News Articles About the Importance of Independent Practice
and the Threats they Face

Independent practices are the cornerstone of the American healthcare system. Here you will find recent news articles about the threats these practices face and the policies that affect them. 

NOVEMBER 2024 

Why Physicians Are Unhappy With Employment

Patsy Newitt, Becker's ASC Review

Physicians in hospital-owned practices report far lower job satisfaction than those in physician-owned practices, according to multiple surveys. Key reasons for dissatisfaction include lower compensation, high workload, lack of autonomy, inefficient processes, poor leadership alignment, limited involvement in decision-making and inadequate resources. For example, 78% of doctors in physician-led practices said their organizations have effective processes and workflows, compared to just 59% of those in hospital-led organizations, and 81% of doctors in physician-led organizations reported satisfaction with their involvement in strategic decision-making, compared to just 50% in hospital-led practices. Burnout also drives many physicians to leave, with over a third of academic physicians planning to exit within two years.

OCTOBER 2024 

The State of Physician-Owned Hospitals: 10 Things to Know  

Patsy Newitt, Becker's ASC Review  

 Physician-owned hospitals (POHs) have been debated for years, especially since the Affordable Care Act (ACA) restricted new and expanded physician ownership in 2010. Advocates argue POHs improve patient outcomes and reduce costs, citing $1.1 billion saved for Medicare in 2019. However, critics say POHs favor healthier, better-insured patients, creating unfair competition. New legislation may remove ACA limitations on POHs, potentially reshaping the market. CMS data shows 40.7% of hospitals have some physician ownership, with family practice and internal medicine most common among owners. Reports highlight that POHs treat fewer Medicaid patients and save 8%-15% in total payments for some groups compared to traditional hospitals. Industry groups remain divided on the impact of POHs on access, competition and health care equity.

Practice Challenges Piling up for Independent Physicians
Patsy Newitt, Becker's ASC Review
Private practice physicians face mounting financial challenges that threaten their stability and ability to provide care. As reimbursements decline, practice costs rise, leverage over payers shrinks and patient bases consolidate under large health systems, more physicians consider leaving independent practice. CMS continues cutting Medicare physician pay, with a 3.4% fee schedule reduction in 2023 and proposed 2.8% cut in 2024. Meanwhile, practice inflation hit a 23-year high of 4.6% in 2022. As large health systems acquire more physician practices, now 58.5% of the total, independent physicians lose negotiating power. “Those who hold out find a shrinking referral base,” said Kenneth Candido, MD, as systems redirect patients internally. Regulatory burdens like prior authorizations, needing 45 approvals weekly per doctor, also hinder physicians.  

Proposed Medicare Payment Changes May Impede Urologic Care

John Schieszer, Renal & Urology News

LUGPA, the national nonprofit trade association representing independent urology groups, is taking new steps to help reform payment updates and promote Physician-Focused Payment Models (PFPMs). The group is calling for reforming or repealing the zero-sum game in the Merit-based Incentive Payment System (MIPS). “Continued and impending payment reductions have forced more and more urologists out of clinical practice and into early retirement,” said Mara Holton, MD, chair of LUGPA health policy and managing partner of AAUrology. “Furthermore, we are seeing continuing vertical integration by hospital systems with acquisition and even, in some cases, total collapse of practices which had previously been considered large and/or diversified enough to be ‘safe’ from market vagaries.” 

SEPTEMBER 2024 

Concerns Raised About Proposed Cut to Medicare Reimbursements

John Schieszer, Renal & Urology News

LUGPA, the national nonprofit trade association representing independent urology groups, has issued a warning about the recent proposal to reduce physician reimbursements as part of the 2025 Medicare Physician Fee Schedule. This proposal is another significant cut that threatens the financial viability of independent urology practices and patient access to care. LUGPA, alongside other leading physician groups nationwide, has long advocated for an overhaul of this policy because it fails to account for inflation and the rising costs of providing medical care. “Keeping up with rising costs with fixed to lower reimbursement every year is a significant barrier,” said Scott Sellinger, MD, incoming LUGPA president. “No business can sustain on this financial model, and independent practicing urologists are no exception.”

Medicare Spending Drops, Patients Benefit When Physicians Work With Private Equity Management, Study Says

Richard Payerchin, Medical Economics

A recent study commissioned by the American Independent Medical Practice Association (AIMPA) reveals that Medicare spending decreases and patient outcomes improve when physicians collaborate with private equity firms. The research, which examined physicians across four physician practice models in five specialties, including urology, found that practices backed by private equity saw a 9.4% reduction in Medicare spending per patient. This partnership also led to enhanced patient care, with fewer hospital admissions and emergency room visits. “Independent physicians have long maintained that we provide high-quality care at lower cost than our physician colleagues who are affiliated with hospitals or vertically integrated insurers,” said AIMPA President and Board Chair Paul Berggreen, MD. “This study supports our hypothesis—and illustrates how private equity investment can be a force for good in our health care system.”

