Physician-owned Hospitals

Physician-owned Hospitals / en Fri, 25 Apr 2025 14:49:20 -0500 Thu, 27 Mar 25 15:33:33 -0500 AHA opposes legislation allowing physician self-referrals, POH expansion /news/headline/2025-03-27-aha-opposes-legislation-allowing-physician-self-referrals-poh-expansion The AHA March 27 voiced <a href="/lettercomment/2025-03-27-aha-letter-opposing-physician-led-and-rural-access-quality-care-act-hr2191">opposition</a> to the Physician Led and Rural Access to Quality Care Act (H.R. 2191), a bill that would lift the ban on the establishment of physician-owned hospitals in certain rural areas and permit the unfettered expansion of POHs nationwide, regardless of location. In place since 2010, current law includes an exceptions process that allows existing POHs to expand if they accept Medicaid patients and are located in areas where beds are needed.&nbsp; “By performing the highest-paying procedures for the best-insured patients, physician-owners inflate health care costs and drain essential resources from community hospitals, which depend on a balance of services and patients to provide indispensable treatment, such as behavioral health and trauma care,” AHA wrote in comments to Rep. Morgan Griffith, R-Va., the bill’s author. “By increasing the presence of these self-referral arrangements, H.R. 2191 would only further destabilize community care.”&nbsp; Thu, 27 Mar 2025 15:33:33 -0500 Physician-owned Hospitals AHA submits comments to House hearing on Medicare legislative proposals /news/headline/2023-10-19-aha-submits-comments-house-hearing-medicare-legislative-proposals In a <a href="/testimony/2023-10-19-aha-statement-committee-energy-and-commerce-subcommittee-health-re-medicare-legislative-proposals">statement</a> submitted to the House Energy and Commerce Health Subcommittee for a <a href="https://energycommerce.house.gov/events/health-legislative-hearing-what-s-the-prognosis-examining-medicare-proposals-to-improve-patient-access-to-care-and-minimize-red-tape-for-doctors">hearing</a>&nbsp;Oct. 19&nbsp;on legislative proposals to increase access to care and reduce administrative burden in the Medicare program, AHA voiced support for legislation that would streamline prior authorization and certain alternative payment model requirements in the Medicare Advantage program; update payment and ease reporting for Medicare clinical diagnostic laboratory services; streamline Medicare quality reporting; and prevent Medicare from publicizing a telehealth provider’s home address.&nbsp; &nbsp; However, AHA strongly opposed any legislation that would ease growth restrictions on physician-owned hospitals, which tend to select the most profitable patients and services, jeopardizing communities’ access to full-service hospital care. The association voiced support for extending incentive payments for Advanced APMs, but opposed imposing a five-year cap on qualifying for the payments.&nbsp; Thu, 19 Oct 2023 14:06:03 -0500 Physician-owned Hospitals AHA blog: Physician-owned Hospitals Cherry-pick Patients, Lead to Lower Quality and Less Access  /news/headline/2023-10-18-aha-blog-physician-owned-hospitals-cherry-pick-patients-lead-lower-quality-and-less-access Physician-owned hospitals cherry-pick healthy and wealthy patients, provide limited emergency services and increase costs for patients, providers and the federal government, write AHA Executive Vice President Stacey Hughes and Federation of ��s President and CEO Chip Kahn. “It is therefore imperative that we maintain the current law, which protects the Medicare program from expansion of POH practices, and not roll-back protections under false, theoretical arguments.” <a href="/news/blog/2023-10-18-theories-dont-replace-facts-physician-owned-hospitals-cherry-pick-patients-lead-lower-quality-and-less">READ MORE</a> Wed, 18 Oct 2023 14:18:48 -0500 Physician-owned Hospitals Theories Don’t Replace Facts: Physician-owned Hospitals Cherry-pick Patients, Lead to Lower Quality and Less Access /news/blog/2023-10-18-theories-dont-replace-facts-physician-owned-hospitals-cherry-pick-patients-lead-lower-quality-and-less One of the tenets of our nation’s health care system is a level playing field in service of higher-quality, more affordable, and improved access to care for patients. This was the impetus for the Ethics in Patient Referrals Act, more commonly known as the “Stark Law,” which limited physicians’ ability to self-refer to entities in which they have a financial stake. And, it is why in 2010 Congress closed the law’s “whole hospital” exception loophole, prohibiting physicians from referring Medicare and Medicaid patients to new hospitals in which they have an ownership interest (also known as