Author Topic: Election Consequences: Decline of Doctor-Owned Practices  (Read 1469 times)

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Christians4LessGvt

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Election Consequences: Decline of Doctor-Owned Practices
« on: November 09, 2012, 11:01:38 AM »
Election Consequences: Decline of Doctor-Owned Practices 

by Dr. Susan Berry

8 Nov 2012 69
 
With the re-election of President Barack Obama, the Affordable Care Act's regulations will continue to roll out through 2014.

There will be new rules for how the states and the federal government will run the new health insurance "exchanges." Insurance companies will have their rules regarding premiums they can charge and the customers they will be required to sign up, regardless of medical history. As for individual Americans, we will be required to present evidence of a "government-defined" health insurance plan to the IRS when we file our tax returns.

But, what about doctors, specifically those who own their own practices? Doctor-owned practices are places where health care is provided, but they are also small businesses, operated by small-business owners and entrepreneurs, the doctors themselves.

Doctors who own their own practices have the same costs as other small businesses: rent or mortgage, staff salaries and benefits, utilities, computers, equipment, furniture, etc. As small businesses that have suffered along with others under the first Obama administration, there is no reason yet to believe they won't suffer more under the second, particularly when Obama and the Democrats want to increase taxes on those who make $250,000 or more. For those health care providers who have practices with many employees, the issue of the ObamaCare employer mandate to provide health insurance for them is another factor of the decision regarding whether a practice is sustainable.

For health providers who rely on health insurance as third party payers, lower reimbursement rates over the years have greatly impacted small business practices. Most Americans would never accept a job in which their prospective employer told them they would get paid less and less each year they work for the business. Yet, health providers agree to this all the time in the system we have had prior to the era of ObamaCare, a system that is equally dysfunctional.

As a result of lowered Medicare reimbursements, for example, more doctors will now be denying care to our seniors. The $716 billion that ObamaCare steals from Medicare is the reimbursement funding that is supposed to have gone to Medicare providers. Gone with the re-election of Obama.

For those health providers who are "fee for service" meaning that patients pay them directly for services without insurance as another intervening element of the transaction, the Obama economic decline has led to high unemployment and, consequently, less customers who can pay fees. Health providers who are small business owners have experienced significant drops in income and the reality that they must pay for office expenses with what would have been personal income. Mental health providers are often in this category, having left insurance-based practices because of the extremely low reimbursement rates by health insurance companies in this specialty area.

Doctoral level mental health providers could once have a successful business because many patients preferred to pay them privately to protect themselves from having a mental health diagnosis on their health insurance records. However, with so many Americans out of work, many fee-for-service practices are barely surviving. With the new rules and regulations of ObamaCare, most will close.

The fact is that the costs of complying with all the ObamaCare regulations makes it difficult to sustain doctor-owned practices. With the government now mandating that doctors use electronic records, so that information is easier to share, the costs to implement the requirements will belong to health providers.

Under ObamaCare, many, if not most, doctors will be forced into hospital employment or Accountable Care Organizations (ACO). That means they will no longer be their own bosses, no longer make the decisions about their individual practices and, consequently, no longer have the same level of responsibility for the health care that is delivered. As we have seen in most bureaucratic systems that are reliant upon the government in some way, the buck always stops someplace higher up.

Perhaps some doctors will like being a "company man or woman," because they won't have to worry about complying with all the new ObamaCare regulations and administrative issues in their own practices. Instead, they can just show up, treat healthcare problems, collect a salary, and let someone else worry about the business end of it.

Like other small businesses, doctor-owned businesses are facing a forceful blow. Health care business owners can either spend all the money and time required to comply with ObamaCare -- money and time taken away from their personal incomes and further investment in their business practices -- or close up shop and become just another health care worker on the assembly line that is life.

http://www.breitbart.com/Big-Government/2012/11/08/Election-Consequences-Decline-of-Doctor-Owned-Practices
"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

Plane

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #1 on: November 11, 2012, 01:35:34 AM »
One of my pet peeves is working for a supervisor that is not an electrician.

