News Articles About the Importance of Independent Practice
and the Threats they Face
APRIL 2023
Health Care Price Transparency, Competition on the Agenda for House
Richard Payerchin, Medical Economics
The United States spent $4.3 trillion on health care in 2021, a larger percentage of the country’s GDP than the rest of the developed world. So, who gets that money? It depends on who you ask, and Congress is asking. The U.S. House Energy & Commerce Subcommittee on Health recently convened for a bipartisan hearing to discuss the need to improve price transparency in health care and improve competition to help lower costs for patients. The subcommittee discussed 17 bills that would impact health care policy and finances, including addressing PBM reform, site-neutral payments, health care consolidation and hospital price transparency. “This payment disparity not only increases costs for beneficiaries and taxpayers, but encourages hospitals to buy up physician practices, leading to market consolidation and increased health care costs,” one witness said when discussing site-neutral payments.
States Step In as Telehealth and Clinic Patients Get Blindsided by Hospital Fees
Markian Hawryluk, Kaiser Health News
Millions of Americans are blindsided by hospital bills for doctor appointments that did not require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses. However, consumer advocates say hospitals should not charge more than independent clinics for the same services. When hospitals acquire physician practices, the physicians’ professional fees go up and, with the addition of facility fees, the total cost of care to patients increases. This process also drives healthcare consolidation. Some states have already implemented laws to limit these charges, such as collecting data on hospitals’ facility fees, prohibiting add-on fees for telehealth and requiring site-neutral payments for certain Medicaid services. One Colorado representative argues, “Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients.”
Why Don't Private Practice Physicians Have More Power in Healthcare?
Patsy Newitt, Becker’s ASC Review
Private practice physicians are struggling as the physician workforce increasingly migrates to employed models. Six physicians discuss why private practice physicians do not have more power in healthcare. Dr. Gopal, an OB-GYN, explains, “It is becoming increasingly difficult for private practice physicians to devote any time to anything other than the practice of medicine, what with the diminishing compensation for services, time spent in keeping up to date with recent developments and the administrative time spent on maintaining a place of business.” Multiple physicians discuss the impact of increased regulations and consolidations in healthcare, leading to a focus on profit and less emphasis on individual physicians. One physician adds that the “biggest issue is the lack of collective bargaining for individual providers.”
March 2023
CMS Must Level Playing Field for Independent Physicians
Evan Goldfischer, MD, Medical Economics
In this opinion piece, LUGPA President Evan Goldfischer, MD discusses the recent Medicare physician payment cuts. “These cuts are particularly destabilizing for independent physician practices…This reality highlights a need to educate policymakers and patients about why these payment cuts will only exacerbate the rising challenges for Americans to access individualized care throughout the U.S.” Dr. Goldfischer argues that Congress must focus on leveling the playing field between hospital and independent physician reimbursement so that independent practices can compete with hospital systems and provide more options for care. “It is my ardent hope that Congress seeks out innovative ways to reform physician payment, so all physicians can provide their patients and communities with timely access to high-quality and cost-effective care.”
How Can We Ensure the Future of Independent Practices?
John Machata, MD, Medical Economics
In this opinion piece, family physician John Machata, MD, discusses the disappearance of small independent practices (SIPs). Dr. Machata explains the negative impact of healthcare consolidation and notes that most Americans are in favor of congressional action to limit consolidation. He adds that “Big Medicine” has not improved quality or lowered costs for patients, and SIPs are better for both patients and physicians. “In my own practice, costs per patient are among the lowest in my state, and my quality metrics rank among the best. But low costs and high quality offer no guarantee of success when faced with a system seemingly dedicated to extinguishing small practices… If the personalized medical care offered by SIPs is to be preserved, the rules of the game must change.”
