Apparently there’s a war over Hospitals – specifically community Hospitals being waged in Congress right now. H.R. 976 and H.R. 2513 are currently being floated, which would significantly modify current law with respect to self-referrals to physician-owned hospitals.
Under most laws and regulations in our health care system, physician self-referral is banned, but physician owners were using an exception (known commonly as the “whole hospital” exception), to get around these conflict of interest rules. The issue of self-referral to physician-owned hospitals, and the inherent conflict of interest it presents, is not a new issue.
These arrangements have been the subject of numerous bipartisan congressional hearings and analyses by independent and government researchers. In fact, the issue was first addressed by a statutory moratorium passed by Republican majorities, and enacted by President Bush, first in the Medicare Modernization Act of 2003 and then in the Deficit Reduction Act of 2005.
The data gathered over the last decade clearly showed that self-referral was creating an unlevel playing field, and threatened patient safety, as well as the health care safety net provided by full-service community hospitals, such as those found in many communities across the state.
These measures could potentially put hospitals in towns like Vermillion, Gettysburg, or Mobridge out of business, simply because it could break the back of the larger hospitals that own them.
In 2010, Congress passed a permanent but prospective ban on self-referral to physician-owned hospitals, providing grandfathered status for those existing hospitals with physician ownership or investment and a Medicare provider agreement in place as of December 31, 2010. Current law represents a compromise, which protects current physician ownership of hospital arrangements and allows these arrangements to grow where needed.
But now, opponents of this provision are seeking to repeal or amend this policy, despite the US Chamber of Commerce taking a strong position against the bills:
US Chamber 141121 Self-Referral Reid McConnell Boehner Pelosi
What do you think? Should physician owned hospitals be able to self-refer and cherry-pick patients? Or does that create an un-level playing field?
Such scare tactics. I have always wondered why independent physicians’ actions are questioned but not health systems who force employed providers to use in-house services? The health systems in this state have annual operational surpluses of upwards of $30 million. If they make that much revenue why would they close a small facility? If self referral is a bad thing why are hospitals permitted to employ physicians?
Nobody said “We have to pass the bill to find out what’s in it!” so that’s a step in the right direction.
Non-profit hospitals are not immune from criticism, but physician-owned hospitals represent conflicted medicine at its worst. See the debacle at the Lewis & Clark Specialty Hospital in Yankton. When there’s a huge dollar incentive clouding medical judgment, patients lose. And the dollars largely at risk are ours via Medicare. I can’t even believe someone would mention margins in the context of this subject. Physician-owned hospitals have enormous margins — much, much larger percentage-wise than non-profits, and it’s fueled by the wealth expectations of their own physician investors and foreign shareholders. That’s why they specialize in the most profitable procedures, leaving community hospitals to care for the poorest and sickest patients and compromising their ability to cross-subsidize those services. That’s not a patient-centered approach to medicine; that’s looking at sick people like investment opportunities, shoving aside the loser stocks. If anything, Congress should close their doors entirely.
Certainly one way to view heath care….however it is very subjective and not supported by the data. How do you quantify the margins of a not-for profit organization? The argument against physician owned facilities comes from competing hospitals. They can’t deal with good competition. Competition is what drives quality & lowers costs. You might find your opinion will change if you make the effort to actually research the data.
I like getting orthopedic surgery in the physician-owned hospital.
First of all, you get a form to sign acknowledging that the physicians own it. They aren’t hiding anything.
Presumably, because they don’t have to do any cost-shifting to cover Medicaid patients, the cost is lower but I have not done a cost comparison.
But unlike many friends who have had surgeries in general hospitals, I didn’t get infected with MRSA, and that’s definitely a plus. It seems post-op infection rates are significantly lower in private hospitals. Since that alone will save you a lot of trouble, money, and maybe your life, it’s a good enough reason to go to them.
Google “Stark Law” or “Stark Law violations” and you’ll find growing questioning and disallowing of employment agreements between hospitals and providers that are based on productivity and in-house referrals. For example: http://www.beckershospitalreview.com/legal-regulatory-issues/the-halo-over-nonprofits-is-gone-and-3-other-takeaways-from-recent-stark-law-settlements.html
I am leery of anything the US Chamber of Commerce proposes. The only thing they seem to want from the government is a subsidy.