physician-owned hospitals or POHs), and limiting the growth of existing POHs. For more than a decade, this has protected the Medicare program from unfettered growth in these facilities and further expanding their practices of selecting the healthiest and most profitable patients, driving up utilization, and deferring emergency services to publicly funded 911 services or general acute care hospitals when their patients need emergency care. Despite these protections, existing POHs have leveraged their position to continue cherry-picking patients and deferring emergent care to community providers. Opponents of these protections — such as the authors of this <a href="https://www.aei.org/research-products/report/hospital-competition-and-restrictions-on-physician-owned-hospitals/">white paper</a> from earlier this year — would eliminate Medicare’s prohibition on physician self-referral to new POHs and restrictions on their growth. They falsely argue that repealing these protections will generate competition that will reduce costs. Despite these claims, the facts and data tell an entirely different story: <ul> <li>POHs don’t increase competition but can increase risk for patients – POHs often provide limited or no emergency services, relying instead on publicly funded 911 services when their patients need emergency care. This delays timely access to needed care for patients. The <a href="https://oig.hhs.gov/oei/reports/oei-02-06-00310.pdf">Department of Health and Human Services’ Office of Inspector General reported</a> that “two-thirds of physician-owned specialty hospitals use 911 as part of their emergency response procedures,” and “most notably, 34 percent of [these specialty] hospitals use 911 to obtain medical assistance to stabilize patients, a practice that may violate Medicare requirements.”</li> <li>POHs increase costs for the government – Closing the “whole hospital” exception loophole to the Stark law reduced the federal deficit by $500 million over ten years, according to the non-partisan Congressional Budget Office (CBO). But federal legislation now under consideration, H.R. 977/S. 470, would erase those savings and raise the deficit.</li> <li>POHs cherry-pick patients, creating inequities in access and choice – Proponents of rolling back protections argue that allowing POHs to grow would increase consumer choice because patients would have more options for care. However, POHs can limit choice by selecting only the healthiest and wealthiest patients. A recent <a href="/fact-sheets/2023-03-28-select-financial-operating-and-patient-characteristics-pohs-compared-non-pohs-fact-sheet">report</a> from Dobson| DaVanzo, a health care data and consulting firm, showed that POHs had lower Medicaid, dual-eligible, and uncompensated care/charity care discharges than full-service acute care hospitals. Specifically, POHs had less than half the proportion of Medicaid discharges compared to non-POHs (3.4% vs. 8.4%). POHs also were less likely to care for dual-eligible patients compared to non-POHs (15.6% compared to 26.3%). Dobson | DaVanzo also found that POHs treated far fewer COVID-19 patients than non-POHs, illustrating the fact that they are ill-equipped to handle patient surges and provide the specialized care needed in a public health crisis. Providing access and choice only for the healthiest and most profitable patients poses program integrity, access and health equity risks for the Medicare program and its beneficiaries.</li> <li>POHs do not improve quality – Additional recent <a href="/system/files/media/file/2023/08/Analysis-of-Selected-Medicare-Quality-Measure-Reporting-Data-by-Hospital-Ownership.pdf"> data</a> from Dobson| DaVanzo showed that POHs report fewer quality measures and are more likely to fall into the lowest peer group under the Hospital Readmission Reductions Program (HRRP). This means that POHs not only treat fewer patients who are dually-eligible for Medicare and Medicaid — a demographic that is documented to be on average sicker and more complex to treat and is the basis for peer-grouping under the HRRP — but also are not subject to many of the quality measures that most full-service acute care hospitals are. Although POHs treat younger, less medically complex patients with fewer comorbidities, the report shows that POHs had higher average readmission penalties, and a much higher percentage of POHs received the maximum payment penalty compared to general acute care hospitals in the same lowest dual-eligible peer group and market. Collectively, these findings suggest that POHs do not improve quality of care, even though they cherry-pick the healthiest patients.