All Americans deserve access to affordable, high-quality health care. We all agree, but how to get there sparks fierce debate. One thing is clear – a strictly government-run health care system (eg, “Medicare For All”) built on false promises of high-quality “free” care that allows patients continued freedom of choice and rewards physicians for exceptional care is neither financially sustainable nor realistic.
Instead, we should defend the “magic” of competition in health care. In fact, it’s not “magic” at all. Competition is a central concept in economic theory and has been shown to work across industries to promote innovation, reduce cost, and improve quality. Healthcare is an industry that needs competition now more than ever.
We must begin to resolve the crisis of competition in healthcare, and physician-owned hospitals (POHs) are a great starting point. But it will need Congress to repeal previous legislation that artificially eliminated competition in health care.
Enacted in 2010, the Affordable Care Act (ACA) contains Section 6001. In essence, Section 6001 of the Anti-Corruption Act (POHs) prohibits newthe culmination of more gradual restrictions on POHs that began about 20 years ago.
Therefore, while lawyers own legal practices, physicians cannot own their own hospitals to improve clinical care for patients. Seems wrong, right?
As with many policy decisions, the idea behind the policy to ban POHs and the goals of the policy do not align with what actually happened once the policy was implemented. The stated reason for this policy was the concern that doctors who had a financial stake in the hospital would simply do so Refer the most financially profitable patients to their own facilities, threatening patient safety and increasing cost at the same time.
What really happened? Less competition and all the associated negative side effects.
The enforced reduction in competition for healthcare delivery has taken a toll on patients. At the same time that POHs have been removed from the competitive landscape of healthcare delivery, Hospital consolidation continued, prices rose, Quality improvement delayed, patient experience decreased. In fact, many of the troubling negative repercussions around POHs have been at play across non-POHs, where referral patterns are catalyzed by market forces regardless of ownership. Ultimately, it was – and still is – feeling the benefits of competition across healthcare due to the ban on POHs.
Recent research from Mercatos Center at George Mason University It also shows that the main concerns that led to POHs being banned in the first place were likely unfounded. In general, POHs actually perform as good, if not better, than non-POHs. Oftentimes, POHs provide high-quality care at lower costs. This helps our fellow Americans return to their daily lives faster, allowing them to spend time with family and contribute to the economy. This is exactly what we want – and need – to help “fix” the broken healthcare delivery system! But we stand in our way.
When we step back and consider these positive outcomes, they make sense. POHs—including those focused on orthopedics or other medical subspecialties—can focus only on what they do best, making them a reality. Integrated Practice Units (IPUs) It provides patients with a “one-stop shop” of care. This makes the delivery of care more efficient and of higher quality, while also improving patient satisfaction. This is a win-win for all stakeholders, especially patients, who are the most important piece of the healthcare delivery puzzle.
As we strive to solve the crisis of our healthcare system by refocusing healthcare once again on the patient-physician relationship, a competitive healthcare market is essential. In fact, the growing competition in hospitals has bipartisan support, including from President Biden. Now is the time to set aside political differences and pass legislation proposed by a group of Republican senators to repeal Section 6001. This is an easy bipartisan decision to make, and it can’t come too soon.
David N. Bernstein, MD, MBA, MEI is a resident physician in the Harvard Orthopedic Joint Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital. He is an expert in value-based healthcare transformation. Follow him on Twitter Tweet embed The opinions of this editorial are solely those of the author.