Removing ObamaCare Era Ban on Physician Hospitals--Implications for Pain?

[drusso]

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Great topic to discuss at Thanksgiving table...

https://www.lankford.senate.gov/news/press-releases/senator-lankford-reintroduces-bill-to-remove-obamacare-ban-on-physician-owned-hospitals-to-provide-greater-access-to-patients

“Obamacare unfairly prohibited the creation and expansion of physician-owned hospitals, depriving Americans of another health care delivery option,” said Lankford. “The Patient Access to Higher Quality Health Care Act would remove the ACA’s ban on POHs and allow them to compete with non-profit, community, and for-profit hospitals to provide innovative services tailored to patient needs. Rather than a blanket prohibition on the creation and expansion of POHs, we can and should increase hospital innovation, help reduce costs, and ensure access to quality health care."

 

[Ligament]

Lets form a Hospital and see how quickly we are murdered. This is mafia level money and the hospitals will not give it up.

 

[pmrmd]

I don't mind this ban on specialty hospitals. If some docs want to form a general hospital that's great..

 

[drusso]

I don't mind this ban on specialty hospitals. If some docs want to form a general hospital that's great..

How would an admin feel if the doctors where s/he worked went from being employees to owners?

 

[pmrmd]

How would an admin feel if the doctors where s/he worked went from being employees to owners?

If the POH came to fruition I imagine they may feel threatened eventually or may have some kind of adversarial relationship. I asked a colleague who is CMO of a hospital group here how he gets along with the competition and he said they are far friendlier than I expected though.

I do agree with the underlying reason for the ban, which was to stop doctors from forming specialty hospitals to siphon away the cases that keep the general hospital solvent.

 

[bronx43]

If the POH came to fruition I imagine they may feel threatened eventually or may have some kind of adversarial relationship. I asked a colleague who is CMO of a hospital group here how he gets along with the competition and he said they are far friendlier than I expected though.

I do agree with the underlying reason for the ban, which was to stop doctors from forming specialty hospitals to siphon away the cases that keep the general hospital solvent.

From what I’ve seen in my neck of the woods, the relationship is not really one of blood-thirsty competition... more like partners in collusion. The hospital and privately owned physician groups try hard not to step on each others’ toes and make sure the market is in equilibrium and to the benefit of both.

 

[hyperalgesia]

How would an admin feel if the doctors where s/he worked went from being employees to owners?

Threatened? Admin are already insecure about their lack of value. They spend their days trying to justify their existence.

I'd rather ditch the SOS differential and compete against hospitals.

 

[10KHertz]

I’d build the most beautiful hospital ever... remember Planetree?

 

[NOSfan]

Great topic to discuss at Thanksgiving table...

https://www.lankford.senate.gov/news/press-releases/senator-lankford-reintroduces-bill-to-remove-obamacare-ban-on-physician-owned-hospitals-to-provide-greater-access-to-patients

“Obamacare unfairly prohibited the creation and expansion of physician-owned hospitals, depriving Americans of another health care delivery option,” said Lankford. “The Patient Access to Higher Quality Health Care Act would remove the ACA’s ban on POHs and allow them to compete with non-profit, community, and for-profit hospitals to provide innovative services tailored to patient needs. Rather than a blanket prohibition on the creation and expansion of POHs, we can and should increase hospital innovation, help reduce costs, and ensure access to quality health care."

Despite a higher quality of care, with a Democratically controlled House (or any branch), reversal of this particular aspect of the law will be unlikely.