They either have to trust me or mistrust me , my integrety is all that prevents them from getting doubbletalk instead of work whether they trust or don't.

I have had many occasions to lament this situation.

The last five years I have been working for an Electrician, one whose experience and competance is always at least equal to my own and is in some respects superior.

Doubble talk is impossible , and when I do a good job he can tell that I did.

I like this situation.

Soon the Civil Service might have to shrink, especially where I am.

But I can type and I have monsterous seniority.

If I get transferred to an office where I become the supervisor of a brace of medical personell , perhaps even Doctors.

The Irony will kill me.

kimba1

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #2 on: November 11, 2012, 04:15:04 AM »
Uhm data is quite bit off. Privately owned practices was already shrinking all by itself due to high cost many other factors too many for me to list.meaning obmacare would be a factor but most definately not the cause of the decline.

Christians4LessGvt

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #3 on: November 11, 2012, 09:31:08 AM »
Uhm data is quite bit off. Privately owned practices was already shrinking all by itself due to high cost many other factors too many for me to list. meaning obmacare would be a factor but most definately not the cause of the decline.



Physician-owned hospitals: Endangered species?

A health reform provision could be the death knell for many doctor-owned facilities,
but some say they are going to fight for survival.


By Chris Silva, amednews staff.

June 28, 2010.
   
The Texas Spine & Joint Hospital began as a renovation of an old Montgomery Ward department store in 2002. Plans for expansion included adding three operating rooms, three procedure rooms and 20 patient rooms.
[Image by Texas Spine & Joint Hospital, Blueprints by Downing Ferguson Peeples LLC]To the physician owners of Texas Spine & Joint Hospital, the health reform debate was a demonstration of how quickly an entire industry's fortunes can change.

Business was so brisk in recent years that executives at the wholly physician-owned orthopedic care facility planned an ambitious expansion project. They drew up plans for three new operating rooms, three new procedure rooms and 20 new beds. The $37 million project would have added 50,000 square feet and created about 540 new jobs in the eastern Texas community surrounding Tyler, where the hospital is based. But all of that is over. A provision in the health reform law enacted in March placed major limits on physician ownership of hospitals.

New doctor-owned facilities that are not certified as Medicare participants by Dec. 31, 2010, no longer will be allowed into the program. Existing physician-owned facilities face immediate restrictions on expansion. Physician investors say those rules are so strict that virtually none of their hospitals will be able to grow. "We were basically going to double our capacity at our main facility," said Michael E. Russell II, MD, an orthopedic spine surgeon at Texas Spine & Joint. "And the health care bill halted that progress."

In Loma Linda, Calif., a team of physician investors led by John Piconi, MD, was collaborating with the local university's medical center to develop a new 110-bed tower and medical office building as part of a $250 million project. He said the project would have addressed underserved areas of care in the community, but because it will not have Medicare certification by the end of the year, it also has been shelved.

"We started this project four years ago when there was no law prohibiting us from doing this. And for us to raise this money and get architectural plans, and then find out we're banned from operating, is disconcerting," said Dr. Piconi, a retired urologist.

Physician Hospitals of America -- an organization based in Sioux Falls, S.D.-- said the reform law will "virtually destroy" more than 60 hospitals that were under development and leaves few prospects for the future of the industry. "Patients across the country should be outraged that, at a time when the government is supposedly attempting to increase access to care, it has chosen to stop the growth of many of the best hospitals in the country," said Molly Sandvig, PHA's executive director.

The hospitals already are fighting back. PHA and Texas Spine & Joint announced June 3 that they had filed suit jointly in U.S. Federal Court for the Eastern District of Texas, challenging the constitutionality of the reform law's physician-owned hospital section. The lawsuit includes a motion for a preliminary injunction that would allow the hospital to proceed with its expansion plans.

A deep-seated conflict

For community hospitals, limiting expansion of physician-owned facilities was a vital piece of the health reform package. Other new regulations include capping physician ownership, ending some exceptions to Stark self-referral bans and mandating more disclosure of physician owners' potential conflicts of interest when they send patients to their own facilities.

