?” Whatever the reasons – and Izor points out a number – physicians moving from independent practice to employed practice tend to become less productive, a phenomenon that can cause problems for employer and employee both unless they're prepared for it. Coincidentally, the “Last Word” department in this issue also offers several caveats for the physician seeking to become employed, although I fervently hope that the nexus of poor management practices that K.M. Rodney Arnold, MD, encountered and describes in her essay is extremely rare.

With ACOs and practice sales becoming more and more common, you will certainly see more on these subjects in Family Practice Management over the coming months, including an introduction to ACOs in one of the fall issues. For now, just evaluate opportunities carefully and hedge your bets. Nothing about the future of health care seems certain except uncertainty.