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LUGPA Policy Brief: The Patient Access to Higher Quality Health Care Act of 2025

Sept. 2025 

The Patient Access to Higher Quality Health Care Act of 2025 (H.R. 4002), introduced on June 12, 2025, by Representatives Beth Van Duyne (R-TX) and Henry Cuellar (D-TX), seeks to repeal provisions of the Affordable Care Act (ACA) that have restricted the development and expansion of physician-owned hospitals (POHs) for more than a decade.

In 2010, Section 6001 of the ACA imposed strict limits on POHs, citing concerns about physician self-referrals and potential overutilization. These provisions:

  • Prohibited new POHs from participating in Medicare.
  • Froze existing POHs at their March 23, 2010, capacity for beds, operating rooms, and procedure rooms.

As a result, about 250 POHs remain in operation today, most “grandfathered” under the law. Meanwhile, hospital systems have expanded aggressively, acquiring physician practices and benefiting from higher reimbursement rates for identical services delivered in hospital-owned settings. This trend has contributed to rising healthcare costs, increased consolidation, and reduced patient choice—issues at the core of LUGPA’s advocacy for competition and site-neutral payments.

Support and Opposition

  • Supportersargue that POHs deliver high-quality, cost-effective care and that removing restrictions would increase patient access, promote competition, and strengthen independent practices.
  • Opponents, primarily large hospital associations, contend that physician ownership could lead to overutilization of services, siphon profitable patients from community hospitals, and destabilize safety-net facilities. However, safeguards within the Stark Law and federal self-referral regulations remain in place to address inappropriate utilization concerns.

Key Provisions of H.R. 4002
H.R. 4002 would:

  • Lift the ACA’s expansion caps on existing POHs, allowing facilities to grow as community needs dictate.
  • Permit the establishment of new POHs, making them eligible for Medicare participation.
  • Maintain current Stark Law self-referral safeguards to prevent conflicts of interest.

The bill has bipartisan sponsorship and has been referred to the House Committees on Energy and Commerce and Ways and Means for consideration.

LUGPA supports reforms that restore balance in the healthcare marketplace by:

  • Promoting competition: Expanding POHs could counteract hospital consolidation, which has driven up costs and limited patient choice.
  • Advancing site-neutrality: Aligning reimbursement across sites of service is central to ensuring fair payments and preventing incentives that favor hospital ownership.
  • Encouraging innovation: Physician-owned facilities often deliver integrated, patient-centered care models that can improve outcomes, particularly for patients with complex conditions.
  • Expanding access: Allowing new POHs could increase care options in underserved communities.

While acknowledging concerns about utilization and patient selection, LUGPA believes that the evidence demonstrates POHs can operate responsibly, complementing rather than replacing community hospitals.

Implications for Urology and Broader Healthcare
For urology practices, the legislation could have significant benefits:

  • Enable the development or expansion of physician-led hospitals with integrated ambulatory surgical centers and inpatient services.
  • Improve efficiency for outpatient-heavy procedures common in urology.
  • Reduce Medicare expenditures tied to higher hospital billing rates.
  • Strengthen practice independence by creating more options for care delivery outside hospital-owned systems.

On a broader scale, reform could help address rising healthcare costs, expand patient choice, and support the transition to value-based care. Without such legislative change, independent practices remain at risk of further marginalization within an increasingly consolidated, hospital-dominated system.

By removing outdated restrictions while retaining necessary safeguards, H.R. 4002 has the potential to restore competition, expand patient access, and promote high-quality, cost-effective care. For independent physician groups, including urology practices, the bill represents an opportunity to foster innovation, strengthen independence, and better serve patients in an evolving healthcare landscape.