The Fight to Save Health Care for Patients and Physicians

National grassroots, non-partisan coalition outlines physician-led roadmap to patient-centered care.

Healthcare decisions affect everyone. Patients worry about drug costs, access to affordable insurance, finding a quality physician and pre-existing conditions. While committed to patient care, physicians also have many crucial concerns. These include burdensome government regulations, vertical integration by large predatory hospital and corporate systems, often forcing doctors who prefer to stay independent into an employed status, as well as declining reimbursements. We are in a desperate fight to save healthcare. We need to focus on the physician’s vital role in the battle.

In addition to the chronic struggles facing patients and physicians, the COVID-19 pandemic has shed new light on flaws in our delivery model. It has exposed the seemingly corrupt supply-chain industry, exposed the economic vulnerability of physician groups both hospital-employed and private practice groups. All this has allowed increased government bureaucratic–intrusion into physician autonomy. It has caused further erosion of the doctor-patient relationship.

I have spent my career working to empower the independent physician. Years ago, my colleagues and I merged groups of otolaryngologists to form a larger single specialty organization in order to maintain our private practices and autonomy. During the last six years, together with others, we formed an independent group of nearly 700 doctors and one of the most successful Accountable Care Organizations (ACOs) in Missouri. It is my passion that physicians be able to care for patients in the way they believe represents the highest level of medical care. More recently, I am pleased to be involved with non-partisan, physician and patient advocacy groups on a national level.

The Corporatization of Medicine

I am involved in these physician groups because over the last ten years, as the physician work force has moved to a more hospital-employed structure, there has been an escalation of costs and the leveling or even decline in the quality of medicine. Other concerning trends are the insurance industry and private equity firms purchasing medical practices, employing physicians and perhaps putting profit above quality care. Many physicians are embracing the idea of selling their practices and ceding the future practice of medicine to a faceless, profit-driven financial entity. In some southern states, a single insurance company controls over 80% of insured lives, thus cornering health markets. These trends are putting patients and independent medical practice at risk by creating monopolies in the delivery of care model and eliminating choice. It largely is an issue of misaligned incentives. Sadly, this plays out as increased healthcare costs, increased premiums, massive increases in pharmaceutical costs, less accessible care for the underprivileged, escalating physician burnout and greatly diminished free market choice in healthcare.

It is overdue that we physicians take a front seat in all healthcare matters including legislation. To that end, I have the privilege of being connected with hundreds of other physicians, representing many thousands more. These organizations, along with patient advocacy groups, make up a non-partisan grassroots effort to improve healthcare for patients and physicians. One of the group’s efforts was to form the movement known as Free to Care, (free2care.org). In the spring of 2019, Free to Care held a symposium in Washington DC and subsequently produced a white paper with a mission to outline a physician-led path to patient-centered care. This roadmap identifies key issues facing physicians and patients in the battle to keep American medicine at the forefront. This paper also exposes ways to reduce cost and waste.

The Future of Medicine Is in Our Hands Today

Since that meeting, the Free to Care movement has continued to gain strength, largely fueled by the fact that healthcare is one of the most important political issues and also it has the support of thousands of physicians and patients. The issues addressed in the Free to Care paper resonate with those suffering most under the current burdensome delivery model— patients and their physicians. While I am sure not all physicians will agree with everything laid out in Free to Care’s white paper, it is clear that physicians need to be integral to major changes in healthcare.

The Free to Care Movement is Tackling Five Primary issues

1. Reduce drug prices and increase supply

Drug and medical device costs are out of control. Exorbitant pricing is a complex problem. The key factor driving prices can be traced to 1987 when a law passed providing a “Safe Harbor” for ‘rebates’ (really kickbacks) to the Group Purchasing Organizations (GPOs) in a pay-to-play market. In 2003, this kickback safe harbor was extended to the Pharmacy Benefit Managers (PBMs) industry. Outside of the pharmaceutical and medical-device industries, kickbacks such as these are illegal in any other healthcare endeavor. Multiple Senate Antitrust Subcommittee meetings exposed the safe harbor law as being the root cause of both drug and medical device shortages as well as the increased cost of medicines. It is estimated that this safe harbor allowance adds $250 billion of unnecessary costs to the healthcare bill. Never before have we seen the breakdown in the medical and pharmaceutical supply chain as we have in 2020. The Covid-19 pandemic has exposed just how deeply the corruption in the industry runs. Patients, physicians, medical practices, clinics and hospitals have all suffered under the current paradigm with less access to personal protective equipment and other vital equipment needed to care for suffering patients. Our country has also seen limited access to many medications as well as the basic chemicals to manufacture medications in the United States. Therefore, it is strongly recommended these safe harbor laws be repealed.

