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How much physicians get paid is increasingly determined by a payment formula that penalizes doctors whose patients are more expensive-even when those higher costs stem from services that other doctors perform says a new report from the Center for Healthcare Quality and Payment Reform.

Although the Affordable Care Act (ACA) made accessibility to health insurance easier, consumers are finding themselves shouldering greater out-of-pocket costs in the form of copayments and deductibles for the care that they receive. Physicians are also feeling the need to collect more fees from more of their patients.