Once upon a time the private practice of medicine was sacrosanct. Today that type of practice is under attack and fighting for survival.
When I was a boy, everybody had their favorite family physician. Most were in solo private practice and most practiced medicine nearly to the day they died. It was a sacred commitment made to the community and the community responded in kind with appreciation and support. Hospitals regarded these private physicians as crucial to their own financial survival; they treated them with respect and catered to their needs. After all, their real customer was the doctor, not the patient, since the doctors decided where to take their patients for hospital care.
Today, hospital-employed physicians are challenging the private practice of medicine. Hospitals are taking advantage of higher reimbursements for the same procedures if done in a hospital instead of a doctor’s office. Hospital administrators no longer cater to the private physician’s needs since they have other doctors on their staff whose paychecks depend on towing the hospital line.
The Doctor’s Law
Private practice physicians are responding to this realignment by forming independent physician associations. One of these associations is called the Association of Independent Doctors (AID) and is headquartered in Winter Park, Florida. They are promoting The Doctors Law, a legislative initiative intended to take back some of the ground lost in the current struggle with hospitals.
Lynne Jeter, writing for Orlando Medical News, says doctors are ticked off, tired of straddling the abyss between independence or signing on as a hospital employee. Many physicians exhausted by the fight are retiring early, even a decade or two sooner than the traditional retirement mark. She quotes one doctor who asked recently, “How did we go from being at the top of the food chain to being the food?”
The Doctor’s Law aims to:
- Bolster anti-trust laws by forbidding hospitals from acquiring physician practices, or at least compromising on capping all hospitals in an area from owning a maximum of 40% of any one specialty in the community.
- Promote parity by requiring third-party payors to reimburse doctors the same amount for the same procedure, whether the doctor is independent or hospital-employed.
- Advance transparency by abolishing facility fees, or at a minimum revealing them.
- Stop nonprofit hospitals’ abuse of their tax-exempt status by requiring the institutions that behave like for-profit hospitals to pay taxes.
Marni Jameson Carey, spokesperson for AID, explains how hospitals abuse their tax-exempt status: “Tax-exempt criteria for nonprofit hospitals allows them to justify their exemption by providing charitable care for the community equal or greater to the taxes they’re not paying. However, they should be required to measure charitable contributions based on Medicare reimbursement rates, not Charge master prices, which are inflated five to ten times of actual costs. They’re ripping off taxpayers and communities.”
She gives examples:
Diagnosis Charge Master rate Medicare allowable
|Major cardiovascular procedure||$118,169||$21,269|
|Back/neck procedure excluding fusion||$51,584||$6,881|
|Infectious/parasitic disease + OR procedure||$180,708||$35,452|
“How do we get to a place where there’s parity among doctors, whether independent or hospital-employed? Get our lawmakers on board with a bill. Talk to the media. Educate consumers and businesses. Jon forces with AID. We have to get big and loud to give doctors a voice and patients a choice,” said Carey.
As a private physician in solo practice I can understand this issue from my 32 years of experience. At no time in my practice have I felt more alienated from the hospitals where I work and less appreciated. Independent practice associations like AID, and others now rapidly forming in the community, are the only way that the private practice of medicine can survive in the future. Consumers and taxpayers should understand this is a fight that benefits them as well as the private physicians they depend upon.