6 Unnecessary Physician Regulatory Burdens
Claire Wallace, Becker's ASC Review
The American Medical Association (AMA) has identified six regulatory burdens that contribute to physician burnout and cost practices time and money. These include requiring frequent electronic health record password changes and documenting medically unnecessary information. Additionally, the AMA explains that sending patient test results to multiple physicians crowds inboxes and can create patient safety hazards due to confusion over who is reviewing the material. The organization also calls for hospitals, health systems and practices to stop asking about mental health history on credentialing forms for physicians. Eliminating these six burdensome practices that are not mandated by regulatory agencies can help reduce physician burnout and improve efficiency, according to the AMA.

 JULY 2024 

LUGPA Champions Medicare Payment Reform Following Latest CMS Proposal

CMS and Congress Must Address Unsustainable Trend of Physician Payment Cuts to Protect Patient Access to Quality Care

Chicago, IL, July 18, 2024 – LUGPA expresses deep concern over the Centers for Medicare and Medicaid Services' (CMS) recent proposal to reduce physician reimbursements as part of the 2025 Medicare Physician Fee Schedule (MPFS). This proposal forebodes another significant cut that threatens the financial viability of independent practices and patient access to care.

“These continuous cuts to physician reimbursement are unsustainable,” said Evan R. Goldfischer, M.D., LUGPA President. “The ongoing and cumulative pay cuts are eroding the foundation of independent practice. Physicians who are small business owners are increasingly driven towards early retirement or employment by large hospital systems. Under the guise of budget neutrality, CMS has perpetuated this detrimental trend, resulting in increased consolidation and higher health care costs.”  Read more. 

CMS Pitches 2.8% Physician Payment Cut for 2025

Andrew Cass, Becker’s Hospital Review

The Centers for Medicare & Medicaid Services (CMS) has proposed a 93 cent (2.8%) decrease in the physician fee schedule conversion factor for 2025, drawing criticism from the American Medical Association (AMA) and the Medical Group Management Association (MGMA). The proposed conversion factor for 2025 is $32.36, down from $33.29 in 2024. AMA President Bruce Scott, MD, noted the widening gap between Medicare payments and the cost of delivering quality care. Meanwhile, MGMA's senior vice president of government affairs, Anders Gilberg, called the reduction critically short-sighted, given the increased operating costs reported by 92% of medical groups. “Medicare physician reimbursement is on a dire trajectory,” Gilberg said. “The need for comprehensive reform is paramount.”

Editor’s Note:   Physician payment from Medicare is not keeping up with practice cost inflation.  According to the AMA, when adjusted for inflation, physician payments have dropped 26% from 2001 to 2023.   This latest cut proposal will continue to make it more difficult for practices (particularly independent practices) to recruit and ultimately degrade seniors’ access to quality healthcare.   - Mark Eldredge, MHA  

JUNE 2024 

MAY 2024 

Site-Neutral Payments Draw Blanket, Bipartisan Support at House Budget Hearing

Dave Muoio, Fierce Healthcare

In a recent House Budget Committee hearing, lawmakers from both sides of the aisle expressed concern over the increasing consolidation within the health care industry. The hearing highlighted the rise in physicians employed by hospitals or health systems, which allows providers to negotiate higher prices from private insurers. This trend has led to concerns about unsustainable spending, dwindling independent providers and limited patient access. The hearing also discussed the potential benefits of site-neutral payments, a policy that received widespread endorsement. Lawmakers and witnesses alike agreed that action is needed to address poorly designed incentives that encourage consolidation. “We could save $150 billion, and we can reduce the out-of-pocket costs for seniors, and we can just improve the system altogether,” said Committee Chair Jodey Arrington (R-Texas). “It seems to me the most obvious [solution].”

Lawmakers Consider Lifting Restrictions on Physician-Owned Hospitals

Mariah Taylor, Becker’s Hospital Review

Federal lawmakers are considering lifting a 2010 restriction on physician-owned hospitals (POHs) through the Patient Access to Higher Quality Health Care Act of 2023 (H.R. 977/S. 470). Proponents argue that increasing the number of POHs, currently around 4% of all U.S. hospitals, could enhance competition and help rural areas maintain local care. Critics, however, contend that POHs cherry-pick healthier, insured patients, leaving general hospitals to manage more complex and uninsured cases. “They’re not providing full service,” said Chip Kahn, CEO of the Federation of American Hospitals. The debate continues as both sides present conflicting data on cost and quality impacts.

APRIL 2024 

LUGPA Policy Alert: FTC Votes to Release Final Rule Banning Most Non-Compete Agreements

On April 23rd, the Federal Trade Commission (FTC) voted on a final rule regarding non-compete agreements. The rule, passed by a 3-2 majority, will ban new non-compete agreements for all workers and require companies to inform current and past employees that they won’t enforce them. Additionally, existing non-compete agreements for most workers will be invalidated, except for senior executives.

Since the FTC first proposed this rule in January 2023, LUGPA has vehemently opposed these efforts for several compelling reasons. If enacted, we firmly believe these rules could disproportionately favor large hospital systems, potentially disrupting the competitive landscape and impeding patient access to diverse healthcare options.  Read more. 