</li> <li>POHs will not “stall or reverse” consolidation in health care markets – The theory that expanding POHs will reduce consolidation among hospitals and physician offices is entirely flawed. There are several compelling reasons why such consolidation occurs. First, hospital consolidation with physician offices allows physicians to manage financial pressures and ensure that access to care in the community is maintained. Also, physicians are increasingly turning to hospitals, health systems and other organizations for financial security so they can focus more on clinical care and less on the administrative burdens and cost concerns of managing their own practices. Despite efforts to paint hospitals and health systems as the sole cause of physician practice pattern changes, the truth is that commercial insurer policies, such as prior authorization, are creating unworkable environments, forcing physicians to prioritize administrative duties over caring for patients. Physicians are searching for alternative practice settings that reduce these burdens and provide adequate reimbursement, while allowing them to focus on caring for patients. Additionally, most of the consolidation of physician practices is due to private equity firms and insurance companies acquiring physician practices, not hospitals.</li> </ul> When it comes to POHs, the facts are clear — POHs cherry-pick healthy and wealthy patients, they provide limited emergency services and are ill-equipped to respond to public health crises, and they increase costs for patients, other providers, and the federal government. The <a href="https://www.cbo.gov/sites/default/files/111th-congress-2009-2010/costestimate/amendreconprop.pdf">CBO</a>, the <a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/Mar05_SpecHospitals.pdf">Medicare Payment Advisory Commission (MedPAC)</a> and the <a href="https://public-inspection.federalregister.gov/2023-16252.pdf">Centers for Medicare &amp; Medicaid Services (CMS)</a> all have concluded that physician self-referral leads to greater per capita utilization of services and higher costs for the Medicare program, among other negative impacts. Indeed, recently CMS once again reinforced the need for this law, proposing to reinstate program integrity restrictions for POHs approved as “high Medicaid facilities” due to the risk for patients and the Medicare program, noting that “protecting the Medicare program and its beneficiaries, as well as Medicaid beneficiaries, uninsured patients, and other underserved populations, from harms such as overutilization, patient steering, cherry-picking, and lemon-dropping outweighs any perceived burden on high Medicaid facilities.” It is therefore imperative that we maintain the current law, which protects the Medicare program from expansion of POH practices, and not roll-back protections under false, theoretical arguments. Stacey Hughes is the America Hospital Association's Executive Vice President. Chip Kahn is the Federation of ��s President and CEO. Wed, 18 Oct 2023 08:23:40 -0500 Physician-owned Hospitals Keeping the Brakes on Physician-owned Hospitals is Best for Patients /news/perspective/2023-08-18-keeping-brakes-physician-owned-hospitals-best-patients Fair competition has always been the driving principle of our nation’s economy. This includes health care, and it’s the reason the Ethics in Patient Referrals Act, more commonly known as the “Stark Law,” has been on the books for decades to protect the Medicare program from the inherent conflict of interest created when physicians self-refer their patients to facilities and services in which they have a financial stake. But the Stark Law’s “whole hospital” exception permitted physicians to refer patients to those hospitals where they had an ownership interest in the entire facility rather than just in a subdivision, such as imaging or surgery. In 2010, Congress closed the “whole hospital” exception loophole, except for grandfathered hospitals. Closing the loophole made good sense then, and it makes even better sense now. We’re concerned that some members of Congress want to roll back this basic patient protection by eliminating Medicare’s prohibition on physician self-referral to new physician-owned hospitals (POHs) and all restrictions on their growth. Backing up 15 years of research, a <a href="/guidesreports/2023-08-03-new-analysis-validates-need-preserve-restrictions-growth-physician-owned-hospitals?utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=aha-today" target="_blank">new report</a>&nbsp;from Dobson | DaVanzo helps cement the powerful case for Congress to maintain current law, preserve the ban on physician self-referrals to new POHs and retain restrictions on the growth of existing POHs. This new study found that POHs report