Predictions for physician owned surgery centers

[Man o War]

There is a debate raging where I work, so thought I'd let SDN settle it. Curious on your thoughts as far as the future of physician owned surgery centers...either partially owned by docs (half or less owned by hospital), or fully owned by docs. These can be cash cows for the doctors, so wondering if the hospital lobby will try to get the reimbursements slashed to them to try and divert high paying private cases back to hospitals.

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[Direct Laryngoscopy]

Why not, we've been whacked in terms of reimbursement left and right. We have few advocates on our behalf.

 

[soorg]

I remember that a part of the ACA forbids the whole existence of physician-owned health care facilities. Hopefully it doesn't apply retroactively to existing places.

 

[repititionition]

I remember that a part of the ACA forbids the whole existence of physician-owned health care facilities. Hopefully it doesn't apply retroactively to existing places.

appropriate corporate structure makes this easy to get around.

 

[pjl]

appropriate corporate structure makes this easy to get around.

Please describe how to do this with physician owned hospitals. My research disagrees with you.


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[repititionition]

Please describe how to do this with physician owned hospitals. My research disagrees with you.


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The hospital prohibition was and is on expansion of existing physician-owned hospitals, so unless you were in the game before, tough luck.

On the other hand, I have firsthand experience with physician-ownership of outpatient care facilities, and do not know of any docs who've divested themselves of their share of surgicenters, etc. Happy to talk more in the private forum.

 

[Pooh & Annie]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

 

[Random Anesthesiologist]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

Disagree.

 

[Man o War]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

I have mixed feelings. On one hand, I'm glad the people who are bringing in the patients are keeping more of the money they generate via facility fees. Oh the other hand, any of of us who have spent any time working in surgery centers have seen the patients they try to bring in for surgery at the centers that have no business being there.

 

[Chloroform4Life]

If a surgeon wants to operate to make money, he's going to do it either way at a center owned by physicians or one owned by corporations. Hell, he might want to operate more when he doesn't own the surgery center to make up for getting less income per patient. I rather see physicians making money than corporate administrators.

 

[Mman]

There is a debate raging where I work, so thought I'd let SDN settle it. Curious on your thoughts as far as the future of physician owned surgery centers...either partially owned by docs (half or less owned by hospital), or fully owned by docs. These can be cash cows for the doctors, so wondering if the hospital lobby will try to get the reimbursements slashed to them to try and divert high paying private cases back to hospitals.

This is a state by state issue and the answer drastically varies between states.

 

[pgg]

I have mixed feelings. On one hand, I'm glad the people who are bringing in the patients are keeping more of the money they generate via facility fees. Oh the other hand, any of of us who have spent any time working in surgery centers have seen the patients they try to bring in for surgery at the centers that have no business being there.

Indeed.

I quit a moonlighting job at a surgicenter after working there less than a week. They weren't paying anywhere near enough to sign charts for multiple CRNAs on the wrecks they scheduled for that place.

And the damn surgeons who owned the place acted like they owned it, too.

 

[Pooh & Annie]

Disagree.

Lots of people do.

 

[Pooh & Annie]

I have mixed feelings. On one hand, I'm glad the people who are bringing in the patients are keeping more of the money they generate via facility fees. Oh the other hand, any of of us who have spent any time working in surgery centers have seen the patients they try to bring in for surgery at the centers that have no business being there.

That's a good point about the people bringing in the money getting to keep it. And yes, the cases they want to do are evidence of a conflict of interest.

 

[VA Hopeful Dr]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

As a PCP, I like these set ups. They are significantly less expensive compared to hospital owned ASCs. In my area we're talking orders of magnitude cheaper.

 

[Wiscoblue]

Cheaper for whom?

 

[Ignatius J]

Please describe how to do this with physician owned hospitals. My research disagrees with you.


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I've seen it several ways.

I've seen 51% private equity/corporate ownership with 49% being shares sold do surgeons. I've also seen 100% physician-owned centers. I question how they get around what seem like very black and white kickback laws.

If you have a good enough lawyer, you can do a lot of things.

 

[Random Anesthesiologist]

Lots of people do.

Yep. Surgery center of OK seems to have a great model. And owned by Anesthesiologists. I'm not into the govt telling someone they know what's best for them, in this case, telling a doc they can't own a surgery center or hospital because they *might* be greedy.

 

[pjl]

I've seen it several ways.

I've seen 51% private equity/corporate ownership with 49% being shares sold do surgeons. I've also seen 100% physician-owned centers. I question how they get around what seem like very black and white kickback laws.