MARCH 2024 

Dr. Langston on Medicare Payment Reform in Urology
Urology Times
“The Medicare physician payment system is very broken,” said Joshua Langston, MD, managing partner and CEO at Urology of Virginia. While payments to health care providers like hospitals rise yearly with inflation, physician payments have remained flat or declined in real terms over the past 20 years, amounting to a 26% pay cut. This threatens physicians’ ability to operate independent practices, limits patient access and drives up overall costs as hospital-employed physicians are reimbursed more for the same work. Dr. Langston discusses LUGPA’s advocacy efforts and advises urologists to clearly communicate these impacts to legislators, noting that the growing Medicare population needs stable urology access. He concludes that unsustainable increases in physician workload amid lower reimbursements contribute to burnout, noting, “as pay is cut year after year ... doctors are doing more so that they can try to stay even.”

FEBRUARY 2024 

More Doctors Leaving Private Practice, Working for Hospitals
John Schieszer, Renal & Urology News
The American Medical Association reports a major shift in medical practice ownership between 2012-2022, with the share of physicians in private practice falling from 60.1% to 46.7%. Meanwhile, hospital employment of physicians grew from 5.6% to 9.6%. “The pandemic radically changed how physicians managed their practice because of the demands placed upon them by telemedicine, increased overhead costs, decreased reimbursement, and lack of staffing,” said Jason S. Greis, JD, a partner with the law firm of Benesch, Friedlander, Coplan & Aronoff. The continued fluctuations in the health care and insurance landscape due to the pandemic, coupled with stringent regulatory requirements, have created a new playing field. “Due to frustration, many physicians have accelerated the movement from privatized medicine to corporatized medicine backed by private equity and large hospital and health system acquirors,” Greis said.

Q&A with LUGPA Forward: Advice for Urology Residents
Ahead of the 2024 Urology Resident Summit & Job Fair, LUGPA connected with Kari Bailey, MD, urologist and leader of the women’s health department at AAUrology in Annapolis, MD, and David Morris, MD, president of Urology Associated in Nashville, TN. Dr. Bailey is chair of the LUGPA Forward Committee and Dr. Morris is one of the most recently elected LUGPA Board members. These two young physician leaders are the co-chairs of LUGPA Forward, a group for early-career physicians within LUGPA member practices that provides education and networking opportunities. We sat down with them to discuss their advice for urology residents -  including why to consider independent practice.

Senators Line Up to Support Restoring Physician Reimbursement Cut in Medicare

Richard Payerchin, Medical Economics

A bipartisan group of 32 senators is urging action against the 3.37% cut in the Medicare Physician Fee Schedule that took effect this year. They highlight the current physician shortage and the potential worsening of this issue in the coming years, attributing it to the Medicare physician payment system's failure to maintain adequate reimbursement levels. The senators express concern that the cuts will hit smaller, independent practices hardest, particularly those in rural and underserved areas. The American Medical Association supports this call, with President Jesse M. Ehrenfeld praising the leadership of Senators John Boozman (R-Ark.) and Peter Welch (D-Vt.). “These cuts endanger health care access for constituents, especially those in rural and underserved areas,” Ehrenfeld said. “Medicare patients are grateful that they have champions in Washington.”

NOVEMBER 2023 

Red Tape Up, Revenues Down in 2023, MGMA Says

Richard Payerchin, Medical Economics

Physicians in 2023 are facing more red tape and less income as government and health insurance rules far outpace reimbursement for medical care, according to a recent report from the Medical Group Management Association (MGMA). The report found that physicians and their staff are spending more time on administration, cutting into time spent with patients. Ninety percent of respondents reported that overall regulatory burden has increased over the past 12 months, specifically highlighting the burden of prior authorizations and Medicare’s Merit-based Incentive Payment System. Nearly all (97%) agreed that reducing regulatory burdens would allow practices to shift resources to patient care. This burden is particularly impacting smaller practices. “As a small, independent, primary care practice, it is very hard to keep up with all the changes… we simply cannot afford it,” one respondent explained.

OCTOBER 2023

Physician-Owned Hospitals Could Save Medicare Over $1B

Jacqueline LaPointe, RevCycleIntelligence

Physician-owned hospitals treated some of the most expensive Medicare beneficiaries at lower costs compared to traditional hospitals despite seeing similar patient populations, according to a recent study from the Physician’s Advocacy Institute (PAI) and The Physicians Foundation. The study estimated that Medicare would have saved $1.1 billion if beneficiaries were treated at physician-owned hospitals in their area. This comes on the heels of a recent Congressional hearing that debated legislation to loosen restrictions on physician-owned hospitals. “Physicians are in the best position to make decisions with and for their patients,” said Michael Darrouzet, vice president of PAI. “Now, Congress has another reason to act… Better quality and notable cost savings to patients and taxpayers is a clear signal that physician-owned hospitals is a policy worthy of adoption.”

Fix the Broken Medicare Physician Payment System That Threatens Patient Access 

Reps. Larry Bucshon, MD (R-Ind.), Ami Bera, MD (D-Calif.), Raul Ruiz, MD (D-Calif.) and Mariannette Miller-Meeks, MD (R-Iowa), The Hill

In this opinion piece, Reps. Larry Bucshon, MD (R-Ind.), Ami Bera, MD (D-Calif.), Raul Ruiz, MD (D-Calif.) and Mariannette Miller-Meeks, MD (R-Iowa), discuss the new Strengthening Medicare for Patients and Providers Act, which would modernize the Medicare physician payment system by applying a permanent, inflation-based update to the Medicare Physician Fee Schedule. If passed, Medicare reimbursements to physicians would more accurately reflect the real-world impact of inflation on the costs to physician practices. “Until policy changes are enacted to address the growing chasm between Medicare reimbursement rates for physicians and the real costs of running a practice, the challenges facing America’s physicians will only worsen,” the representatives said. “Ultimately, the consequences will undermine patient access to care, accelerate provider consolidation and intensify the physician and health care workforce shortage that is already threatening many communities.”

