The ACA is working:
Private insurers and government, as part of health reform's cost-cutting, are changing the way they pay for care. Rather than reimburse for every service a doctor performs, they have begun to pay lump sums per patient, forcing doctors to more efficiently manage the health of patients, especially those with chronic illnesses.
To adapt, doctors have been forced to change the way they practice. They have to stay open longer, use electronic records, keep better tabs on patients with chronic illnesses and make other changes aimed at keeping patients healthy and out of expensive hospitals and emergency rooms.
Or the doctors have decided to quit their own businesses and go work for hospitals, which can use their bigger multiple-physician leverage to negotiate costs down further.