"This moves us towards that goal of providing a more level playing field," said Michael Strazzella, vice president of federal relations for the Hospital & Healthsystem Assn. of Pennsylvania, which represents nearly 250 community hospitals.

The health reform law caps physician ownership levels for hospitals. Organizations such as the American Hospital Assn. have argued that physician-owned facilities operate under inherent conflicts of interests, cherry-pick more profitable patients and place strains on community hospitals, forcing reductions in key services. While sympathizing with physician owners who are shelving expansion projects that have been in the works for years, Strazzella said Congress simply was following a pattern of containment that those owners should have recognized.

Key lawmakers have targeted the growth of physician-owned facilities numerous times. Starting in 2003, the growth of the doctor-owned specialty hospital industry effectively was frozen for nearly three years through a combination of legislative and administrative barriers.

But the facilities have their champions. The American Medical Association says physician ownership has created superior care alternatives for patients and excellent employment opportunities for hospital-based physicians.

"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," said then-AMA President J. James Rohack, MD. "Restricting physician-owned hospitals is counter to what we are working to achieve: a better health care system for patients and physicians."

Legislative attempts to curb physician ownership often target so-called specialty hospitals -- typically cardiac, orthopedic or surgical facilities that focus on limited services. But the health reform statute stops dead in its tracks any facility that has physician ownership, even if it's less than 1% doctor-owned, according to PHA.

Swept into the mix are acute care facilities, multispecialty hospitals and even struggling community hospitals that have been propped up financially by physicians.

That means the impact of the provisions will be felt at Westfield Hospital in Allentown, Pa., a wholly physician-owned facility. Westfield is an acute care general hospital complete with intensive care beds and an emergency department.

"We are doing things very cost effectively right now, but we are growing and need to add extra capacity," said Yasin Khan, MD, an anesthesiologist and Westfield's CEO.

Dr. Khan said critics' arguments against doctor-owned hospitals during the health reform debate were ill-conceived and outdated. Some of the points raised by the AHA might have applied to specialty hospitals 10 years ago, but not now, he said. "The problem is, they are basically lumping everyone together."

Physician investors saw positive developments when they started directing hospital administration, rather than the other way around.

PHA's Sandvig said physician-run hospitals attract doctors because of the lower degree of bureaucratic jostling. At community hospitals, "there's a real competition between physicians and administration. There's not a lot of love lost."

But the physician ownership model "cuts out the administration as the No. 1 decision-maker," she said. "The reason our physicians open these hospitals is because they want to do something right by their patients. They want to be able to control health care, and they don't feel like they can do that at [community] facilities any more."

Mark Galliart, the administrator of McBride Orthopedic Hospital in Oklahoma City, worked for a community-owned hospital for 10 years and said he's amazed at the difference.

"We are so much more efficient," he said. "We make decisions so much quicker, and I think that's better for the patient."

The model was apparently working for patients. A $2 million expansion project at McBride aimed at broadening the spectrum of care to meet patient demand was approaching the groundbreaking stage. The reform law forced them to pull the plug.

Galliart disputes the contention that hospitals such as his cherry-pick more profitable patients. McBride, which is owned entirely by physicians, takes care of a patient population that is about 60% Medicare, he said. And like Westfield Hospital, McBride has an emergency department.

Sandvig said opponents of physician ownership are worried that the better way of doing things will push them toward obscurity. "They see a new model that works very well, that's high-quality, low-cost, better efficiency. It's a case of an innovation that they don't want to have to match."

A murky future

Until litigation, legislation or regulation direct otherwise, plans for new or expanded physician-owned hospitals will be in a holding pattern. Facilities also will need to make sure they don't run afoul of the law in their continuing operations.

The reform statute caps physician ownership levels at the point they were on March 23, when the reform bill became law. So if Sierra Surgical Hospital in Carson City, Nev., which is about 30% physician-owned, wants to take on a new physician investor, either another doctor has to sell his or her share, or the total investments of the other doctors must be scaled back.