MGMA: Sustainable Financing Needed to Protect Rural Health Care

Jacqueline LaPointe, RevCycleIntelligence

Physician and facility reimbursement for rural practices is not sustainable and impacts patient access to rural health care, the Medical Group Management Association (MGMA) told Congress in a recent comment. Operational costs for medical practices have nearly doubled over the last two decades, while physicians are essentially facing a decrease in revenue as inflation bogs down small increases to reimbursement rates. Still, physicians paid under the Medicare Physician Fee Schedule are slated to take a cut totaling 3.36% in 2024. Practices told MGMA in a recent survey that they would consider limiting new Medicare patients, reducing clinical staff, closing satellite locations and more in response to these challenges. “A fundamental bedrock needed to support medical groups’ ability to provide high-quality care to Medicare beneficiaries is a functioning and appropriate reimbursement system,” MGMA wrote in a statement.

SEPTEMBER 2023 

The Cost of Corporatized Medicine

Emily Hutto, MedPage Today

Jane Zhu, MD, primary care physician and associate professor of medicine at Oregon Health & Science University in Portland, discusses the corporatization of health care. Half of all physician practices are now owned by a hospital, health system or larger corporate entity, a significant departure from previous years. Dr. Zhu explains that corporate medicine poses major risks. “One is increasing health care prices and spending,” Zhu said. “Another is changes in practice patterns and utilization of care. Then the third is that it may contribute to burnout, moral injury, or professional dissatisfaction... it's increasingly important for physicians themselves to ensure that their clinical autonomy, their professional satisfaction, their career longevity and most importantly the sacredness of the patient/physician relationship aren't superseded by the interests of investors and shareholders in this context.”

Proposed Bill Would Bring More Analysis to Impact of Health Care Consolidation

Ron Southwick, Medical Economics

Congressional lawmakers have introduced a new bill, the Providers and Payers COMPETE Act of 2023, that could bring more scrutiny to hospital and health care mergers. The lawmakers say the bill would require the U.S. Department of Health and Human Services (HHS) to examine how the regulatory process is affecting health care mergers and produce annual reports to Congress determining whether Medicare payment rules are affecting consolidation. "Our health care system demands a comprehensive examination to eliminate anti-competitive practices," said Rep. Michael Burgess (R-Texas), one of the bill’s sponsors. "This legislation will empower HHS with a thorough understanding of the implications of new payment proposals, fostering a climate of competition and shielding American patients from exorbitant health care costs. By doing so, we are safeguarding both patient autonomy and financial well-being."

AUGUST 2023 

Independent Hospital Acquisitions Tied to Higher Health Care Prices

Victoria Bailey, RevCycleIntelligence

Independent hospital acquisitions led to higher health care prices for consumers and poorer care quality, a recent report from Elevance Health revealed. Health systems are increasingly acquiring independent hospitals. The study found that payers and consumers experienced higher prices following acquisitions—average inpatient prices for commercially insured patients grew by 5% above market trend, and prices increased by 5-8% across the top seven major diagnostic categories by volume. A reduction in personnel may be a driving factor behind poorer quality, as hospitals with greater staff reductions faced higher readmission rate increases. Additionally, acquisitions negatively impacted patient access to care in some areas. These findings highlight the need to implement quality standards in merger review processes and establish partnerships to help independent hospitals remain independent.

JULY 2023 

From 2012 to 2022, Physicians Working in Private Practices Fell From 60.1% To 46.7%, AMA Says

Christopher Cheney, HealthLeaders

Physicians are less likely to work in private practices than they were a decade ago, falling from 60.1% in 2012 to 46.7% in 2022, according to a survey from the American Medical Association (AMA). Financial and administrative pressures on physicians are driving the shift away from independent practices. The primary reason cited for hospital and health system acquisition of physician practices was the need to negotiate higher payment rates with payers. Additionally, practice sizes have increased; the proportion of physicians working in practices with 10 or fewer physicians decreased significantly. "The AMA analysis shows that the shift away from independent practices is emblematic of the fiscal uncertainty and economic stress many physicians face due to statutory payment cuts in Medicare, rising practice costs, and intrusive administrative burdens,” said Jesse Ehrenfeld, MD, AMA President.

JUNE 2023 

Physician Compensation Is Rising But Not Keeping Pace With Inflation, MGMA Survey Finds

Heather Landi, Fierce Healthcare

Despite physician and advanced practice provider (APP) productivity continuing its post-pandemic recovery, compensation gains are being outstripped by the most severe inflationary growth in decades, according to a new report from the Medical Group Management Association (MGMA). MGMA’s President and CEO Dr. Fischer-Wright added that “unpredictable economic conditions continue to hamper salary growth and productivity.” Physician-owned practices, however, report higher levels of productivity on several measures compared to their counterparts at hospital-owned practices. According to the report, medical practices are evolving their staffing models and finding innovative solutions to address challenges, such as embracing the APP's role in health care practices. Urology was one of the most common specialties where APP utilization was reported. “Health care leaders must develop proactive plans and strategically budget for recruiting and retaining the future of their workforce,” Dr. Fischer-Wright said.

