An effort as large as the federal EMR subsidy program was bound to have at least a few unintended consequences. One such negative effect seems to be the consolidation of care into large organizations in many markets, according to BNet columnist Ken Terry. It's a problem that actually started in 2006, when HHS created the exemption to the Stark physician self-referral and Medicare anti-kickback rules to allow hospitals and health systems to help affiliated physicians purchase EMRs. FierceEMR