A Doctor’s Concern for Private Practice
by Chad Davis, M.D.
Indiana’s private practitioners, family doctors among them, need your help — a Code Red, if you will. Specifically, they need you to understand the economic pressures that change how your medical care is provided — and not just those changes associated with the Patient Protection and Affordable Care Act (also known as ObamaCare).
The Wall Street Journal, for instance, has warned that the pieces of legislation, both Republican and Democrat, headed for approval in Congress all favor the consolidation of doctors into salaried roles inside hospitals, “in effect ending independent medical practices.”
The New York Times reports that the main reason for high hospital costs in the United States is fiscal, not medical: “Hospitals are the most powerful players in a healthcare system that has little or no price regulation in the private market,” the newspaper warned.
And an article in the Indianapolis Star related that in Indianapolis an MRI (magnetic resonance image) on the lower back can range from $300 to $5,000. Again, the fault seems to be a system in which pricing is detached from either cost or profit.
So, what can we in Indiana do?
“The first thing is to realize that, in hospitals, bigger is not necessarily better,” advises The Indiana Policy Review, “and that can be true in all aspects, including quality of care, cost transparency and the professional character of the attending physician.”
There may not be anything explicit in ObamaCare that says hospitals should buy physician practices, but because it encourages bundled payments for a patient’s care, which a hospital then distributes to the doctor and others, it encourages hospital ownership of doctors.
A Fort Wayne surgeon set this gloomy scene for the foundation:
“The physician’s highest priority will become the whims and wishes of the hospital system, not the needs and desires of the patient. But if the hospital does not prioritize the patients’ needs first — and it won’t be able to do so because of bureaucratic red tape and regulations — then the doctor will be forced to render limited substandard care because the ‘system’ demands it or because the doctor will lose his job for going against the system.”
To summarize, Hoosiers have reason to ask lawmakers to take a few steps back from the regulations and systems that work against the humane motivations that have created a world-class pool of independent private physicians:
- In general, press your congressional delegation to remove the pervasive biases in ObamaCare that favor hospital ownership of medical practices. Those provisions that create incentives for the coordinated delivery of medical care (those payment bundles) depend on hospitals employing doctors.
- Lobby to remove IT infrastructure requirements. These cost millions of dollars and force doctors away from individual practices and into hospitals, which can afford to absorb the costs.
- Similarly, the cost of the required Electronic Medical Record (EMR) is exorbitant. And as of January 1, if a private practice doesn’t have a “government-approved” EMR, it is penalized 1 percent of annual Medicare reimbursements. In 2016, that increases to 3 percent, and in 2017 to 5 percent a year in perpetuity.
- Indiana legislators could relax restrictions on hospital construction — restrictions now weighted in favor of the politically powerful general hospitals and against the small specialty hospitals and ambulatory surgery centers.
- Hospitals could be asked to give patients a firm price in advance of a procedure or operation.
Indiana doesn’t have to wait for Washington to save its private physicians. All it will take is your understanding of the issues involved, plus some legislative will.
Chad Davis, M.D., a general surgeon in Indianapolis, is an adjunct scholar of the foundation and one of its founding members.