APRIL 2023 

Health Care Price Transparency, Competition on the Agenda for House

Richard Payerchin, Medical Economics

The United States spent $4.3 trillion on health care in 2021, a larger percentage of the country’s GDP than the rest of the developed world. So, who gets that money? It depends on who you ask, and Congress is asking. The U.S. House Energy & Commerce Subcommittee on Health recently convened for a bipartisan hearing to discuss the need to improve price transparency in health care and improve competition to help lower costs for patients. The subcommittee discussed 17 bills that would impact health care policy and finances, including addressing PBM reform, site-neutral payments, health care consolidation and hospital price transparency. “This payment disparity not only increases costs for beneficiaries and taxpayers, but encourages hospitals to buy up physician practices, leading to market consolidation and increased health care costs,” one witness said when discussing site-neutral payments.

States Step In as Telehealth and Clinic Patients Get Blindsided by Hospital Fees

Markian Hawryluk, Kaiser Health News

Millions of Americans are blindsided by hospital bills for doctor appointments that did not require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses. However, consumer advocates say hospitals should not charge more than independent clinics for the same services. When hospitals acquire physician practices, the physicians’ professional fees go up and, with the addition of facility fees, the total cost of care to patients increases. This process also drives healthcare consolidation. Some states have already implemented laws to limit these charges, such as collecting data on hospitals’ facility fees, prohibiting add-on fees for telehealth and requiring site-neutral payments for certain Medicaid services. One Colorado representative argues, “Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients.”

Why Don't Private Practice Physicians Have More Power in Healthcare?

Patsy Newitt, Becker’s ASC Review

Private practice physicians are struggling as the physician workforce increasingly migrates to employed models. Six physicians discuss why private practice physicians do not have more power in healthcare. Dr. Gopal, an OB-GYN, explains, “It is becoming increasingly difficult for private practice physicians to devote any time to anything other than the practice of medicine, what with the diminishing compensation for services, time spent in keeping up to date with recent developments and the administrative time spent on maintaining a place of business.” Multiple physicians discuss the impact of increased regulations and consolidations in healthcare, leading to a focus on profit and less emphasis on individual physicians. One physician adds that the “biggest issue is the lack of collective bargaining for individual providers.”  

March 2023 

CMS Must Level Playing Field for Independent Physicians

Evan Goldfischer, MD, Medical Economics

In this opinion piece, LUGPA President Evan Goldfischer, MD discusses the recent Medicare physician payment cuts. “These cuts are particularly destabilizing for independent physician practices…This reality highlights a need to educate policymakers and patients about why these payment cuts will only exacerbate the rising challenges for Americans to access individualized care throughout the U.S.” Dr. Goldfischer argues that Congress must focus on leveling the playing field between hospital and independent physician reimbursement so that independent practices can compete with hospital systems and provide more options for care. “It is my ardent hope that Congress seeks out innovative ways to reform physician payment, so all physicians can provide their patients and communities with timely access to high-quality and cost-effective care.”

How Can We Ensure the Future of Independent Practices?

John Machata, MD, Medical Economics

In this opinion piece, family physician John Machata, MD, discusses the disappearance of small independent practices (SIPs). Dr. Machata explains the negative impact of healthcare consolidation and notes that most Americans are in favor of congressional action to limit consolidation. He adds that “Big Medicine” has not improved quality or lowered costs for patients, and SIPs are better for both patients and physicians. “In my own practice, costs per patient are among the lowest in my state, and my quality metrics rank among the best. But low costs and high quality offer no guarantee of success when faced with a system seemingly dedicated to extinguishing small practices… If the personalized medical care offered by SIPs is to be preserved, the rules of the game must change.”

Surgeries Cost Far More at Hospitals in Networks vs. Independent Facilities, Study Finds

Alan Condon, Becker’s Hospital Review

The prices for surgical procedures at hospitals in networks are far higher than at independent hospitals, according to a recent JAMA study. Researchers examined the negotiated prices of nearly 3,200 hospitals. For 15 out of the 16 surgical procedures analyzed, the median negotiated price was significantly higher at hospitals within networks compared with independent hospitals. For example, the median price for prostatectomy was $9,567 at facilities in hospital networks and $8,601 at independent facilities. The study comes on the heels of a recent report that found only a quarter of hospitals were compliant with federal price transparency rules, with many of the country's largest health systems having no compliant hospitals.

