Change in pricing practices for hospitals buying private practices

[MichaelB]

Another item included in the budget deal that will help restrain healthcare inflation. When hospitals buy physician groups private practices they rename them as part of the hospital, even though they are not part of the hospital campus, then raise the price, and Medicare pays more. This will change http://www.nytimes.com/2015/10/29/u...more-thats-set-to-change.html?ref=health&_r=0

The current budget deal, if it passes, would let any current hospital-owned practice continue to pocket the higher prices, but it would prevent future practices from being able to get higher payments just by merging with a hospital. In order to get hospital-size payments in the future, doctors’ offices will need to be located “on campus.”

This will not make a big dent in healthcare costs but is another step in the right direction.

 

[Walt34]

My doctor's office got in under the wire on that one. The hospital bought the practice just a few months ago.

 

[travelover]

.............This will not make a big dent in healthcare costs but is another step in the right direction.

Amen. Seems like such a blatant rip off.

 

[pb4uski]

Perhaps a step in the right direction but it is still sort of stupid that Medicare pays different prices for the same service depending on the nature of the ownership.

 

[travelover]

Perhaps a step in the right direction but it is still sort of stupid that Medicare pays different prices for the same service depending on the nature of the ownership.

Sort of stupid that they don't negotiate drug prices, too.

 

[sailor]

And I was wandering, why there were several new "professional buildings" in two nearby hospitals and several doctors moved their offices there.
Requirement easy to circumvent.

 

[rodi]

How will this work for practices that have more than one office - one on/adjacent to the hospital campus (shared parking with hospital) and another office about 5 miles away. If the doctor is in the hospital office, they charge more, if they see the patient at the suburban office they charge less? Same doctor, same service, just different location?

(I know of two practices that have this setup... One isn't likely to bill huge amounts to medicare as it is OB/GYN - but it would still have patients over 65... just no babies being delivered to those over 65.)

 

[MBSC]

How will this work for practices that have more than one office - one on/adjacent to the hospital campus (shared parking with hospital) and another office about 5 miles away. If the doctor is in the hospital office, they charge more, if they see the patient at the suburban office they charge less? Same doctor, same service, just different location?

This is about Medicare Part B reimbursement (fee schedule allowed amount), not how much each office charges. If the off-site office is already hospital owned, they will continue to receive the higher reimbursement rate. Since Part B generally pays 80%, the remaining 20% of the higher rate is patient/Medigap responsiblity.

If the off-site office is not hospital owned by the deadline, nothing changes and they continue to receive the lower reimbursement.

 

[Animorph]

I've been trying to find my doctor in one of the ACA insurance networks. Like many others, my choices are mostly HMO's for 2016. I actually found a PPO that had my doctor in network, off the state marketplace but available directly through the insurer. I double checked with my doctor, who said that insurer was going to drop him for 2016. They were no longer interested in working with single-doctor practices. Pretty noticeable with all the HMO's available to me as well. They each use one or two hospital-centered provider networks. That might drive more practices to the hospitals, even if they don't get paid more.

 

[EastWest Gal]

The whole practice of hospitals buying doctor's practices then jacking up the prices is a blatant ripoff, not just of Medicare but insurance companies and patients as well. It is very noticeable in laboratory tests and radiology. It takes under a minute to do a CBC, as it is just about all automated, and yet the hospital lab charges an arm and a leg, and everyone pays more for the same test, find more cheaply and accurately than it was done 50 years ago.

It isn't just the independent doctors that are being squeezed, it's all of us. Trying to find a non-hospital lab that is in network is nearly impossible. And now all the PPOs are being dropped, the few private office docs are being squeezed out of business.

It feels like a monopoly in our area, but no one has pursued it legally. This practice hurts everyone except the executives of these so-called non-profits who own all the practices.

One thing I did not appreciate until I left California is that in that state, at least practicing physicians cannot be directly employed by the hospital. That is true in only five of states.

When I moved to PA I quickly found that administrators are very quick to interfere with physician's practices when allowed to do so. I worked for a hospital system for 5 years and the stress was unbelievable. I was set up to look bad (assigned to chair a committee then the hospital clinic booked my schedule through every committee meeting). I had to decide between leaving a committee stranded or patients. Either way it gave a misogynistic chairman a way to get rid of an uppity and ambitious female physician. It worked out in the end as private and contracted practices gave me the autonomy I needed and better pay.

It is sad to see so many physicians give up all autonomy.

Good luck in your search! I'm in the same boat. I hope you can keep your doctor and that your doctor survives the squeeze.


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