For almost a decade now, physician-owned hospitals have received a great deal of attention, political scrutiny and public examination. Opposition to physician-owned hospitals first appeared in Congress back in 2002 with the introduction of legislation pushed by the American Hospital Association, the Federation of American Hospitals and several members of Congress. Since that time, physician hospitals have been targeted in no less than 12 separate pieces of legislation.
Eight of these legislative challenges took place in the past 18-months.
In addition, since 2002, physician hospitals have been scrutinized by the Government Accountability Office three times, the CMS twice, the Medicare Payment Advisory Commission twice, and in more hospital association funded research papers than I care to count.
Many of these studies were intended to prove that our hospitals were an aberration in the healthcare system. Our opponents stood by eagerly hoping to find the smoking gun that would destroy physicians rights to own a hospital.
Meanwhile, as the bulk of these studies were under way, for 34 months from 2004 to 2006, physician hospitals underwent multiple moratoriums on growth, again, with the intent of allowing the government enough time to prove that we were bad for healthcare.
What are the results of all of this attempted legislation, these numerous studies, and the multiple moratoriums on growth? Other than our opposition wasting a great deal of valuable time and spending taxpayer money, nothing. Physician hospitals and our opponents are exactly where we were almost a decade ago. No smoking gun was detected in the numerous governmental studies. In fact, the results of these studies were overwhelmingly positive. After 34 months of stifled growth, Congress and the CMS chose to lift the moratorium on physician-hospital development. And, physician hospitals have so far escaped annihilation by way of legislative challenge.
Still, our opponents continue to spout rhetoric about the fact that physician hospitals are putting them out of business (although in more than 10 years they have not found an example of a hospital that has been affected). They continue to accuse physicians of taking only the healthiest patients to their hospitals (although when the CMS decided to change its payment system to better reflect patient acuity and pay more for sicker patients, the AHA and FAH opposed these changes, while the Physician Hospitals of America and physician hospitals publicly supported the CMS).
They continue to indict physicians on the charge self-referral, and that doctors are unable to make decisions that are in the best interests of their patients when hospital ownership is involved. (However, the AHA and FAH support physicians being employed by hospitals and required to refer patients only within the system, via contract and other indirect methods. The AHA and FAH also support gain-sharing to align hospital/physician interests, hmm ...).
And our opposition continues to support full disclosure of any and all relationships, economic and otherwise, for physician hospitals. Although the PHA and physician hospitals have continuously supported and complied with full disclosure, the AHA and FAH have publicly opposed lesser disclosure requirements regarding physician/hospital relationships in their own facilities.
All of this begs the question, with such strong opposition, why are physician hospitals still around? Are we just lucky, or are we good? From 2000 until now, we have been both. We have incredible political champions who have truly pulled out the stops to support physician hospitals. We have an active group of physicians, nurses and patients who have told their stories with passion and bent the ears of legislators who were previously less inclined to listen. And, simply put, we have facts and logic on our side. Physician hospitals make sense. They are good for patients, for communities, for physicians and are a positive, if disruptive innovation, at a time when healthcare requires exactly that.
At this time, physician hospitals are under more pressure than at any other time in the past decade.
Yet the present challenges in healthcare require more innovation, not less. Our biggest problem right now is simple: Many members of Congress are currently too caught up in political gaming to consider the facts any longer. At this point, efforts to reform healthcare are missing the obvious.
Too many politicians support higher quality and better efficiency in healthcare, but ignore the achievements of physician hospitals in these areas. Politicians talk about improving healthcare for Americas patients, but pay no attention to the fact that those patients across the board rate their experiences at physician hospitals as far superior to nonphysician-owned hospitals.
And, politicians spend billions to stimulate the economy and create more jobs, but disregard the 78,000 jobs, billions of dollars in trade payables, and millions of tax dollars that are at risk because physician hospitals are constantly under political fire.
Instead of attacking physician ownership, Congress and the Obama administration need to engage with all stakeholders in the healthcare system, including physician hospitals, and find a systematic way to address the real challenges facing medical care in this country.
Endless debates about who owns what will not insure one uninsured American, train one new physician, help one rural or inner-city hospital survive, reduce costs or increase quality.
There is a reason that for years physician hospitals have been successfully proving ourselves a Road Runner to our oppositions Wile E. Coyote. We must insist that those in charge consider logic, fact and good sense, and not rely on an Acme instruction manual for reform.
The legislative and political energy that has been devoted to the ownership fight over the past 10 years could have been put to much better use: helping all Americans get better medical care.
Molly SandvigExecutive directorPhysician Hospitals of America Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.