on fewer Medicare quality measures and perform worse on readmission penalties than full-service community hospitals, demonstrating that POHs are fundamentally different from full-service community hospitals — they treat fewer patients, provide fewer services and do not meet as wide a range of patient clinical needs. This report and others have shown the adverse impact POHs have had on: Patient Selection — The <a href="/news/headline/2023-03-28-study-reaffirms-need-ban-self-referral-physician-owned-hospitals?utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=aha-today" target="_blank">Dobson | DaVanzo report</a> reinforced earlier findings&nbsp; that POHs treat younger, less medically complex patients who are less likely to be enrolled in Medicare or Medicaid. Physician-owners’ practice of selecting the healthiest and wealthiest patients and avoiding less profitable Medicaid and uninsured patients creates a destabilizing environment that leaves sicker and less-affluent patients to community hospitals, threatening the health care safety net. Access — POHs provide limited or no emergency services, relying instead on publicly funded 911 services when their patients need emergency care. In fact, a Department of Health and Human Services’ report found that a third of POHs “use 911 to obtain medical assistance to stabilize patients, a practice that may violate Medicare requirements.” Cost — According to the Congressional Budget Office, physician self-referral leads to greater utilization of services and higher health care costs. Closing the “whole hospital” exception loophole to the Stark Law reduced the federal deficit by $500 million over 10 years, according to CBO. But some members of Congress support ill-advised legislation (H.R. 977/S. 470) that would repeal current law — eliminating all restrictions on POHs, allowing unfettered growth of these arrangements, and raising the deficit at a time when our nation is trying to control increases in health care costs. Preventing physician-owners from steering patients to facilities in which they have a financial stake is a sensible “first, do no harm” policy. This latest analysis once again reaffirms the need to maintain current law banning physician self-referrals to new POHs and restricting the growth of existing POHs. <h2>Hawaii Wildfires</h2> Americans everywhere have watched with shock, dismay and alarm as the deadliest wildfire in modern U.S. history devastated the beautiful island of Maui, exacting a terrible toll in lives lost and injured while causing vast damage to homes, businesses and property — including vital health care clinics and medical supplies. Once again, it was our front-line responders who first answered the cries for help. Meanwhile, our hospitals, health systems and care teams are tending to the injured. And our health care workers continue to put the needs of their patients and communities first, even as many of them have lost so much. The AHA stands with our colleagues at The Healthcare Association of Hawaii, which has shared a list of organizations that are supporting the victims. They are: <ul> <li><a href="https://www.hawaiicommunityfoundation.org/maui-strong">Hawaii Community Foundation’s Maui Strong Fund</a></li> <li><a href="https://mauifoodbank.org/donate/" target="_blank">Maui Food Bank</a></li> <li><a href="https://www.gofundme.com/f/hawaii-chamber-foundation-business-relief-fund" target="_blank">Hawaii Chamber of Commerce Foundation Business Relief Fund</a></li> <li><a href="https://ignite.stratuslive.com/auw/get-involved/donate/mauirelief" target="_blank">Aloha United Way Maui Fire Relief Fund</a></li> </ul> We join with all Americans in extending our support, hope and prayers to all those affected by this natural disaster as Hawaiians face the challenging road to recovery. Fri, 18 Aug 2023 09:09:08 -0500 Physician-owned Hospitals Study: Physician-owned hospitals perform worse on readmissions, report on fewer quality measures /news/headline/2023-08-03-study-physician-owned-hospitals-perform-worse-readmissions-report-fewer-quality-measures As some members of Congress propose to weaken Medicare’s prohibition on physician self-referral to new physician-owned hospitals and ease restrictions on their growth, <a href="/guidesreports/2023-08-03-analysis-selected-medicare-quality-measure-reporting-data-hospital-ownership">new data from Dobson | DaVanzo</a>&nbsp;show that POHs publicly report on fewer Medicare quality measures and perform worse on readmission penalties than full-service community hospitals. The study also reinforces previous findings that POHs generally treat a population that is younger, less medically complex and less likely to be enrolled in Medicare or Medicaid.