If you have a good enough lawyer, you can do a lot of things.

surgery centers vs hospitals...very different rules.


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[Ignatius J]

surgery centers vs hospitals...very different rules.


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How so? Especially as it relates to the surgery side?

 

[Brahnold Bloodaxe]

Restrictions on physician ownership of hospitals and other facilities seems to me to be nothing more than government enforced rent seeking for the benefit of the corporate class. There is always going to be a conflict of interest between the financial motives of the owners and the best interests of the patients, it doesn't matter one bit whether those owners are physicians or corporate empty suits.

Simply put, the corporate class wants a slice of the healthcare pie. Unlike other areas of endeavor (manufacturing, banking, airlines etc) which require massive organizations in which the top skims off all the profit, medicine used to be dominated by a flat private practice structure, where the fruits of the physician "worker's" labor was captured by that very same physician and not his corporate overlord 10 levels of management up. There was simply no need for corporate leeches in the healthcare delivery process to the same extent that there was in other areas of enterprise. So the government and the corporate class colluded to create such a need, and the barring of physicians from owning the facilities at which they perform their work was one tool in this process.

 

[VA Hopeful Dr]

Cheaper for whom?

Everyone. Insurance doesn't pay them as much. Cash pay patients don't either.

 

[Silent Cool]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

Keep in mind that most dental practices are basically the equivalent of physician-owned surgical centers.

 

[Pooh & Annie]

Keep in mind that most dental practices are basically the equivalent of physician-owned surgical centers.

Have you ever heard a dentist talk about another dentist's work? If you have, you know even they admit how often people are getting gouged.

 

[VA Hopeful Dr]

Cheaper for whom?

I wanted to expand on this just a little bit.

Had a patient a few months back who needed his uvula out. His hospital employed ENT was willing to discount the surgeon fee, but the hospital-owned OR and anesthesia fees together were going to be about $15k for my cash-paying patient. The same surgery at a local physician owned ASC was $900.

 

[pjl]

Have you ever heard a dentist talk about another dentist's work? If you have, you know even they admit how often people are getting gouged.

Do you then feel that all dentists should work for large not for profit centers?


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[nimbus]

I wanted to expand on this just a little bit.

Had a patient a few months back who needed his uvula out. His hospital employed ENT was willing to discount the surgeon fee, but the hospital-owned OR and anesthesia fees together were going to be about $15k for my cash-paying patient. The same surgery at a local physician owned ASC was $900.

Sounds about right.

 

[Pooh & Annie]

Do you then feel that all dentists should work for large not for profit centers?


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I'm saying I wish gouging patients wasn't common. No matter where they work.

 

[deleted171991]

Have you ever heard a dentist talk about another dentist's work? If you have, you know even they admit how often people are getting gouged.

Let's not talk about car mechanics, lawyers, accountants and a lot of other self-employed people.

It's well-known that groups and ASCs acquired by hospitals become more expensive, not cheaper, so the main reason for not letting docs own hospitals is corporate greed and lobbying.

 

[Pooh & Annie]

Let's not talk about car mechanics, lawyers, accountants and a lot of other self-employed people.

It's well-known that groups and ASCs acquired by hospitals become more expensive, not cheaper, so the main reason for not letting docs own hospitals is corporate greed and lobbying.

Often with consolidation of administrative costs to the business and insurance compacts, they do not become more expensive.
If greed is the impulse for corporations to get in the business, I guess altruism must be the impulse for physicians.

 

[deleted171991]

Often with consolidation of administrative costs to the business and insurance compacts, they do not become more expensive.
If greed is the impulse for corporations to get in the business, I guess altruism must be the impulse for physicians.

As a patient and relative of patients, I can tell you that they did not become cheaper in my area. Au contraire. The reason being that consolidation is just another name for oligopoly.

 

[VA Hopeful Dr]

Often with consolidation of administrative costs to the business and insurance compacts, they do not become more expensive.
If greed is the impulse for corporations to get in the business, I guess altruism must be the impulse for physicians.

Granted my anecdote is only that, but seeing as how the physician-owmed ASC is over an order of magnitude cheaper, I definitely have my doubts about anything getting cheaper after being bought out by a hospital.

 

[repititionition]

Often with consolidation of administrative costs to the business and insurance compacts, they do not become more expensive.
If greed is the impulse for corporations to get in the business, I guess altruism must be the impulse for physicians.

