Medicine in Alabama is changing hands. Independent clinics owned by the providers who work in them are becoming rare. This is a business story before it is a healthcare story. Independent practices face the same pressures as any small business: rising labor costs, expensive technology, payer complexity, staffing shortages, and margins that keep thinning.
At the beginning of 2026, 82% of American physicians were employed by hospitals or other corporate entities, according to the Physicians Advocacy Institute. Over eight years, the number of independent physicians fell by more than 152,000. Hospitals and corporate owners now hold nearly 64% of physician practices, up from under 30% in 2018.
A primary care office earns its revenue one visit at a time. See fewer patients, earn less. Payment for the patients you do see arrives two to four weeks after the claim goes out, and sometimes not at all. Each new billing rule, portal requirement, prior authorization process, or software upgrade lands another fixed cost on a business already running thin. Eventually, selling can look less like giving up and more like survival.
For Alabama, the stakes are even higher. As of May 2025, 61 of our 67 counties were federally designated primary care shortage areas, with the majority of that gap being in rural and semi-rural areas. When an independent practice in a small town closes or is absorbed into a larger system, that community often loses an employer, and patients lose the person who knew them by name.
Can an independent practice stay solvent without burning out its physicians? Increasingly, that depends on whether the clinic is paid for the work primary care has always done but could not bill for: the work between visits.
CMS has spent the past decade moving toward value-based care, which incentivizes quality and outcomes rather than volume. Chronic disease is where the payment model meets the clinical need. The CDC ties 90% of the nation’s health care spending to patients with chronic and mental health conditions. Whether diabetes, hypertension, heart failure, or COPD stays controlled is rarely determined by the office visit alone. It depends on the ongoing management that follows: adjusting medications, coordinating care after hospitalization, monitoring symptoms, and helping patients stay on track between appointments.
The reduction in healthcare utilization associated with this model has led Medicare payers to increasingly reimburse care management services. Chronic Care Management pays practices each month to coordinate care for patients with multiple chronic conditions. Remote Patient Monitoring supports tracking measures like blood pressure or weight from home. In 2025, CMS introduced Advanced Primary Care Management, allowing qualifying primary care clinicians to bill monthly for a broader bundle of ongoing care management.
The recurring nature of that payment is what changes the revenue cycle. It creates a steadier line of income tied directly to the work that keeps high-risk patients out of the hospital, and it builds the infrastructure payers increasingly expect: care plans, medication reconciliation, follow-up after discharge, quality tracking, and outreach that does not wait for the next appointment.
While the programs do value quality care, that work takes clinical staff time that a busy practice usually does not have to spare. Some practices build the program in house. Others partner with an outside clinical team who work under the practice’s own clinicians. Either path can work, and a growing number of Alabama practices are utilizing these options to support sustainability, close gaps, and optimize care for their patients.
None of this reverses consolidation by itself. For many practices, independence has become a question of economics rather than identity. It now depends on whether a practice can be reimbursed for keeping patients healthy, and rebuilding revenue around the care the patients already require.
Alabama cannot afford to lose more hometown providers. The independent practice model may be more durable than it looks by optimizing the value-based care model on its own terms.
Holly Clark Crawley, PharmD, BCPS, BCCCP, is director of clinical services at Torch Wellness, a pharmacist-led care management company based in North Alabama. A board-certified pharmacist in pharmacotherapy and critical care, she works with independent primary care practices across Alabama to run Medicare-reimbursed care management services and value-based care programs. Her focus is the clinical care that happens between office visits, where most chronic disease is managed.