&nbsp; &nbsp; “This new analysis adds to more than 15 years of research suggesting that POHs select their patients by avoiding less profitable Medicaid and uninsured patients, treat fewer medically complex patients, and provide fewer emergency services,” AHA and the Federation of ��s note in a <a href="/guidesreports/2023-08-03-new-analysis-validates-need-preserve-restrictions-growth-physician-owned-hospitals">one-pager</a>&nbsp;on the report. “Beyond validating findings by the Government Accountability Office, Health and Human Services Office of Inspector General, and the Medicare Payment Advisory Commission that POHs do not treat the same scope, complexity, or acuity of patients as non-POHs within the same market, this analysis also shows that POHs have higher average penalties for readmissions compared to full-service community hospitals. In short, by choosing the healthiest and wealthiest patients, POHs pose program integrity, access and health equity risks for the Medicare program.”&nbsp; Thu, 03 Aug 2023 15:02:00 -0500 Physician-owned Hospitals New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals /guidesreports/2023-08-03-new-analysis-validates-need-preserve-restrictions-growth-physician-owned-hospitals <div class="container"> <div class="row"> <div class="col-md-8"> As some members of Congress continue to propose weakening Medicare’s prohibition on physician self-referral to new <a href="/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals" target="_blank">physician-owned hospitals (POHs)</a> and loosening restrictions on the growth of existing POHs, new data from <a href="/guidesreports/2023-08-03-analysis-selected-medicare-quality-measure-reporting-data-hospital-ownership">Dobson | DaVanzo</a> show that POHs report fewer quality measures and perform worse on readmission penalties compared to full-service community hospitals. Hospital Star Ratings are reported on the Centers for Medicare &amp; Medicaid Services’ (CMS) Care Compare website, and these ratings allow the public to compare hospitals’ performance based on standardized quality metrics. This new analysis reinforces <a href="/news/blog/2023-04-24-physician-owned-hospitals-are-bad-patients-and-communities">previous findings</a> that POHs generally treat a population that is younger, less complex or comorbid, and less likely to be dually eligible for Medicare and Medicaid. Despite treating a healthier and better insured population than similarly situated community hospitals, POHs received higher readmission penalties from CMS. This new study found that: <ul> <li>POHs generally report fewer quality measures within each measure domain of Medicare’s Hospital Star Ratings compared to general full-service acute care hospitals. On average, POHs reported fewer measures compared to general acute care hospitals for patient safety (2.8 vs. 5.0 measures), readmissions (4.3 vs. 7.7 measures), and timely and effective care (2.9 vs. 6.4 measures). The fact that POHs report on fewer quality measures demonstrates that they are fundamentally different from full-service community hospitals – they treat fewer patients (and therefore may not reach thresholds for reporting), provide fewer services and do not meet as wide a range of patient clinical needs.</li> <li>POHs are more likely to be in the lowest peer group for Hospital Readmissions Reduction Program (HRRP) reporting and perform worse than other hospitals within their own peer group. Peer groups in the HRRP are defined based on the proportion of a hospital’s care that is provided to patients who are dual-eligible for Medicare and Medicaid. Specifically, 78% of POHs were in the lowest dual-eligible peer group for HRRP reporting compared to 19% of general acute care facilities. This finding validates prior research showing that POHs treat far fewer dual-eligible patients than general acute care hospitals.</li> <li>POHs performed worse than full-service community hospitals on readmission metrics as part of the HRRP, which reduces Medicare payments to hospitals with excess readmissions. Even though POHs treat younger, less medically complex patients with fewer comorbidities, the report shows that POHs had higher average penalties (0.4% payment reduction vs. 0.3% payment reduction), and a much higher percentage of POHs received the maximum payment penalty compared to general acute care hospitals in the same lowest dual-eligible peer group and market (6.7% vs. 0.5%). At least eight POHs in the lowest peer group received the maximum readmission penalty, which is notable considering only 17 total hospitals (both POH and non-POH) across all five peer groups received the maximum penalty in 2023 and only 10 total hospitals received the maximum penalty in the lowest peer group.