Independent doctors like law that discloses facility fees
The National Physicians Council on Healthcare Policy convened on Capitol Hill recently and the mood was grim. The group of 50 independent physicians and lawmakers met in the Rules Committee Chamber of the Capitol building to discuss legislation that would impact them. While the news regarding regulatory changes coming at them was less than encouraging, there was one bright spot.
When my turn came to address the group, I began by saying, “I hope after I’m done speaking, you will all see a little ray of hope.”
Rays of hope are few and far between for independent physicians these days, but at the Association of Independent Doctors, we are creating them. During my 15-minute talk, I gave three examples of what our national nonprofit advocacy group, which is based in Winter Park, was doing nationwide on behalf of independent physicians — that is, doctors who are not hospital employees, as more and more are becoming. Each example was met by a round of applause. There is hope. One of the three examples I shared was A.I.D.’s work to advance a law recently passed in Connecticut. The law is a push for price transparency. Specifically, it requires hospital-employed physicians to disclose to patients before their appointments that they will be charged facility fees and how much.
Moreover, it requires these doctors’ offices to tell patients that if they went to an office not owned by a hospital, they would not be charged facility fees. And it requires providers to tell patients in clearly written language. This should be the law in every state. Hospitals charge facility fees for outpatient services performed by employed physicians that independent physicians and free-standing facilities do not charge. Facility fees are separate from professional fees, and can increase the total cost of a service by three to five times compared to the same service provided by an independent physician, according to the Medicare Payment Advisory Committee.
Facility fees are why a Medicare patient can go to his doctor for a heart ultrasound one month and pay 20 percent of $189, Medicare’s contracted rate with the doctor’s office. The next month, if a hospital has bought the doctor’s practice, the same patient will pay 20 percent of $453 for the same test in the same building by the same doctor using the same equipment. Taxpayers, of course, pay the balance.
The extra payment that hospitals get is part of what’s driving hospitals to buy up medical groups, a trend that is causing health-care costs to skyrocket. The muchhigher bills are compounded by the downstream effect: Hospital-owned groups refer exclusively to other hospital-owned providers, which charge — you guessed it — facility fees.
More transparency would not only spare consumers sticker shock and let them vote with their feet and their dollars, but it also might curb hospitals’ appetites for private practices.
This Connecticut law has already had a positive impact on independent physicians. A version of the law is moving forward in Kansas, thanks to A.I.D. member Dr. Elizabeth Rowe of Lenexa, Kan., who got the bill into the Kansas Senate. The bill has strong bipartisan support.
In Florida, other A.I.D. members are working with local and state medical associations to push forward a similar proposal, one that would also require doctors to clearly disclose whether they are employed by a hospital or independent.
“The point is very straightforward,” said Rowe. “If there are two offices reasonably close to each other, and one charges facility fees and one does not, then the hospitalowned office needs to notify patients about this cost difference before they use those services. As it is now, patients have no warning.”
At A.I.D., we believe patients have the right to know facts up-front that will triple their bills and likely lead them to receive less access to care because their doctors must refer only to other hospital-employed doctors, even if the best doctor is independent.
That’s what I told the National Physicians Council on Health Care in Washington last week. That’s when they applauded. However, this concept deserves more than a round of applause. It deserves to be the law.