That being said, it makes sense to lift the ban. As reported, better patient experience and higher quality at a lower cost than non-physician owned hospitals.

https://www.medicaleconomics.com/business/it-time-lift-ban-physician-owned-hospitals

 

[lonelobo]

Here is what we really should be worried about , especially all you Trump Lovers

An executive order and a policy report every PA should read : JAAPA

An abstract is unavailable.

journals.lww.com

 

[clubdeac]

Here is what we really should be worried about , especially all you Trump Lovers

An executive order and a policy report every PA should read : JAAPA

An abstract is unavailable.

journals.lww.com

Articles like this make me sick. The two most dangerous phrases in healthcare right now are ‘top of their license’—i.e., to the "full extent of their abilities" and "full practice authority". We all need to be rallying against this. I'm a member of a facebook group call Physicians for Patient Protection. Everyone on this form should join. What's going on in our country is absolutely horrifying. Physicians are being replaced (like literally being fired) by NPs every day in our country. It's time to wake up my friends

 

[lonelobo]

What Does Trump’s New Executive Order Mean for Nurses? – Capitol Beat

anacapitolbeat.org

American Association of Nurse Practitioners Statement on Medicare Executive Order

Today, the president of the American Association of Nurse Practitioners ® (AANP), Sophia L. Thomas, issued the following statement regarding President Trump's executive order, entitled Protecting and Improving Medicare for our Nation's Seniors . "We applaud the Administration's continued efforts…

www.aanp.org

 

[Ducttape]

I thought ppl stated that Trump was going to be the savior of physicians and medical practice as we know it....

after the election, someone previously stated:

Those who promoted Obamacare, top-down control of health care, expansion of hospital-health system networks, and activist Federal agencies (CDC, EPA, HSS) learned an important lesson from this election. Big Government is not the solution. Instead, deregulate the insurance industry, abolish faux-EBM/"one-size-fits all" population-based health care, and return local control to county medical societies, hospital medical staff committees, and prioritize the sanctity of the personalized patient-physician relationship.

instead, give control to PAs and NPs and completely bypass physicians.....

 

[drusso]

I thought ppl stated that Trump was going to be the savior of physicians and medical practice as we know it....

after the election, someone previously stated: instead, give control to PAs and NPs and completely bypass physicians.....

How's your experience supervising PA's?

 

[Ducttape]

I don't.
I do supervise an NP.

and directly. we have a sit down 20-40 min meeting weekly, and talk/text at least 4-5 times during the days that she sees patients.

 

[bronx43]

In my neck of the woods, midlevels are already practicing more or less independently. They have a physician “a phone call away” for backup... whatever that means.

Let them be independent. They can deal with their own liability and malpractice. Independence is a poison chalice.

 

[drusso]

I don't.
I do supervise an NP.

and directly. we have a sit down 20-40 min meeting weekly, and talk/text at least 4-5 times during the days that she sees patients.

NP's are the worst.

 

[hyperalgesia]

What Does Trump’s New Executive Order Mean for Nurses? – Capitol Beat

anacapitolbeat.org

American Association of Nurse Practitioners Statement on Medicare Executive Order

Today, the president of the American Association of Nurse Practitioners ® (AANP), Sophia L. Thomas, issued the following statement regarding President Trump's executive order, entitled Protecting and Improving Medicare for our Nation's Seniors . "We applaud the Administration's continued efforts…

www.aanp.org

For the lazy, here is the NP-friendly section of the EO:

(c) conducting a comprehensive review of regulatory policies that create disparities in reimbursement between physicians and non-physician practitioners and proposing a regulation that would, to the extent allowed by law, ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners, are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation.

Taken as a whole, this is a very market-friendly EO. I am less afraid of NPs than I am of Medicare red tape and micromanagement.

My goal would be to have a cheap, population-based system that does not interfere with the robust and dynamic free market system.

 

[callmeanesthesia]

For the lazy, here is the NP-friendly section of the EO:

Taken as a whole, this is a very market-friendly EO. I am less afraid of NPs than I am of Medicare red tape and micromanagement.

My goal would be to have a cheap, population-based system that does not interfere with the robust and dynamic free market system.