Sierra CEO Jim Sergeant said the facility wanted to add at least one more operating room and a two-room ambulatory surgical center. But the cap and expansion ban may put the industry into what he described as a death spiral. Investors eventually will start to ignore the facilities, he said.

"I don't know of any other industry that is regulated as heavily as we are," he said. "And then to be prohibited from trying to compete ... it just dumbfounds me that Congress would allow this to occur, especially when they're looking for jobs."

Still, the hardest part of the situation for Sergeant has been hearing that hospitals like his do not add value to their communities. "Anything we do here is to enhance community services."

What's ironic, McBride's Galliart said, is that doctor-owned facilities eventually may be forced to cherry-pick more profitable patients if they can't expand capacity. "I call it a self-fulfilling prophecy. What you're saying we do, you're actually going to force us to do."




--------------------------------------------------------------------------------

ADDITIONAL INFORMATION:
The health reform law effectively will ban new physician-owned hospitals
from starting up and existing ones from expanding. Here's where the 265 facilities stand:

■Employees -- more than 75,000 full- and part-time workers
■Average payroll -- $13 million
■Average staffed bed size -- 233 (general acute care), 65 (heart), 40 (multispecialty surgical), 34 (rehabilitation), 30 (long-term acute care), 24 (orthopedic)
Source: Physician Hospitals of America

Not all specialty
There are 265 physician-owned hospitals in the U.S., but not all of them are considered specialty hospitals.

Multispecialty 149
General acute care 54
Heart 18
Orthopedic 18
Rehabilitation 12
Long-term acute care 8
Emergency care 3
Heart and general acute 1
Multispecialty children's 1
Multispecialty women's 1
Total 265

Source: Physician Hospitals of America

http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm
"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

kimba1

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #4 on: November 11, 2012, 10:26:28 AM »
Think that afirm my statement since this was two years ago not post election. I stated private practice has been going down. But that law is tied to the first article. Though. My point was indicated by situated by stuff that happen five years earlier caused by mainly insurances not healthcare laws.


Note all thses doctors did not get out of pocket loses but after a point te profit s not worth it for that kind of business .


Christians4LessGvt

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #5 on: November 11, 2012, 12:13:50 PM »
Kimba....there are lots of I suppose sub-topics that this issue involves.

I mean of course there are less small private practice doctors than there
was for example in the 1950's.......so yes they've been in decline in that sense.

But there also has been a growing "niche" of doctor owned hospitals and clinics
Many patients are getting excellent care at these facilities.
It's one part of a complicated equation.

My brother is having gastric-sleeve bariatric surgery this coming week...
He is having it done at a private doctor-owned boutique hospital.
This hospital is a beautiful new facility....doctor owned.
These "boutique hospitals" have been popping up everywhere here in Dallas.
Some are hosiptals that mainly focus on orthopedics...others focus on gastric.....
others pediatrics...others cosmetic procedures...ect.

I have personally spoken with doctors at some of these facilities
and they are very worried about Obamacare and what it means
for their operation.

Basically it boils down to the long-term goals of Obama & the Democrats
is to put the provider side of health care in the public sector. Personally
I think that is going to be a real disaster here in the United States.

"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

kimba1

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #6 on: November 11, 2012, 12:54:18 PM »
Very possible
Very true too many factors involved in ths topic . But notice nobody is addressing whats the best system to use. It's more like what people like.

My interest is the cost . Not what people pay out of pocket but what is charged.
Is the goal of giving birth to a child under 5k possible without the aid of insurance or subsidy or charity possible?

Remember technically speaking this should cost a whole lot less and it does in third world counties

sirs

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #7 on: November 12, 2012, 12:38:39 PM »
Think that afirm my statement since this was two years ago not post election. I stated private practice has been going down. But that law is tied to the first article. Though. My point was indicated by situated by stuff that happen five years earlier caused by mainly insurances not healthcare laws.


Note all thses doctors did not get out of pocket loses but after a point te profit s not worth it for that kind of business .

