It has already passed in the House, and the legislation to expand the State Children's Health Insurance Program will likely make its way through the Senate with little resistance. After all, who would want to deny emergency health coverage to children who need it, particularly in a time like this?
Therein lies the brilliance of opponents of physician-owned hospitals, who have buried in the SCHIP bill a provision aimed at curtailing the growth and development of these facilities. The restrictions aren't currently in the Senate version of the bill, and it's unclear if they will make it into the final legislation. If they do, existing physician-owned hospitals would be barred from expanding, investment in such hospitals would be restricted, and no new Medicare reimbursement approvals would be issued.
It's an old trick in Washington—you hide potentially controversial measures in a must-pass bill to limit debate and tie opponents' hands—and it is a familiar tactic in this old fight.
In 2008, similar language was slipped into several bills, including legislation related to funding the war in Iraq and a completely unrelated farm bill, but the ban never passed. As I wrote last spring, this is a very divisive battle involving both physician and hospital heavyweights.
Physician owners contend that their specialty hospitals offer patients greater choice and better care, while hospitals warn that physician ownership can lead to self-referrals and doctors cherry-picking patients.
Both sides make a valid point or two, and it is a debate worth having—just not like this.
Although it may not fit the technical definition, the provision in SCHIP is essentially an earmark. A number of hospitals have lost market share to physician-owned competitors, and the ban could have a substantial financial impact on their bottom lines.
Are there legitimate concerns about self-referral? Sure. But CMS already has an elaborate process for dealing with that issue. Why not debate the constraints to put on physician hospital ownership through the usual channels?
I suspect it is because hospital associations are afraid they would lose. There are already 199 physician-owned hospitals nationwide, and another 85 currently under development, according to Physician Hospitals of America. That represents "$2.4 billion in total payroll, $509 million in federal taxes, $1.9 billion in trade payables, and 55,000 full- and part-time employees."
Physician-owned hospitals have already proven their utility. CMS has investigated the claims and given them the green light. An open debate would likely focus on how to regulate these entities, rather than whether or not they have a right to exist.
"The real issue at the heart of this is competition and control," says Molly Sandvig, executive director of Physician Hospitals of America. Opponents of physician-owned hospitals don't want regulated competitors. They'd prefer to not have the competition at all, which is why they keep trying to sneak a ban by Congress.
To borrow a phrase from the new President's inauguration speech this week, the time has come to set aside childish things. Physician-owned hospitals have the right to exist, but can be improved by greater transparency and accountability. That goes for this debate, too.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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The proportion of children and working-age Americans who went without a prescription drug because of cost concerns jumped to one in seven in 2007, up from one in 10 in 2003, according to a study released by the Center for Studying Health System Change and funded by the Robert Wood Johnson Foundation. Rising prescription drug costs and less generous drug coverage likely contributed to the growth in nonelderly Americans who went without a prescribed medication because of cost concerns—from 10.3% in 2003 to 13.9% in 2007, according to the findings. The most vulnerable people—those with low incomes, chronic conditions and the uninsured—continue to face the greatest unmet prescription drug needs, the study found.
This article published in The New England Journal of Medicine examines the current trend that has many health systems and providers strengthening policies and oversight with regard to conflicts of interest and requiring that all industry relationships be submitted for approval. "Concerns about privacy notwithstanding, accurate, interpretable, and timely online disclosures can provide immediate access to potentially relevant information and demonstrate that relationships are not being hidden," writes the author.
The top Republican on the House Veterans Affairs Committee has demanded that the VA explain how it allowed software glitches to put the medical care of patients at its health centers nationwide at risk. Patients at VA health centers were given incorrect doses of drugs, had needed treatments delayed, and may have been exposed to other medical errors due to the glitches that showed faulty displays of their electronic health records.
A bill making its way through Congress to provide more low-income children with health-insurance coverage could spell financial trouble for scores of hospitals owned by physicians. The proposed legislation will prohibit "the unethical kickbacks that physicians receive from ownership hospitals, most of which are of questionable safety and quality," said Rep. Pete Stark, chairman of the House Ways and Means health subcommittee. A provision that Rep. Stark helped write in the child-health bill would effectively put a halt to the construction of any new doctor-owned hospitals and would seriously hamper plans of existing ones to expand.
Park Nicollet Health Services has become the first healthcare system in Minnesota to require doctors to publicly disclose their financial relationships with drug and medical device companies. The move by Park Nicollet is designed to allay concerns that these relationships pose a conflict of interest by influencing doctors' treatment decisions. Drug and device companies defend the payments, saying doctors' expertise is needed to make their products better.