Your swooning adoration for the free market system is adorably optimistic. What this really means is mid levels doing cervical epidurals and RFs after a weekend course, because apparently no matter who bills for a CPT 62321 regardless of their level of training they should be paid. Hell, have the fluoro tech do it. She’s seen enough of them, right? Patients are not in many cases able to tell the differences between real doctors and pretenders. Flashy marketing misinformation them. We have at least some duty to protect our patients from unqualified “providers.”

 

[hyperalgesia]

Your swooning adoration for the free market system is adorably optimistic. What this really means is mid levels doing cervical epidurals and RFs after a weekend course, because apparently no matter who bills for a CPT 62321 regardless of their level of training they should be paid. Hell, have the fluoro tech do it. She’s seen enough of them, right? Patients are not in many cases able to tell the differences between real doctors and pretenders. Flashy marketing misinformation them. We have at least some duty to protect our patients from unqualified “providers.”

You're saying that because we get paid more than nps for the same cpt, this protects our patients?

 

[callmeanesthesia]

You're saying that because we get paid more than nps for the same cpt, this protects our patients?

I’m saying that the language you quoted basically says that any “clinician” should be able to be paid by insurance for a service, regardless of their level of training or whether they are qualified to provide that service.

 

[hyperalgesia]

I’m saying that the language you quoted basically says that any “clinician” should be able to be paid by insurance for a service, regardless of their level of training or whether they are qualified to provide that service.

No it doesn't say you can be unqualified.

Along with other parts of the EO, it says basically:
1. Everyone inc nurses and others should be able to practice to the max of their ability (qualifications determined by state state I assume).
2. Everyone should get paid the same for a given CPT.

Clearly nurses fingerprints are all over this. And I would absolutely stand by you and argue that we are the ONLY ones qualified to do what we do independently. Full stop.

I just don't see the EO really contradicting this. Once you determine someone is qualified to do a CPT, at that point, I don't think you're protecting pts by paying whatever the CPT is worth.

Anyway, I'm really just pushing back on lonelobo who implies that Trump is betraying physicians. I still think he's good for docs on the whole.

 

[callmeanesthesia]

No it doesn't say you can be unqualified.

Along with other parts of the EO, it says basically:
1. Everyone inc nurses and others should be able to practice to the max of their ability (qualifications determined by state state I assume).
2. Everyone should get paid the same for a given CPT.

Clearly nurses fingerprints are all over this. And I would absolutely stand by you and argue that we are the ONLY ones qualified to do what we do independently. Full stop.

I just don't see the EO really contradicting this. Once you determine someone is qualified to do a CPT, at that point, I don't think you're protecting pts by paying whatever the CPT is worth.

Anyway, I'm really just pushing back on lonelobo who implies that Trump is betraying physicians. I still think he's good for docs on the whole.

“Practice at the top of their license” is always code for independent practice. There are already CRNAs out there practicing pain in states where they have independent practice. Now that all the NP and PA programs are starting to masquerade as doctorates, they are calling themselves doctors too. Most patients don’t understand medical education and can’t tell the difference. This isn’t catastrophizing; it’s already happening. I don’t think Trump is either good or bad for physicians yet because he hasn’t done much on healthcare.

 

[drusso]

I thought ppl stated that Trump was going to be the savior of physicians and medical practice as we know it....

after the election, someone previously stated: instead, give control to PAs and NPs and completely bypass physicians.....

Can you believe that we finally have an Administration that is standing up to Big Hospital and HOPD-Interests and pushing for transparency, site-neutral payment, and competition? There is no way I could see a Democrat advancing those values. Obama never did.

Hospitals sue Trump administration over price disclosure rule

A coalition of major hospital groups filed a lawsuit Wednesday to stop the Trump administration from requiring them to disclose the prices they privately negotiate with insurers.

www.cnn.com

 

[lonelobo]

They want Equal pay with doctors and equal status ( NP, PA)

 

[drusso]

They want Equal pay with doctors and equal status ( NP, PA)

How certain are you that they can demonstrate equal quality and equal outcomes?

