Depending on which physician group's news release you read, the recently passed healthcare reform legislation represents a “monumental moment,” “half-baked” legislation that will be a “budget buster” for Medicaid programs or “aspirin dispensed for the treatment of cancer.”
Some back it, some smack it
Doc groups take polar opposite positions on reform
Many doctors, meanwhile, are still struggling to find out what reform will mean for them and what effect it will have on their daily lives and the operation of their practices. Also, there are aspects of the bill—such as restrictions on physician hospital ownership—that received scant attention during the months of heated debate but now threaten to doom clinically and economically successful enterprises.
“The passage of the healthcare reform bill will have a devastating impact on physician-owned hospitals, the patients they treat and the communities they serve,” said Molly Sandvig, executive director of the Physicians Hospitals of America lobbying group, in an e-mail. “The legislation virtually destroys over 60 hospitals that are currently under development, and leaves little room for the future growth of the industry.”
John Dietz is an orthopedic surgeon and chairman of Indiana Orthopaedic Hospital, a 37-bed, 10-operating room facility in Indianapolis that Dietz owns with 62 other doctors. He said, despite scoring high on quality and patient-satisfaction measures, it will be tough for the operation to survive within the limits placed on physician-owned facilities by the new reform law because it will limit the hospital's ability to adapt to changing market conditions. As Dietz explained, the new law will severely restrict physician owners' ability to compete.
“Now we cannot change the percentage of physician ownership, so basically we cannot add or change partners,” Dietz said, adding that there are also restrictions on expansion, which will compromise the hospital's construction of a new, three operating-room facility. “We're going to complete the construction because we're already too far down this path.”
The law also has “transparency” provisions that call for alerting patients to the hospital's physician-owned status, which Dietz said he doesn't mind one bit.
“We don't object to the requirement that we tell our patients we own our hospital,” Dietz said. “We have a sign out front that proudly proclaims it.”
The American Medical Association, which called the signing of the new law a “monumental moment,” came under fire from some physician groups for supporting its passage. Similar to the PHA, the Chicago-based association also objected to the restrictions on physician ownership contained in the reform legislation.
“Physician-owned hospitals provide high-quality patient care and increase competition and choice in the marketplace—those should be the hallmarks against which these hospitals are judged,” the AMA said in an e-mail attributed to its president, J. James Rohack. “Restricting physician-owned hospitals is counter to what we are working to achieve—a better healthcare system for patients and physicians.”
Rohack, a cardiologist from Temple, Texas, angered other physicians in his state as the 45,000-member Texas Medical Association—the nation's largest state physician society— railed against the bill. In a news release, the association's president, William Fleming III, called the law “a half-baked budget buster.”
Congress “passed a bill that does nothing to fix glaring problems in our current healthcare system,” Fleming said. “Instead, it saddles Texans with higher costs, higher taxes, more red tape and more bureaucracy. We believe the bill's unaffordable health system reforms, piled on top of a crumbling Medicare foundation, will create even more dire consequences for all.”
Other state associations saw it differently. The Massachusetts Medical Society said it was pleased the reform law was approved, but called it “far from perfect” and classified its support as “qualified.”
“Overall, it's good for patients, but by no means is it a fix,” said the society's president, Mario Motta, a Salem-based cardiologist, who added that he read the entire bill. Reform “will affect Massachusetts less than the rest of the country because we've already done it.”
Motta said that 96.4% of Massachusetts has insurance coverage, and the federal legislation should add coverage for about 70,000 more people, “getting us closer to 99%.” But what's unknown is what effect a new federal provision requiring companies with 50 or more employees to offer health insurance will have on the state law requiring companies with 11 or more employees to do so.
The Physicians for a National Health Program single-payer advocacy group said the new law results in 23 million people remaining uninsured for the next nine years and said the legislation was like using aspirin to treat cancer.
The American Board of Medical Specialties spoke in favor of an obscure provision in the bill that links the specialties board's maintenance of certification program with the CMS's Physician Quality Reporting Initiative, or PQRI.
Kevin Weiss, the specialties board's president and CEO, said about 200,000 physicians participate in the maintenance program, with 30,000 and 40,000 added each year. As opposed to physicians cramming for a board exam every several years, the maintenance program calls for continuous learning and self-assessment, and Weiss believes linking it to the PQRI and offering a bonus of about 0.5% of Medicare Part B allowable charges will promote more growth of the program. “It's going to be real useful and a driving force for quality, Weiss said.
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