I've made this point earlier, several times......we had our CEO provide us with a bi-annual "townhall meeting", where he talks about issues effecting the hospital and staff.  About a year after Obamacare was crammed down our throats, the hospital began going thru some major reorganization and structural changes to staffing.  They were trying to "prepare" for Obamacare.  The topic of reimbursement was brought up, and I'm not sure he realized what he was saying, but he made it crystal clear that reimbursement from private insurance was occurring on a substantially good basis.  It was what was keeping the hospital afloat. 

Reimbursement from the Government, was far less, and that the hospital was actually losing money.   And yet just prior to that little bit of revelation, he spoke on how he supported the idea of Universal Healthcare.  Scary....he was supporting that which was taking his hospital down a fiscally unsafe path, which we are now seeing the repercussions, as several departments have had to close now, and our therapy dept has to cut what equates to 7 full time employees.....and yet still provide the same quality of care, for just as many patients, if not more.   
"The worst form of inequality is to try to make unequal things equal." -- Aristotle

Christians4LessGvt

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #8 on: November 12, 2012, 01:44:38 PM »
we are now seeing the repercussions, as several departments have had to close now, and our therapy dept has to cut what equates to 7 full time employees.....and yet still provide the same quality of care, for just as many patients, if not more.

Oh but SIRS....only Romney cuts jobs! (ha ha)

This is sad SIRS.
The gvt takeover of healthcare is a nighmare & tragedy in the making.

A nurse told me recently the gvt patients at her hospital cause headaches
because if a patient files a complaint about waiting too long for a nurse
the gvt delays and/or doesnt pay the hospital the full rate....and she says
that when a patient with a breathing difficulty rings for a nurse or a patient
rings for more crushed ice which one you think she is going to respond to?
Yet if the patient waiting on the crushed ice has to wait and files a complaint
the hospital gets screwed by the gvt because the nurse was saving someone's
life with a breathing difficulty.
"Mr. Gorbachev, tear down this wall!" - Ronald Reagan - June 12, 1987

sirs

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #9 on: November 12, 2012, 01:56:51 PM »
It's an imminent nightmare we have no chance in stopping now.  It's foot has gotten thru the door, thanks to the Democrats ramrodding it down our throats, on a pure party line basis, & despite the majority of the country not wanting it.

The worst, most irresponsible comment I've ever heard a politician publically make, was Pelosi's asinine "We have to pass it to find out what's in it" garbage.  The worst example in responsibility of tax payer dollars, I've ever heard

And yet.........it's all Bush's fault, we need to "move forward"

And the electorate, as ignorant as the masses were, bought it.  Now they've bought a greece-like end to this country's status, for their children, and their children's children.  THAT will be Obama's "legacy", and not that he was the 1st black president....only the worst
"The worst form of inequality is to try to make unequal things equal." -- Aristotle

Plane

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #10 on: November 12, 2012, 02:31:28 PM »
Very possible
Very true too many factors involved in ths topic . But notice nobody is addressing whats the best system to use. It's more like what people like.

My interest is the cost . Not what people pay out of pocket but what is charged.
Is the goal of giving birth to a child under 5k possible without the aid of insurance or subsidy or charity possible?

Remember technically speaking this should cost a whole lot less and it does in third world counties

If it were your wife and child , or your body and child , would you sign away your right to sue reguardless of the events of the birth?

Would you hire a Doula or Midwife and deliver at home?

kimba1

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #11 on: November 12, 2012, 07:06:58 PM »
I`m not even sure doctors today even offer the option of a Doula or midwife for the to be mom diagnost to be healthy for child birth.


Plane

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #12 on: November 12, 2012, 08:23:12 PM »
You could get Doctors of engineering to change your tires too , if you were willing to buy their time for what it was worth.

Do we need Medical Doctors to treat our colds and flus? Normal pregnaqncy and well baby care?

If we do , then we need to pay what that Doctorate degree is worth , by the hour.

Where can we cut this corner and use RN or tecnition level personell without loosing safety?

sirs

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Re: Election Consequences: Decline of Doctor-Owned Practices
« Reply #13 on: November 14, 2012, 04:20:12 AM »
"The worst form of inequality is to try to make unequal things equal." -- Aristotle