If youre not feeling well, who would you trust most to make you get better? Your physician, the administrator of your local hospital or Sen. Chuck Grassley (R-Iowa)?
Most people would say they would trust their physician more than the other two, but the administrator of your local hospital and Grassley want to take that choice away from patients. They think they, not physicians, know best how patients should receive care, and the raft of special-interest legislation theyre backing would support their view.
Grassley has introduced two pieces of legislation that target physician ownership of medical services. The intent of the bills is to discourage if not outright ban physician ownership of medical services, eliminating the competition that helps control costs and reducing the much-needed dose of patient choice the industry needs.
The first bill, called the Medicare Imaging Disclosure Sunshine Act of 2008, would require physicians to discloseat the time of referraltheir ownership interest in an imaging service to which theyre referring Medicare patients and to offer patients a list of alternative imaging services from which they could receive care (July 28, p. 4). The second bill, called the Rural Hospital Assistance Act of 2008, would ban physician self-referrals to new physician-owned hospitals and limit physician self-referrals to existing physician-owned hospitals.
My colleague Todd Sloane correctly argued in this space last week that the use of diagnostic imaging should be dictated by evidence that use of the procedures leads to better patient outcomes and that overuse absent such evidence is driving up Medicare spending on imaging services. But Grassleys approach to the problemdiscouraging physicians from owning their own office imaging equipmentwill only drive up costs higher as it would give a franchise on those services to hospitals and other providers.
The same is true of the physician hospital ownership provisions of his rural hospital bill. Discouraging and banning physicians from referring patients to general and specialty hospitals in which they have an ownership interest will lead to higher costs.
Grassley undermines his pro-patient rhetoric with his true agenda, which is revealed in the second bill. He wants to create yet another category of hospitals under Medicare Part A that would be reimbursed differently. Grassleys bill would tweak the payment formula to these so-called tweener hospitalswhich he defined as too big to qualify as critical-access hospitals but too small to survive under the existing prospective payment systemso they would get more money from Medicare. That money, not surprisingly, would come from the funds that allegedly would be saved by reducing Medicare patient utilization of physician-owned general and specialty hospitals. And exactly where are these tweener hospitals? There are eight in Grassleys home state of Iowa, although the senator assures us that there are others across the country.
The American Hospital Association, which desperately is trying to kill physician ownership of hospitals to protect the financial interests of its acute-care constituency, told Grassley in a letter that it applauds your commitment to Americas rural healthcare providers.
This is special-interest legislation of the worst kind. The bills aim to kill off competition to protect one special-interest and shunt money to another special interest, all under the guise of protecting patients from those evil, money-grubbing doctors who are lining their own pockets by ordering unnecessary imaging tests and by referring too many wealthy and healthy patients to their own hospitals.
Interestingly, the only ones complainingat least publiclyabout physicians are the politicians and the hospitals. We havent heard complaints from patients whose scans turned up treatable tumors or whose stays at physician-owned specialty hospitals made them better at less cost. Who would you trust with your care?