<a href="#fn1">1</a></li> </ul> This new analysis adds to more than 15 years of research suggesting that POHs select their patients by avoiding less profitable Medicaid and uninsured patients, treat fewer medically complex patients, and provide fewer emergency services. Beyond validating findings by the Government Accountability Office, <a href="https://oig.hhs.gov/oei/reports/oei-02-06-00310.pdf" target="_blank">Health and Human Services Office of Inspector General</a>, and the <a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/Mar05_SpecHospitals.pdf" target="_blank">Medicare Payment Advisory Commission</a> that POHs do not treat the same scope, complexity, or acuity of patients as non-POHs within the same market, this analysis also shows that POHs have higher average penalties for readmissions compared to full-service community hospitals. In short, by choosing the healthiest and wealthiest patients, POHs pose program integrity, access and health equity risks for the Medicare program. The latest analysis from Dobson | DaVanzo once again reaffirms the need to maintain current law banning physician self-referrals to new POHs and restricting the growth of existing POHs. <hr> <ol> <li id="fn1"><a href="https://kffhealthnews.org/news/hospital-penalties/readmissions/" target="_blank">https://kffhealthnews.org/news/hospital-penalties/readmissions/</a></li> </ol> </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/08/New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.pdf" target="_blank" title="Click here to download the New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals PDF.">Click here to download the Overview PDF</a></div> <a href="/system/files/media/file/2023/08/New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.pdf" target="_blank" title="Click here to download the New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals PDF."><img alt="New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals page 1." data-entity-type="file" data-entity-uuid="c0138c7a-1726-47bb-ab9e-5f89bc11a1b3" src="/sites/default/files/inline-images/Page-1-New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.png" width="691" height="900"></a> </div> </div> </div> Thu, 03 Aug 2023 06:15:00 -0500 Physician-owned Hospitals Blog: New Study Validates the Risks of Expanding Physician-owned Hospitals /news/headline/2023-06-29-blog-new-study-validates-risks-expanding-physician-owned-hospitals A new study on physician-owned hospitals only reinforces Congress’ concerns amid calls by some to repeal restrictions on POHs, write AHA Executive Vice President Stacey Hughes and Federation of ��s President and CEO Chip Kahn. <a href="/news/blog/2023-06-29-new-study-validates-risks-expanding-physician-owned-hospitals" target="_blank">READ MORE</a> Thu, 29 Jun 2023 13:29:20 -0500 Physician-owned Hospitals New Study Validates the Risks of Expanding Physician-owned Hospitals /news/blog/2023-06-29-new-study-validates-risks-expanding-physician-owned-hospitals A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806510">new study</a> funded by Patient Rights Advocate adds to the evidence that physician-owned hospitals (POHs) are not comparable to or substitutes for full-service acute care hospitals. Buried beneath its flawed conclusions on hospital prices are three simple truths: the study was based on a very limited sample size (just eight medical procedures), it relies on misleading data, and, most importantly, the study’s own data shows conclusively that POHs shun medically complex patients, as well as the uninsured and those on Medicaid. The study finding lower prices on eight self-selected procedures obscures the reality proven time and again that expanding POHs would actually increase overall costs to patients, employers, and the federal government, and destabilize access to critical and higher acuity hospital-based services in communities across the country. &nbsp; Specific issues with the study include: &nbsp; <ul> <li>Limited sample of procedures: The study only evaluates a small, self-selected set of eight medical procedures. Perhaps this is because the authors recognize that POHs do not provide the full breadth of services that full-service acute care hospitals provide, as a majority of POHs only offer care for specific services like orthopedic or cardiac care at their facilities. It’s impossible to draw any meaningful conclusions from such an incomplete sample. &nbsp;</li> <li>Relies on misleading data: The most substantial flaw is in the authors’ reliance on price transparency data rather than claims data. The truth is price transparency data does not necessarily reflect what a provider is actually