Surgeries Cost Far More at Hospitals in Networks vs. Independent Facilities, Study Finds
Alan Condon, Becker’s Hospital Review
The prices for surgical procedures at hospitals in networks are far higher than at independent hospitals, according to a recent JAMA study. Researchers examined the negotiated prices of nearly 3,200 hospitals. For 15 out of the 16 surgical procedures analyzed, the median negotiated price was significantly higher at hospitals within networks compared with independent hospitals. For example, the median price for prostatectomy was $9,567 at facilities in hospital networks and $8,601 at independent facilities. The study comes on the heels of a recent report that found only a quarter of hospitals were compliant with federal price transparency rules, with many of the country's largest health systems having no compliant hospitals.
February 2023
Health Care Cronyism Is Fueling Hospital Consolidation and Rising Medical Costs
Anthony DiGiorgio, The Hill
In this opinion piece, neurosurgeon Anthony DiGiorgio discusses the problem of hospital consolidation and policies for reform. The issue has generated bipartisan action, with senators holding hearings and the Biden administration issuing orders to combat it. However, there are many federal programs that favor larger health systems over independent physician practices, and these are driving consolidation and harming the financial stability of smaller practices. The Medicare 340B drug discount program, for example, gives a large competitive advantage to hospital-affiliated clinics, to the point where independent clinics cannot compete. This discount is intended for hospitals that primarily serve vulnerable patients. It is not a revenue stream to drive consolidation. Any serious effort at addressing health care consolidation must address 340B, DiGiorgio argues.
Patients Lose When States Block Independent Doctors
Jaimie Cavanaugh and Daryl James, KevinMD
In this opinion piece, attorney Jaimie Cavanaugh and Daryl James discuss cases where state “certificate of need” laws have limited independent physicians. Before providers can launch or expand services in these jurisdictions, they first must prove to the government’s satisfaction that a need exists. Cavanaugh and James argue, “Patients win when independent doctors open shop... Yet states often intervene to shut down health care competition.” New Hampshire repealed its CON laws in 2016, joining 11 other CON-free states—the next battleground for CON reform is South Carolina, where lawmakers have debated repeal since 2015. Meanwhile, the consolidation of independent practices across the U.S. has hit an all-time high, limiting competition and leaving patients with less options and higher prices for care.
Medical Practices Face Widespread Staff Shortages
John Schieszer, Renal & Urology News
In 2023, managing and growing a medical practice are challenging due to record-breaking staff shortages. Significant structural changes in the health care system are needed to address the labor shortages today and in the future. “LUGPA has dedicated efforts to work with the next generation of physicians, as they are essential to the future of independent practice and to our country’s ability to provide effective urologic care in the decades to come,” said Evan R. Goldfischer, MD, president of LUGPA. Due to the health care workers shortage, more practices are experiencing increases in labor costs and Medicare rates have not kept up. Independent urologists must do all they can to educate policymakers on the benefits of integrated urologic care to ensure all patients have access to high-quality, affordable and efficient overall care.
More Physicians Are Experiencing Burnout and Depression
Christine Lehmann, Medscape
Physician burnout and depression continue to worsen, according to a new report from Medscape. More than half of physicians said they are feeling burned out, up from 42% saying so in 2018 and 47% in 2021. Nearly a quarter also reported being depressed in 2022. The majority of doctors attributed their burnout to too many bureaucratic tasks. This year’s report showed less burnout in solo practices than in other work settings thanks to autonomy and having control over productivity. “Organizations need to provide the resources necessary to address the mental health needs of physicians and that they can trust that those conversations will be kept confidential,” said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.
January 2023
Health System Hospitals, Physicians Deliver 'Marginally' Better Care at Higher Cost Than Independent Peers: Study
Dave Muoio, Fierce Healthcare
A new JAMA study found that the enormous proportion of care delivered by health systems comes at a higher cost with few other advantages, adding to the argument for greater scrutiny of provider consolidation. The study found higher commercial prices among systems for outpatient physician visits (26% higher), inpatient stays (13% higher) and admissions in common diagnosis groups (31% higher). One expert explained, “In the worst case, we could wind up with a system in which quality is lower and spending higher than need be, but we would never know it because the only possible comparisons would be among large systems. This dismal possibility highlights the need for continued research on—and federal and state antitrust attention to—health system and health insurer size and performance.”
