Texas should not place additional taxes on caring for the sick.
Support responsible ownership of hospitals
Texas’ health care delivery system has changed dramatically over the past decades. Lifesaving technologies and treatments, and the types of settings in which patients receive services have proliferated. Physicians, hospitals, and others have invested extensively in these technologies and settings. While physician investment in the health care system is not new, there have been considerable changes in health care coverage, financing, licensing, and regulatory environment over the past decade. These changes drive the debate over who should invest in facilities. Texas is also the uninsured capital of America, which creates competition for a dwindling supply of paying patients.
TMA strongly supports responsible physician investment in technology, facilities, services, or equipment. Physicians invest in facilities to improve the effectiveness, efficiency, timeliness, and quality of the care they provide to their patients. The focus should be not on who owns the medical facility — a physician, a nonprofit entity, or a for- profit company — but on the quality of the facility and appropriateness of patient care. Referrals to a physician-owned entity or an entity in which the physician has a financial relationship must be based on the patient’s medical needs, and full disclosure of financial relationships to patients is appropriate. If overutilization or deviations from quality care are the issues, legislators should address those problems regardless of ownership, rather than limiting patient choice and innovation in the marketplace.
One of the more egregious sections of the Patient Protection and Accountable Care Act significantly inhibits physicians’ legal right to own or invest in hospitals and other facilities that provide high- quality care to their patients. Section 6001 prohibits new doctor investment in hospitals that take Medicare patients; no physician-owned hospitals
62 TEXAS MEDICINE October 2012
may start nor may current ones expand. Federal law should not interfere with physician ownership of hospitals. Studies show physician hospitals have better health care outcomes, shorter hospital stays, and much higher patient satisfaction ratings than nonphysician-owned hospitals. In Texas, physician-owned hospitals employed 22,226 people and paid $1.2 billion in salaries in 2009.60 Nationally, physician-owned hospitals provide, on average, approximately 6.2-percent charity care.61 These hospitals pay billions in salaries, hundreds of millions in taxes, provide charity care, and deliver services in underserved or abandoned areas. TMA has filed several legal briefs that support a lawsuit seeking to overturn Section 6001 of the PPACA.
ENDNOTES
50 Klein, Philip. The Empress of Obamacare. June 2010. The American Spectator. Available at
http://spectator.org/archives/2010/06/04/the- empress-of-obamacare. Accessed April 2012.
51 Department of Justice and the Federal Trade Commission. Improving Health Care: A Dose of Competition. July 2004. Available at http://www.
justice.gov/atr/public/health_care/204694.pdf. Accessed April 2012.
52 Computational Legal Studies. H.R. 4872 Word Cloud. March 2010. Available at
http://computationallegalstudies.com/2010/03/22/h-r-4872- word-cloud/. Accessed April 2012.
53 Berenson, Robert A. Separating Fact From Fiction: A New Role For Health Affairs. Health Affairs. November 2007, 26(6):1528-1530. Available at:
http://content.healthaffairs.org/content/26/6/1528.full. Accessed May 2012.
54
http://www.gao.gov/assets/320/315811.pdf
55 The Lewin Group. Prepared for the American Medical Association. The Economic Impact of Office-Based Physicians in Maryland. January 2011. Available at
http://www.bizjournals.com/baltimore/pdf/Maryland- physicians-report.pdf. Accessed April 2012.
56 The Lewin Group. Prepared for the American Medical Association. The State-Level Economic Impact of Office-Based Physicians. February 2011. Available at
http://www.ama-assn.org/resources/doc/arc/ economic-impact/economic-impact-report.pdf. Accessed April 2012.
57 BeSaw, Larry. ICD-10 Conversion. Texas Medicine. February 2012. 108(2):24.
58 Nachimson Advisors. The Impact of Implementing ICD10 on Physician Practices and Clinical Laboratories. A Report to the ICD10 Coalition. October 2008. Available at
http://nachimsonadvisors.com/ Documents/ICD-10%20Impacts%20on%20Providers.pdf. Accessed April 2012.
59 Texas Medical Association. Legislative Brief: Taxes. 2011. Available at
http://www.texmed.org/Template.aspx?id=19667. Accessed April 2012.
60 Texas Medical Association. TMA Supports Physician Hospital Ownership. September 2010. Available at
http://www.texmed.org/ Template.aspx?id=17264. Accessed April 2012.
61 Schneider, John and Decker, Christopher. Health Economics Consulting Group. The Economic Impact of Physician-Owned Hospitals in Eight States. January 2009. Available at
http://tphac.org/resources/ Economic-Impact-Analysis-of-POHs.pdf. Accessed April 2012.
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