2. Strengthen the safety net for the vulnerable

It is necessary to create and strengthen the safety net for the most vulnerable of our society. One of the initiatives to help with this is to even the playing field for providers of pro-bono care. Presently, unlike hospitals, physicians are not able to write off charitable care. There is currently a proposed bill called the Physician Pro Bono Care Act of 2019 (HR 856). While it has been introduced, it needs support to move it forward. Passage of this bill will help provide medical care for patients in financial need and would increase access, encouraging more physicians to participate in charitable care. In addition to this bill, there is a specific movement for a tax deduction to be extended to physicians and nurses who donate time in public settings to educate the public on state-based pro-bono care.

3. Foster fresh models to pay for medical care

There needs to be new and innovative models to pay for medical care. Free to Care recommends an expansion of Health Savings Accounts (HSAs) to decrease third party interference. Additionally, expansion of the Direct Primary Care (DPC) model has been shown to increase access and decrease cost of care. This DPC model removes much of the waste associated with claims processing and insurance middleman involvement, producing savings for patients. It can be expanded to include Direct Specialty Care as well.

4. Reverse the impending physician shortage

There is an impending physician shortage and high levels of career dissatisfaction, leading to early retirement. Federal mandates (HITECH, MACRA, ACA, EHR and MIPS) place onerous financial burdens on physicians and private practices. These data collecting initiatives require reporting that is outside the scope of real patient-care efforts. These lead to increased burnout of physicians and financially drive physicians, who often desire to remain in private practice, into an employed status. These mandates need to be corrected by eliminating the Electronic Health Record (EHR) and Merit Based Incentive Payment System (MIPS) requirements for practices with less than 50 physicians. Additionally, the administrative burden of obtaining prior authorizations needs to be eliminated. This directly interferes with the doctor-patient relationship. Also tackled in Free to Care’s white paper is the need for true medical malpractice reform and the necessity of training more physicians.

5. Make health care prices transparent

There is significant support and efforts being led to create price transparency. While the Executive Order from the President, stood to help in this effort, the battle has just begun. After the Executive Order, the American Hospital Association (AHA) sued to block the transparency order but in June 2020 it lost its legal battle. This means, unless appeals occur, in January 2021 hospitals will be required to publish their pricing structures and more importantly be obligated to publish any rates negotiated with third-party payers. These two groups work in conjunction to drive up the cost of care to maximize their own profits. Included in this effort to make pricing transparent, is eliminating the tax-exempt status of non-for-profit hospitals. Tax-exempt non-profit hospitals may write off charitable care at charge-master level while also receiving Disproportionate Share (DSH) reimbursements from the federal government. This “double-dipping” translates to writing off care while also receiving taxpayer funding for that same charitable care. Among addressed issues, another of significance is to create Site-Neutrality among hospital-based practices with those in private practice. As hospitals are able to charge a facility fee when patients see an employed-physician, an unnecessary cost is passed to the patient. Additionally, it creates more economic incentives for hospitals to employ physicians. While the American Hospital Association often claims that vertical integration reduces cost through consolidation, the increased revenue gained by such consolidation is most often retained by the hospital and not passed back to the patients whose healthcare expenditures increased in the process. This hospital-employed model clearly shows an increase in the overall cost of care to the patients.

Reports recently have also indicated that many large hospital systems have lost money under the shutdown during the pandemic. There have been furloughs of employed “integrated” physicians, nurses and many front-line workers. The shutdown to “flatten the curve” and the pause in non-urgent care has sadly affected rural hospitals and those hospitals not part of a large horizontal system in a more adverse way. Many of the large hospitals systems are receiving money under the CARES act yet smaller hospitals may never recover from the economic impact of closing down. Yet, in the larger systems as clinical staff is taking pay cuts or being relieved of their positions, administrative employment remains at all time levels. This seems woefully out of sync as administrators are not the individuals risking their lives to care for patients.

Call to Action

The Free to Care coalition of physicians, patient advocacy groups and business leaders seeks to restore the doctor-patient relationship. While the details of these efforts continue to be evaluated, it is of utmost importance that we stay engaged in the legislative efforts that so greatly affect us and our ability to practice our craft. The future of medicine now more than ever, lies in our hands.

I would encourage you to find out more about these physician-led efforts and know that there is a coalition working for the best interests of doctors and patients. Although we are not alone in our efforts and desires to improve care, our patients and the future generations of physicians need our help. For too long, we have allowed the other players, none of whom have the same level of patient responsibility, to control the direction of healthcare. Visit free2care.org to download the entire white paper and to learn more about its efforts. Most importantly, consider lending your voice to the coalition.