Picking the Best Place to Practice Medicine
John Schieszer, Renal & Urology News
When choosing where to set up a practice, physicians have many factors to consider. What is best for one clinician might not be quite as important for another, especially at different stages of their careers. Jonathan Henderson, MD, immediate past president of LUGPA, discusses the challenges of establishing an independent practice today. “The patient backlog from two years of the pandemic is daunting, and the shortage of providers is more critical than ever and heightens daily,” Dr. Henderson explained. “There is a national labor shortage, and supply chain disruptions continue to be compounded in unexpected ways.”
The Million Dollar Mistake: Why Medical Schools Don’t Teach Business and How It’s Costing Physicians
Dr. Curtis Graham, KevinMD
In this op-ed, physician Curtis Graham, MD discusses the importance of providing physicians with a business education, arguing that business skills are what gives physicians the necessary tools to succeed in medicine. Dr. Graham explains, “Without physicians who inspire and teach those lacking in business knowledge, independent medical practice would not exist today.” With ongoing changes to the healthcare system and advanced needs from patients, physicians require a more comprehensive business education. He suggests that this lack of education is a failure from medical schools, particularly for those physicians who wish to practice independently. Dr. Graham also lists a multitude of benefits that a business education can provide, including improving practice management skills, managing staff and ultimately providing better care for patients.
December 2022
Stop Hospital Consolidations to Lower Health Care Prices for All Americans
Brian J. Miller, MD, and Jesse M. Ehrenfeld, MD, The Hill
With hospital monopolies gouging Americans, now is the time for reasonable reforms to promote choice and competition. Hospital market power has reached a critical level, and hospitals are driving even more consolidation by buying physician practices. The authors of this article lay out pragmatic solutions for tackling hospital monopoly power and lowering costs for patients. Health systems often use anti-competitive contract clauses, preventing health plans from directing patients to other low-cost, high-quality physicians. Policymakers should identify these practices and direct the Federal Trade Commission (FTC) and Department of Justice (DOJ) Antitrust Division to study them, giving the FTC the power to address them. Congress should additionally promote the growth of small businesses and prevent regulatory agencies from needlessly interfering in medical decision-making.
Arkansas Urologist Receives First-Ever Spirit of Independence Award
Arkansas Money and Politics
LUGPA has named Dr. Gail Reede Jones of Arkansas Urology as the inaugural recipient of the Spirit of Independence Award at the 2022 Annual Meeting. Dr. Jones was the first female urologist in the state of Arkansas. After several years of private practice, she joined forces with other urologists to found the state’s largest urology practice. “This award is about much more than just me. This is a testament to my fellow physician partners at Arkansas Urology, as well as my patients for entrusting their health to me, enabling me to have three decades of urology practice in Little Rock,” Dr. Jones said. “I’m proud of the growth, impact and evolution our team has seen through the years as the state’s largest independently owned urology practice. It is such a privilege to receive the inaugural Independent Spirit Award from LUGPA, and I share this honor with our entire team.”
November 2022
LUGPA President Dr. Goldfischer Discusses the Challenges Facing Independent Urology
Benjamin P. Saylor, Urology Times
Independent urology continues to face challenges, including reimbursement cuts and staffing issues. New LUGPA President Evan R. Goldfischer, MD, MBA, FACS discusses goals for his term and summarizes a session on prostate-specific membrane antigen-positron emission tomography (PSMA-PET) that he led at the LUGPA 2022 Annual Meeting. He explains that the first priority of his presidency will be health policy, expanding LUGPA’s work with the Hill and state legislatures. Second, he aims to enhance LUGPA’s programming for all member groups, including the Annual Meeting, regional meetings and other programs. Another goal for Dr. Goldfischer is to get LUGPA’s younger members more involved and make that a priority, expanding on current programs such as LUGPA Forward and the Executive Leadership Program.
How Effective is the Government’s Campaign Against Hospital Mergers?