 

[NOSfan]

They want Equal pay with doctors and equal status ( NP, PA)

Of course. Just as psychologists seek prescriptive privileges, chiropractors doing FJI and PT performing EMG/NCV. All are seeking expansion of their scope of practice.

Please note, the STATES primarily mandate/regulate privileges for practitioners and define the scope of practice.

 

[lonelobo]

How certain are you that they can demonstrate equal quality and equal outcomes?

Of course they can't, , but once they achieve equal pay it will only embolden them and their groups to further try to erode into physicians territory

 

[10KHertz]

there will always be a need for the “doctor”.

let the mid levels practice rogue .(and pay for their medical errors)

let the physicians own hospitals.

let the stew simmer and then we will see the winner... almost poetic

 

[bronx43]

there will always be a need for the “doctor”.

let the mid levels practice rogue .(and pay for their medical errors)

let the physicians own hospitals.

let the stew simmer and then we will see the winner... almost poetic

Couldn’t agree more. If this is a war between physicians and midlevels in terms of medical care, I’d take us in a heart beat.

Once ambulance chasers get a whiff of Midlevel malpractice, it will be a feeding frenzy.

 

[drusso]

there will always be a need for the “doctor”.

let the mid levels practice rogue .(and pay for their medical errors)

let the physicians own hospitals.

let the stew simmer and then we will see the winner... almost poetic

I love this.

 

[Ferrismonk]

there will always be a need for the “doctor”.

let the mid levels practice rogue .(and pay for their medical errors)

let the physicians own hospitals.

let the stew simmer and then we will see the winner... almost poetic

I agree, but only as long as patients get a choice. Just like the CRNA mess, often the patient doesn't have the choice. They just walk up and say I'm your anesthesia provider.

Need to be seen in the ER? PA-C will come evaluate you. Going to see a PCP? Dr. Nurse will see you because their the only one that takes your insurance. Going for surgery? Surgical PA does most of the case. In the ICU? Dr. Nurse is the only one in the unit tonight. As hospitals gobble up more and more of the "healthcare" pie, people will be forced to be taken care of by midlevels, whether they want to or not.

 

[drusso]

I agree, but only as long as patients get a choice. Just like the CRNA mess, often the patient doesn't have the choice. They just walk up and say I'm your anesthesia provider.

Need to be seen in the ER? PA-C will come evaluate you. Going to see a PCP? Dr. Nurse will see you because their the only one that takes your insurance. Going for surgery? Surgical PA does most of the case. In the ICU? Dr. Nurse is the only one in the unit tonight. As hospitals gobble up more and more of the "healthcare" pie, people will be forced to be taken care of by midlevels, whether they want to or not.

Do you think one's opinion about mid-levels is in part formed by one's perspective? I mean, if you own mid-level employment contracts then maybe you are more predisposed to seeing benefits such as access or control. But, if you are only directed to work with them as peers or supervise them for administrative "cover" then maybe you are more predisposed to seeing risks such as competition or liability.

 

[Ferrismonk]

Do you think one's opinion about mid-levels is in part formed by one's perspective? I mean, if you own mid-level employment contracts then maybe you are more predisposed to seeing benefits such as access or control. But, if you are only directed to work with them as peers or supervise them for administrative "cover" then maybe you are more predisposed to seeing risks such as competition or liability.

I suppose that makes sense, but I am willing to bet it's simpler. Doctors like them because they do the "scut-work" for them, Hospitals like them because they are more malleable and gets paid less.

 

[clubdeac]

We need to push for legislation that says only physicians can bill and be paid for a certain cpt codes such as 62323. Right now anyone who wants to bill for this code can and will be paid. It’s ludicrous and the only way we’re going to stop this madness is insist that only board certified pain physicians can bill pain codes. It’s as simple as that. We need to lobby and push for this legislation.... like now!