Is Congress Doing Enough to Protect Physician Practices?
By David Doolittle

PAI_OversightThe rapid consolidation in the health care market place – including so-called “vertical” alliances among hospitals, insurers, and health systems – and the increased acquisition of physician practices will further restrict patient choices, drive up costs, and drive out more independent practices.

That’s why the Physicians Advocacy Institute (PAI) is urging federal lawmakers to re-examine health care policies to ensure they promote competition and put private physicians on a level playing field with hospitals and other corporate entities.

In a letter addressed to the U.S. House of Representatives Subcommittee on Health, PAI asked lawmakers to consider: 

  • Modernizing the Physician Self-Referral Law, which, among other provisions, prohibits physicians from making referrals for certain services payable by Medicare to an entity in which they have a financial relationship;
  • Lifting restrictions on forming and expanding physician-owned hospitals;
  • Reviewing antitrust laws to foster competition and to ensure against marketplace over-consolidation; and
  • Adopting site-neutral payment policies;

“There are many laws and regulations that have not kept pace with the evolution of a high-performance health system, particularly with regard to the important role of physicians,” said the letter, signed by PAI President Robert W. Seligson. “PAI strongly encourages congressional efforts to revisit enacted policies to ensure they foster, rather than hinder, increased competition and choice that will lead to further innovations and promote quality improvements.” 

The letter included findings from an ongoing research collaboration between PAI and Avalere Health on the effects of hospital acquisitions of physician practices, which increased by 86 percent between 2012 and 2015. The research showed that hospitals charge significantly more for Medicare-covered services than independent physicians, including for services delivered in the hospital outpatient department setting.

“In PAI’s view, the decline of the independent medical practice and lack of physician-owned hospitals have negative implications for continuity of patient care, quality, and innovation in the health care system,” the letter said. “There also is reason for concern that in a health care system dominated largely by corporate entities, physicians will not have appropriate input into clinical decisions that impact patients.”

PAI is a not-for-profit organization that works to advance fair and transparent policies in the health care system to sustain the profession of medicine for the benefit of patients. TMA is a charter member.


Last Updated On

February 27, 2018

David Doolittle

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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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