Allan Sloan and Carson Kessler, ProPublica
In recent months, the FTC has blocked four hospital mergers, marking notable achievements following President Biden’s executive order that criticized hospital consolidation and aimed to promote competition. An examination of the cases the FTC has and has not taken on suggests that the agency has a long way to go. The FTC initiated three challenges of hospital mergers during this period and allowed 54 to proceed without taking public action. One reason these numbers have not risen further is because the FTC’s guidelines focus exclusively on challenging mergers of hospitals within a single geographic region, therefore not interfering in cross-market deals that make up an increasing portion of hospital mergers. Experts argue that the FTC should intervene in these mergers, as they can allow hospital chains to gain significant power to raise prices.
October 2022
The Medicare Providers Act Delays Payment Cuts for Needed Physician Services
Brian McNicoll, Washington Times
The key to keeping Medicare operating, particularly in rural and underserved areas, is to ensure doctors continue to be paid appropriately. Unless Congress acts soon, flawed federal policy will result in a 4.42% cut to Medicare physician fee schedule payments in 2023. These payment cuts are likely to force some smaller practices to close or consolidate with larger systems, meaning less access to care for patients. Legislators have introduced the Support Medicare Providers Act to address this issue by delaying the impending cut for physician services by a year. This does not represent the permanent solution that is needed, but it does provide a modicum of relief for physicians while inflation is still soaring, as well as time for Congress and CMS to work out a lasting deal.
As Giant Hospitals Get Bigger, An Independent Doctor Feels the Pinch
Fred Clasen-Kelly, Kaiser Health News
Before the coronavirus pandemic, Dr. Andrew Bush, an independent orthopedic surgeon in North Carolina, treated nearly 1,000 patients every month. He is now among a dwindling number of independent physicians who are selling their practices to hospital systems or leaving the profession altogether. Experts say this trend underlines how billions of dollars in pandemic federal aid favored large hospital systems, allowing them to post larger profits or continue to pursue mergers. Dr. Bush’s patient visits have recovered only to half of pre-pandemic levels. The loss of independent practices threatens to fundamentally reshape the physician-patient relationship as more doctors become beholden to their employers. President Biden has pushed the FTC to fight consolidation in the healthcare industry, arguing that it has left many communities with inadequate or more expensive healthcare options.
3 Top-Of-Mind Challenges for Specialty Care and How to Overcome Them
Shirley H. Lee, MedCityNews
After the COVID-19 pandemic, specialty practices have had to consider how their practices will return to normal. This question was top of mind for urologists during the LUGPA regional meeting this past spring. When asked to consider the pain points that are holding urology practices back from adapting to a post-COVID-19 environment, 69% of urologists and administrators cited challenges with staff and physician recruitment and retention, while two out of three pointed to rising costs and decreasing reimbursement. Staff and physician burnout (57%) were also major issues. Three considerations for navigating these challenges in specialty care include tightening triage protocols, looking for ways to ease call volume pressures for physicians and clinicians and leveraging data-based tools to identify which patients would most benefit from follow-up with a specialist.
Vulnerable Patients Are Back on the Chopping Block
Mark Garcia, MD, MedPage Today
CMS is proposing to cut the Medicare conversion factor, the starting point for calculating Medicare payments, by about 4.5%, threatening specialty care providers' ability to keep their doors open. If these cuts are implemented, Americans -- particularly people of color, those who live in rural communities, and the elderly -- will see clinics they rely on for live-saving care disappear from their communities. This policy decision will put vulnerable patient populations squarely on the chopping block and will widen the healthcare equity gap that already exists. Black and Latino patients suffer disproportionately from many of the diseases treated by the specialty providers who are seeing the biggest cuts, and they often live in areas where healthcare access is already limited. Local physicians’ offices are a critical part of our healthcare infrastructure, and if shut down, it will leave underserved and sick patients to find treatment in the already overburdened hospital system. The trend of hospital consolidation is already concerning, and we have seen that these constant cuts are leaving office-based and small healthcare providers with no other option than to either move to a hospital setting or close their doors outright.
