A Bipartisan Note

Axios reports that Congressional lawmakers of both parties are expressing interest in changing Medicare policies that currently allow hospitals to charge more for the same service than when it is provided by a private doctor.  This is a crazy policy which over the past decade had led to the purchase of many private practices by hospitals, because it allows hospitals to increase their profits (yes, even "non-profit" hospitals which can be very lucrative places to work at).

I had this conversation with my PCP in Connecticut before we moved.  He liked private practice and building a relationship over the long term with his patients, but financially things were getting tighter between Medicare and private insurance rules.  He explained that hospitals get paid more by Medicare for providing the same service than he could get in private practice and it was why so many doctors were selling their practices to hospitals and becoming employees.  The process results in yet another set of rules (hospital) further interfering with the doctor-patient relationship.  Before than I had no clue this was an issue but since have heard the same from other physicians in private practice.

Proponents of change are advocating for "site-neutral" payments where it does not make a difference where the service is provided.

Along with some bipartisan Congressional support, Axios reports that think tank support is also across the political spectrum:

Proponents include the Koch-led Americans for Prosperity, the center-left Progressive Policy Institute and high-profile health policy scholars like Brookings Institution's [liberal] Loren Adler and the American Enterprise Institute's Brian Miller [conservative].

As you might expect, the American Hospital Association is fighting back.  Axios reports:

"We need to be sure we bring enough discomfort to make sure members understand this is a non-starter," Stacey Hughes, AHA's executive vice president for government relations and public policy, told hospital executives at a Washington, D.C. conference this week.  "If we can do that well, we hope that goes to the back burner and doesn't see the light of day in a true markup," she said.

The AHA is pretty powerful.  We'll see how this goes, but changing the current rule would be good policy.