How independent physicians can combat ongoing hospital consolidation

Independent physicians across the country continue to experience changes to the way we practice. While the public might think the most significant changes are driven by new medicines or technologies, the increasing rate of hospital consolidation is perhaps the most pressing threat we face today.

As the healthcare landscape evolves, challenges to our daily practices include frequent government-mandated changes, insurer intrusions and ever-changing marketplace dynamics. Currently, we are being confronted with the ongoing monopolization of healthcare by hospital systems aggressively acquiring independently-run physician practices. For those of us who are committed to treating patients in our communities, these mergers are occurring at an alarming rate.

I’ve seen - and felt - the impact of hospital consolidation firsthand as a practicing independent urologist for the last 30 years. Many of my colleagues could no longer compete. They felt they had no choice but to agree to be purchased by a hospital system.

This problem is not unique to urology. Hospitals across the country are purchasing private practices in all specialties to extend their service areas even though patients prefer seeing independent physicians.

The Large Urology Group Practice Association (LUGPA) commissioned data that demonstrated a majority of Americans (65 percent) trust independent physicians in general and associate us with more personalized and patient-focused care compared to physicians employed by hospitals.

Hospital systems’ continued purchase of independent practices is making my patients nervous. Nearly one-third of older Americans (31 percent) worry they won’t get the care they need at a location they choose for a price they can afford. Their concern comes as no surprise given that hospitals are usually more expensive than independent practices.

It’s simple economics that pricing increases when a player monopolizes the market. A review by the Health Care Cost Institute showcased where the price differences are particularly stark, including:

• Chemotherapy infusions, where hospitals are reimbursed $281 versus $136 for independent practices

• Cardiac imaging, where hospitals are reimbursed $2,078 versus $655 for independent practices

• Colonoscopies, where hospitals are reimbursed $1,383 versus $625 for independent practices.

As a result of unchecked hospital monopolization, patients are left with fewer options and higher costs - contrary to the benefits hospitals claim mergers offer. data from LUGPA also revealed more than two-thirds of Americans want a solution to the growing trend of hospital purchases of independent practices. They also want payers to compensate all medical practices equally, a concept known as site-neutral payments.

The numbers don’t lie, and the evidence is clear: Patients want to be in control of their health and have the ability to choose the best option for their care. They want to receive care at a site that’s most convenient and comfortable for them. Patients do not want to be forced to rely on large, impenetrable and much more expensive hospital systems that are gobbling up the local family practices they’ve been visiting for decades.

The care we offer as independent physicians is incredibly valuable to patients. Likewise, it is both a reward and a privilege to care for them. But an equally important role for independent practices, though largely unseen by our patients, is that our very existence protects them from hospitals’ monopolistic activities.

Independent physicians have a major role to play in shaping health policy. As such, we must continue to advocate on behalf of all patients to ensure they receive the highest quality care possible and at the location of their choice.

We can care for our patients by championing legislation that levels the playing field between hospitals and independent practices. We can call for more aggressive Federal Trade Commission (FTC) review and enforcement of a hospital mergers and acquisitions. I invite you to join us in these efforts to make our collective voice heard.

Richard G. Harris, MD, is president of LUGPA, the only nonprofit urology trade association in the United States that provides resources to preserve and advance the independent practice of urology.