February 2023 

Health Care Cronyism Is Fueling Hospital Consolidation and Rising Medical Costs

Anthony DiGiorgio, The Hill

In this opinion piece, neurosurgeon Anthony DiGiorgio discusses the problem of hospital consolidation and policies for reform. The issue has generated bipartisan action, with senators holding hearings and the Biden administration issuing orders to combat it. However, there are many federal programs that favor larger health systems over independent physician practices, and these are driving consolidation and harming the financial stability of smaller practices. The Medicare 340B drug discount program, for example, gives a large competitive advantage to hospital-affiliated clinics, to the point where independent clinics cannot compete. This discount is intended for hospitals that primarily serve vulnerable patients. It is not a revenue stream to drive consolidation. Any serious effort at addressing health care consolidation must address 340B, DiGiorgio argues.

 Patients Lose When States Block Independent Doctors

Jaimie Cavanaugh and Daryl James, KevinMD

In this opinion piece, attorney Jaimie Cavanaugh and Daryl James discuss cases where state “certificate of need” laws have limited independent physicians. Before providers can launch or expand services in these jurisdictions, they first must prove to the government’s satisfaction that a need exists. Cavanaugh and James argue, “Patients win when independent doctors open shop... Yet states often intervene to shut down health care competition.” New Hampshire repealed its CON laws in 2016, joining 11 other CON-free states—the next battleground for CON reform is South Carolina, where lawmakers have debated repeal since 2015. Meanwhile, the consolidation of independent practices across the U.S. has hit an all-time high, limiting competition and leaving patients with less options and higher prices for care.

Medical Practices Face Widespread Staff Shortages

John Schieszer, Renal & Urology News

In 2023, managing and growing a medical practice are challenging due to record-breaking staff shortages. Significant structural changes in the health care system are needed to address the labor shortages today and in the future. “LUGPA has dedicated efforts to work with the next generation of physicians, as they are essential to the future of independent practice and to our country’s ability to provide effective urologic care in the decades to come,” said Evan R. Goldfischer, MD, president of LUGPA. Due to the health care workers shortage, more practices are experiencing increases in labor costs and Medicare rates have not kept up. Independent urologists must do all they can to educate policymakers on the benefits of integrated urologic care to ensure all patients have access to high-quality, affordable and efficient overall care.

More Physicians Are Experiencing Burnout and Depression

Christine Lehmann, Medscape

Physician burnout and depression continue to worsen, according to a new report from Medscape. More than half of physicians said they are feeling burned out, up from 42% saying so in 2018 and 47% in 2021. Nearly a quarter also reported being depressed in 2022. The majority of doctors attributed their burnout to too many bureaucratic tasks. This year’s report showed less burnout in solo practices than in other work settings thanks to autonomy and having control over productivity. “Organizations need to provide the resources necessary to address the mental health needs of physicians and that they can trust that those conversations will be kept confidential,” said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

January 2023 

Health System Hospitals, Physicians Deliver 'Marginally' Better Care at Higher Cost Than Independent Peers: Study

Dave Muoio, Fierce Healthcare

A new JAMA study found that the enormous proportion of care delivered by health systems comes at a higher cost with few other advantages, adding to the argument for greater scrutiny of provider consolidation. The study found higher commercial prices among systems for outpatient physician visits (26% higher), inpatient stays (13% higher) and admissions in common diagnosis groups (31% higher). One expert explained, “In the worst case, we could wind up with a system in which quality is lower and spending higher than need be, but we would never know it because the only possible comparisons would be among large systems. This dismal possibility highlights the need for continued research on—and federal and state antitrust attention to—health system and health insurer size and performance.”

Picking the Best Place to Practice Medicine

John Schieszer, Renal & Urology News

When choosing where to set up a practice, physicians have many factors to consider. What is best for one clinician might not be quite as important for another, especially at different stages of their careers. Jonathan Henderson, MD, immediate past president of LUGPA, discusses the challenges of establishing an independent practice today. “The patient backlog from two years of the pandemic is daunting, and the shortage of providers is more critical than ever and heightens daily,” Dr. Henderson explained. “There is a national labor shortage, and supply chain disruptions continue to be compounded in unexpected ways.”

The Million Dollar Mistake: Why Medical Schools Don’t Teach Business and How It’s Costing Physicians

Dr. Curtis Graham, KevinMD

In this op-ed, physician Curtis Graham, MD discusses the importance of providing physicians with a business education, arguing that business skills are what gives physicians the necessary tools to succeed in medicine. Dr. Graham explains, “Without physicians who inspire and teach those lacking in business knowledge, independent medical practice would not exist today.” With ongoing changes to the healthcare system and advanced needs from patients, physicians require a more comprehensive business education. He suggests that this lack of education is a failure from medical schools, particularly for those physicians who wish to practice independently. Dr. Graham also lists a multitude of benefits that a business education can provide, including improving practice management skills, managing staff and ultimately providing better care for patients.

December 2022 

Stop Hospital Consolidations to Lower Health Care Prices for All Americans

Brian J. Miller, MD, and Jesse M. Ehrenfeld, MD, The Hill

With hospital monopolies gouging Americans, now is the time for reasonable reforms to promote choice and competition. Hospital market power has reached a critical level, and hospitals are driving even more consolidation by buying physician practices. The authors of this article lay out pragmatic solutions for tackling hospital monopoly power and lowering costs for patients. Health systems often use anti-competitive contract clauses, preventing health plans from directing patients to other low-cost, high-quality physicians. Policymakers should identify these practices and direct the Federal Trade Commission (FTC) and Department of Justice (DOJ) Antitrust Division to study them, giving the FTC the power to address them. Congress should additionally promote the growth of small businesses and prevent regulatory agencies from needlessly interfering in medical decision-making.