Medical Groups May Reduce Staff, Patients Amid Medicare Payment Cuts
Victoria Bailey, RevCycleIntelligence
As medical groups expect to see Medicare payment cuts in 2023, practices are considering limiting the number of new Medicare patients and reducing clinical staff to ensure financial stability, according to the Medical Group Management Association (MGMA)’s study of 517 group practices across 45 states. Over 90% of practices said that 2022 Medicare reimbursement rates already do not adequately cover the cost of care provided. To maintain finances in the wake of even further reductions, medical groups will have to adjust some of their practices. Some practices report that they are already stretched thin due to increasing labor and supply costs, and a cut in Medicare would be beyond what they could manage. Nearly 60% of groups are considering limiting new Medicare patients, and 58% of respondents said they might have to reduce their clinical staff. Medical groups and practices have urged Congress to act accordingly to prevent this significant Medicare payment reduction.
September 2022
New Paper Claims Hospital Prices Are “Bleeding Americans Dry”
Jacqueline LaPointe, RevCycleIntelligence
A new paper from the patient advocacy group Families USA is taking aim at hospitals and health systems. The report claims that high hospital prices are “bleeding Americans dry” as these organizations become more corporatized and put profits over patients. The writers of the paper claim that “the corporate hospital business model has fundamentally transformed into one that favors monopolies and setting high prices at the expense of our health.” Hospital prices have increased by as much as 31% since 2015 and have grown over four times faster than workers’ wages. Not only have hospital prices increased, but they also continue to vary by location. The paper states that the price tag and variation is just another way hospitals charge whatever they want for services, rather than pricing procedures and tests based on actual cost, efficacy and quality. The paper calls for a more competitive health care industry to make care more affordable and increase price transparency.
Physicians Slam Fee Schedule Cuts, Call for Medicare Payment Reform
Jacqueline LaPointe, RevCycleIntelligence
Physician advocacy groups are calling on CMS to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for physicians next year. CMS proposed in July to decrease the Fee Schedule conversion factor by $1.53 to $33.08 in 2023. Many physician advocacy groups argue that the Fee Schedule cut would harm patient access to care. They also warn that these cuts are unsustainable for independent practices, as the difference between the costs of running a practice and actual Medicare payments could incentivize providers to further consolidate as they face the administrative and financial burdens of participating in Medicare. The physician groups are calling for a baseline positive annual update reflecting inflation in practice costs and for the elimination or replacement of the budget neutrality requirements. They are also urging policymakers to reward providers for delivering value-based care, rather than administrative activities, through a variety of alternative payment models tailored to specific specialties and practice settings.
3 Tips for Seeking Health Care
Family Features, City Pulse
Americans want options for their health care, receiving personalized care at a reasonable price and at a location that is convenient and comfortable. When people are not in an emergency situation, it is beneficial to shop around for best prices of health care services. According to a survey from LUGPA, nearly one-third of older Americans worry they won’t get the care they need at a location they choose for a price they can afford. Americans should also consider independent practices, as they typically have a lower average cost per patient. Jonathan Henderson, MD, president of LUGPA, explains, “Independent physicians work for patients.” According to a LUGPA survey, 65% of Americans trust independent physicians and associate them with more individualized and patient-focused care compared to physicians employed by hospitals. Lastly, patients should also pursue telehealth options if available to increase access to care.
August 2022
Capturing Specialty Practice Revenue
Shirley H. Lee, CRNP-FNP, MPH, Medical Economics
Two out of three physicians surveyed at the LUGPA regional meeting this past spring cited rising costs and declining reimbursement as one of the top challenges they face in a COVID-19 era of care. These challenges require looking at new ways to increase efficiency and revenue, even as workforce shortages and pandemic-specific obstacles strain resources. There are multiple approaches that specialty practices can take to strengthen quality of care, access and revenue amid these challenges. First, practices can explore opportunities to expand ancillary services offerings and promote them widely. Second, practices can use software platforms to track and manage care activities for patients’ chronic conditions, which will improve outcomes for this population while boosting revenue. Finally, practices can make their virtual care efforts more efficient through activities such as remote patient monitoring and remote therapeutic monitoring.
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