paid for an episode of care. For example, payers routinely deny claims in whole or in part, thus reducing the actual value of what is paid. The rates in the price transparency files also do not account for myriad other factors that could impact the actual amount paid, such as whether the service was one of several the patient received during an episode of care or whether the payment was based in part on performance-based adjustments. At the most extreme example, using the price transparency files runs the risk that the authors are comparing prices for services a POH may not even provide due to “ghost rates” that are known to exist in the transparency files. Take, for example, emergency services. The study compares prices for certain emergency department procedures but fails to acknowledge that POHs provide far fewer emergency services — if any at all — to patients than non-POHs, as <a href="/fact-sheets/2023-03-28-select-financial-operating-and-patient-characteristics-pohs-compared-non-pohs-fact-sheet">prior research</a> has found. Instead POHs generally shift costs for these services, relying on publicly funded 911 services or general acute care hospitals when their patients need emergency care. &nbsp;</li> <li>Ignores POHs’ patient mix: The authors discount the impact of POHs treating a far less medically complex patient population than full-scale acute care hospitals, something that directly impacts the cost of providing care. In other words, POHs select a set of high-margin services to provide to healthier patients who have more generous insurance. For example, the study finds that full-service acute care hospitals treated more than twice as many Medicaid patients and provided nearly three times as much charity care as POHs, a population that is well-documented to be more medically complex, sicker, and higher cost to care for than other patients. </li> </ul> These findings, along with the fact that POHs enjoyed significantly higher financial margins as a result, are entirely consistent with <a href="/fact-sheets/2023-03-28-select-financial-operating-and-patient-characteristics-pohs-compared-non-pohs-fact-sheet">prior research</a> and with previous findings from the Government Accountability Office, the Centers for Medicare &amp; Medicaid Services, the Medicare Payment Advisory Commission, and others.&nbsp;The implications of this patient selection on affordability and access to care led Congress to ban new POHs and restrict the growth of existing facilities thirteen years ago. This study only reinforces Congress’ concerns amid calls by some to repeal restrictions on POHs. In short, this study adds to a growing body of evidence that bolsters the need to maintain current law on POHs. At the same time, it makes unsubstantiated claims based on flawed data about the value of POHs. Congress must consider the far-reaching implications of repealing current law: less access for the nation’s medically underserved, more expensive hospital care for all patients, and an increase in the federal deficit. Stacey Hughes is the �� Association's executive vice president. Chip Kahn is the Federation of ��'s president and CEO. Thu, 29 Jun 2023 10:33:24 -0500 Physician-owned Hospitals AHA, FHA blog says physician-owned hospitals are bad for patients and communities /news/headline/2023-04-24-aha-fha-blog-says-physician-owned-hospitals-are-bad-patients-and-communities Physician-owned hospitals are “not good for patients, communities, the integrity of the Medicare program, or providers who are actually in the business of caring for all patients, 24/7, regardless of their ability to pay or their medical condition,” the AHA and Federation of ��s wrote today in a <a href="/news/blog/2023-04-24-physician-owned-hospitals-are-bad-patients-and-communities">blog post</a>. &nbsp; &nbsp; The blog highlights new data from the health care consulting firm Dobson | Davanzo reaffirming that POHs cherry-pick patients by avoiding the less profitable Medicaid and uninsured patients; treat fewer medically complex patients; and provide fewer emergency services and often rely on publicly funded 911 services and acute care, community hospitals for these services for their own patients.&nbsp; &nbsp;&nbsp; In addition, the blog highlights how the Centers for Medicare &amp; Medicaid Services recently reinforced the need for the ban on new POHs and restrictions on the growth of existing facilities. In this month’s inpatient prospective payment system proposed rule, CMS proposed to reinstate program integrity restrictions for POHs approved as “high Medicaid facilities” due to the risk for patients and the Medicare program. &nbsp;&nbsp; Mon, 24 Apr 2023 15:12:08 -0500 Physician-owned Hospitals