As a patient and relative of patients, I can tell you that they did not become cheaper in my area. Au contraire. The reason being that consolidation is just another name for oligopoly.

cost ≠ price

 

[Pooh & Annie]

cost ≠ price

PRICE>PAYMENT

 

[Pooh & Annie]

As a patient and relative of patients, I can tell you that they did not become cheaper in my area. Au contraire. The reason being that consolidation is just another name for oligopoly.

I believe you. I'm not in favor of corporate greed's slimy mitts on people's health either.

 

[Random Anesthesiologist]

Let's not talk about car mechanics, lawyers, accountants and a lot of other self-employed people.

It's well-known that groups and ASCs acquired by hospitals become more expensive, not cheaper, so the main reason for not letting docs own hospitals is corporate greed and lobbying.

And it's bogus. It's the equivalent of telling (fill in the blank demographic) they can't do something because some people in that demographic were idiots. Thought crime at its best.

Be harder on people who commit crimes, not people who want to own a legit business.

 

[Silent Cool]

I wanted to expand on this just a little bit.

Had a patient a few months back who needed his uvula out. His hospital employed ENT was willing to discount the surgeon fee, but the hospital-owned OR and anesthesia fees together were going to be about $15k for my cash-paying patient. The same surgery at a local physician owned ASC was $900.

BOOM.

Consider that most health care in this country used to be provided in a much more entrepreneurial fashion, prior to the advent of medicare and EMTALA. Everyone can see with the above example how much more expensive the government has made health care. Prior to the consolidation and price-fixing caused by the ACA and Medicare/EMTALA, health care was cheap and people could pay cash for much of it. It's not inherently expensive. It is made expensive by government intrusion. My dad used to pay cash to see a dentist back in the 60s, and when dental insurance was introduced, the dentist said, "I have no idea why they are doing this. It will just make the care more expensive." Sure enough, the costs went up.

 

[Brahnold Bloodaxe]

BOOM.

Consider that most health care in this country used to be provided in a much more entrepreneurial fashion, prior to the advent of medicare and EMTALA. Everyone can see with the above example how much more expensive the government has made health care. Prior to the consolidation and price-fixing caused by the ACA and Medicare/EMTALA, health care was cheap and people could pay cash for much of it. It's not inherently expensive. It is made expensive by government intrusion. My dad used to pay cash to see a dentist back in the 60s, and when dental insurance was introduced, the dentist said, "I have no idea why they are doing this. It will just make the care more expensive." Sure enough, the costs went up.

Were physicians similarly well compensated back in that era of cheap prices and governmental noninterference as they are today in terms of readily comperable metrics such as the ratio of physician salary to average salary? So in other words, did government meddling increase provider salaries or merely create extraneous waste through creating and feeding a vast army of admins and bureaucrats?

 

[Silent Cool]

Were physicians similarly well compensated back in that era of cheap prices and governmental noninterference as they are today in terms of readily comperable metrics such as the ratio of physician salary to average salary? So in other words, did government meddling increase provider salaries or merely create extraneous waste through creating and feeding a vast army of admins and bureaucrats?

I believe that when medicare was first introduced incomes went up. Now, however, because so many more people are dependent on medicare, the incomes have declined (I think) because medicare is going bankrupt.

 

[VA Hopeful Dr]

Were physicians similarly well compensated back in that era of cheap prices and governmental noninterference as they are today in terms of readily comperable metrics such as the ratio of physician salary to average salary? So in other words, did government meddling increase provider salaries or merely create extraneous waste through creating and feeding a vast army of admins and bureaucrats?

Both actually

 

[Mad Jack]

I hope this practice DOES go away. The conflicts of interest with treating medicine as a way to get rich are travesties. I understand the necessity of the profit drive to help advance the field, but some practices are clearly unethical.

What is unethical about wanting to own the facilities in which you serve your patients, thus allowing you to provide the best service and facilities possible?

 

[deleted162650]

It's bc she thinks the government is the only one that should be allowed to run medical facilities.

 

[Pooh & Annie]

It's bc she thinks the government is the only one that should be allowed to run medical facilities.

? I didn't say that. I said there's a conflict of interest. It's hard to prescribe PT and weight loss when you can offer a couple new joints.

And I know these places generally run efficiently and with a high standard of care. That's great. But high-reimbursement, healthy patients get priority, if not exclusive access to many of them. Who picks up the rest? And how good is the care gonna be at the hospitals that get only the leftover sh1t reimbursement patients and the unhealthiest patients?
And I'm not a she