David beat Goliath once. But could he beat him 10 times in a row? That's the challenge now facing physician-owned hospitals, whose benefits to the healthcare delivery system are being seriously threatened by onerous provisions of the various healthcare reform bills being debated by Congress.
The provisions, which are included in the bills courtesy of the American Hospital Association and the Federation of American Hospitals, would all but put physician-owned hospitals out of business. The provisions would bar existing facilities from expanding. They would not grandfather in facilities under development but not yet opened. And they would bar any new facilities.
Physician-owned hospitals, led by Physicians Hospitals of America, successfully have defeated similar legislative attempts to shut them down for the past nine years. But as one PHA lobbyist noted at the group's annual meeting last week in New Orleans, the AHA is feeling pretty confident this time around. According to the PHA lobbyist, a competing lobbyist for the AHA taunted her, saying, “This was our year.”
Working in the hospital lobby's favor is the fact that the physician ownership provisions in the reform bills are just several of hundreds if not thousands of provisions in the legislation. “To get someone (in Congress) to tackle one issue is almost impossible,” the PHA lobbyist said during a panel discussion at last week's conference.
(In the interest of full disclosure, I spoke at the conference in a separate session. I received no speaking fee, and Modern Physician covered all my expenses.)
In other words, the ownership provisions, which have failed on their merits for the past nine years, may pass this year simply because they're getting lost in the milieu of reform and may get swept into the final legislation because no one was really paying attention. That's a good way to make bad healthcare policy.
Physician-owned hospitals add much needed competition to a number of local healthcare markets. That competition, in turn, expands access, improves care and helps control costs. General acute-care hospitals, which the PHA refers to as “big-box hospitals,” don't want physician-owned hospitals around. They fear the competition just like when they duck behind certificate-of-need laws to thwart a competitor's building project. It has nothing to do with patients. It has to do with money.
“Clearly, we want no impact on physician-owned hospitals. But we need to look at our options," said Molly Sandvig, the PHA's executive director, at the panel discussion. “We have to be realistic about where we are right now. We want the most fair outcome for all our members.”
Sandvig's comments seemed to be designed to lower the expectations of the group's members. We urge the PHA and its members not to make any concessions or compromises in this fight. Don't just take the best deal you can get. It's time to hurl another stone at Goliath rather than running behind the lines and saying you did what you could. Physician-owned hospitals are doing too much good for patients to do anything else.
And we urge Congress to let the physician-ownership provisions of the healthcare reform bills to sink or swim on their own merits. Don't just let them become law because they were slipped into the reform bills and you were too busy to care.
David Burda
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