Arkansas Urologist Receives First-Ever Spirit of Independence Award

Arkansas Money and Politics

LUGPA has named Dr. Gail Reede Jones of Arkansas Urology as the inaugural recipient of the Spirit of Independence Award at the 2022 Annual Meeting. Dr. Jones was the first female urologist in the state of Arkansas. After several years of private practice, she joined forces with other urologists to found the state’s largest urology practice. “This award is about much more than just me. This is a testament to my fellow physician partners at Arkansas Urology, as well as my patients for entrusting their health to me, enabling me to have three decades of urology practice in Little Rock,” Dr. Jones said. “I’m proud of the growth, impact and evolution our team has seen through the years as the state’s largest independently owned urology practice. It is such a privilege to receive the inaugural Independent Spirit Award from LUGPA, and I share this honor with our entire team.”

November 2022 

LUGPA President Dr. Goldfischer Discusses the Challenges Facing Independent Urology 

Benjamin P. Saylor, Urology Times

Independent urology continues to face challenges, including reimbursement cuts and staffing issues. New LUGPA President Evan R. Goldfischer, MD, MBA, FACS discusses goals for his term and summarizes a session on prostate-specific membrane antigen-positron emission tomography (PSMA-PET) that he led at the LUGPA 2022 Annual Meeting. He explains that the first priority of his presidency will be health policy, expanding LUGPA’s work with the Hill and state legislatures. Second, he aims to enhance LUGPA’s programming for all member groups, including the Annual Meeting, regional meetings and other programs. Another goal for Dr. Goldfischer is to get LUGPA’s younger members more involved and make that a priority, expanding on current programs such as LUGPA Forward and the Executive Leadership Program.

How Effective is the Government’s Campaign Against Hospital Mergers?

Allan Sloan and Carson Kessler, ProPublica

In recent months, the FTC has blocked four hospital mergers, marking notable achievements following President Biden’s executive order that criticized hospital consolidation and aimed to promote competition. An examination of the cases the FTC has and has not taken on suggests that the agency has a long way to go. The FTC initiated three challenges of hospital mergers during this period and allowed 54 to proceed without taking public action. One reason these numbers have not risen further is because the FTC’s guidelines focus exclusively on challenging mergers of hospitals within a single geographic region, therefore not interfering in cross-market deals that make up an increasing portion of hospital mergers. Experts argue that the FTC should intervene in these mergers, as they can allow hospital chains to gain significant power to raise prices.

October 2022 

The Medicare Providers Act Delays Payment Cuts for Needed Physician Services

Brian McNicoll, Washington Times

The key to keeping Medicare operating, particularly in rural and underserved areas, is to ensure doctors continue to be paid appropriately. Unless Congress acts soon, flawed federal policy will result in a 4.42% cut to Medicare physician fee schedule payments in 2023. These payment cuts are likely to force some smaller practices to close or consolidate with larger systems, meaning less access to care for patients. Legislators have introduced the Support Medicare Providers Act to address this issue by delaying the impending cut for physician services by a year. This does not represent the permanent solution that is needed, but it does provide a modicum of relief for physicians while inflation is still soaring, as well as time for Congress and CMS to work out a lasting deal.

As Giant Hospitals Get Bigger, An Independent Doctor Feels the Pinch

Fred Clasen-Kelly, Kaiser Health News

Before the coronavirus pandemic, Dr. Andrew Bush, an independent orthopedic surgeon in North Carolina, treated nearly 1,000 patients every month. He is now among a dwindling number of independent physicians who are selling their practices to hospital systems or leaving the profession altogether. Experts say this trend underlines how billions of dollars in pandemic federal aid favored large hospital systems, allowing them to post larger profits or continue to pursue mergers. Dr. Bush’s patient visits have recovered only to half of pre-pandemic levels. The loss of independent practices threatens to fundamentally reshape the physician-patient relationship as more doctors become beholden to their employers. President Biden has pushed the FTC to fight consolidation in the healthcare industry, arguing that it has left many communities with inadequate or more expensive healthcare options.

3 Top-Of-Mind Challenges for Specialty Care and How to Overcome Them

Shirley H. Lee, MedCityNews

After the COVID-19 pandemic, specialty practices have had to consider how their practices will return to normal. This question was top of mind for urologists during the LUGPA regional meeting this past spring. When asked to consider the pain points that are holding urology practices back from adapting to a post-COVID-19 environment, 69% of urologists and administrators cited challenges with staff and physician recruitment and retention, while two out of three pointed to rising costs and decreasing reimbursement. Staff and physician burnout (57%) were also major issues. Three considerations for navigating these challenges in specialty care include tightening triage protocols, looking for ways to ease call volume pressures for physicians and clinicians and leveraging data-based tools to identify which patients would most benefit from follow-up with a specialist.  

Vulnerable Patients Are Back on the Chopping Block

Mark Garcia, MD, MedPage Today

CMS is proposing to cut the Medicare conversion factor, the starting point for calculating Medicare payments, by about 4.5%, threatening specialty care providers' ability to keep their doors open. If these cuts are implemented, Americans -- particularly people of color, those who live in rural communities, and the elderly -- will see clinics they rely on for live-saving care disappear from their communities. This policy decision will put vulnerable patient populations squarely on the chopping block and will widen the healthcare equity gap that already exists. Black and Latino patients suffer disproportionately from many of the diseases treated by the specialty providers who are seeing the biggest cuts, and they often live in areas where healthcare access is already limited. Local physicians’ offices are a critical part of our healthcare infrastructure, and if shut down, it will leave underserved and sick patients to find treatment in the already overburdened hospital system. The trend of hospital consolidation is already concerning, and we have seen that these constant cuts are leaving office-based and small healthcare providers with no other option than to either move to a hospital setting or close their doors outright.

Medical Groups May Reduce Staff, Patients Amid Medicare Payment Cuts

Victoria Bailey, RevCycleIntelligence

As medical groups expect to see Medicare payment cuts in 2023, practices are considering limiting the number of new Medicare patients and reducing clinical staff to ensure financial stability, according to the Medical Group Management Association (MGMA)’s study of 517 group practices across 45 states. Over 90% of practices said that 2022 Medicare reimbursement rates already do not adequately cover the cost of care provided. To maintain finances in the wake of even further reductions, medical groups will have to adjust some of their practices. Some practices report that they are already stretched thin due to increasing labor and supply costs, and a cut in Medicare would be beyond what they could manage. Nearly 60% of groups are considering limiting new Medicare patients, and 58% of respondents said they might have to reduce their clinical staff. Medical groups and practices have urged Congress to act accordingly to prevent this significant Medicare payment reduction.

September 2022 

New Paper Claims Hospital Prices Are “Bleeding Americans Dry”

Jacqueline LaPointe, RevCycleIntelligence

A new paper from the patient advocacy group Families USA is taking aim at hospitals and health systems. The report claims that high hospital prices are “bleeding Americans dry” as these organizations become more corporatized and put profits over patients. The writers of the paper claim that “the corporate hospital business model has fundamentally transformed into one that favors monopolies and setting high prices at the expense of our health.” Hospital prices have increased by as much as 31% since 2015 and have grown over four times faster than workers’ wages. Not only have hospital prices increased, but they also continue to vary by location. The paper states that the price tag and variation is just another way hospitals charge whatever they want for services, rather than pricing procedures and tests based on actual cost, efficacy and quality. The paper calls for a more competitive health care industry to make care more affordable and increase price transparency.

Physicians Slam Fee Schedule Cuts, Call for Medicare Payment Reform

Jacqueline LaPointe, RevCycleIntelligence

Physician advocacy groups are calling on CMS to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for physicians next year. CMS proposed in July to decrease the Fee Schedule conversion factor by $1.53 to $33.08 in 2023. Many physician advocacy groups argue that the Fee Schedule cut would harm patient access to care. They also warn that these cuts are unsustainable for independent practices, as the difference between the costs of running a practice and actual Medicare payments could incentivize providers to further consolidate as they face the administrative and financial burdens of participating in Medicare. The physician groups are calling for a baseline positive annual update reflecting inflation in practice costs and for the elimination or replacement of the budget neutrality requirements. They are also urging policymakers to reward providers for delivering value-based care, rather than administrative activities, through a variety of alternative payment models tailored to specific specialties and practice settings.

3 Tips for Seeking Health Care

Family Features, City Pulse

Americans want options for their health care, receiving personalized care at a reasonable price and at a location that is convenient and comfortable. When people are not in an emergency situation, it is beneficial to shop around for best prices of health care services. According to a survey from LUGPA, nearly one-third of older Americans worry they won’t get the care they need at a location they choose for a price they can afford. Americans should also consider independent practices, as they typically have a lower average cost per patient. Jonathan Henderson, MD, president of LUGPA, explains, “Independent physicians work for patients.” According to a LUGPA survey, 65% of Americans trust independent physicians and associate them with more individualized and patient-focused care compared to physicians employed by hospitals. Lastly, patients should also pursue telehealth options if available to increase access to care.

August 2022 

Capturing Specialty Practice Revenue

Shirley H. Lee, CRNP-FNP, MPH, Medical Economics

Two out of three physicians surveyed at the LUGPA regional meeting this past spring cited rising costs and declining reimbursement as one of the top challenges they face in a COVID-19 era of care. These challenges require looking at new ways to increase efficiency and revenue, even as workforce shortages and pandemic-specific obstacles strain resources. There are multiple approaches that specialty practices can take to strengthen quality of care, access and revenue amid these challenges. First, practices can explore opportunities to expand ancillary services offerings and promote them widely. Second, practices can use software platforms to track and manage care activities for patients’ chronic conditions, which will improve outcomes for this population while boosting revenue. Finally, practices can make their virtual care efforts more efficient through activities such as remote patient monitoring and remote therapeutic monitoring. 

 Hi

I just wanted to give you a heads-up that you are the Media Monitor reviewers for May 2024.   

So, next week, around May 2, I’ll send you an issue of Media Monitor for you to review and comment on. 

If you will be out, or unavailable for any reason, let me know and I’ll reschedule you.    

Hope all is well with you both!

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