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News Clips
Health Affairs (8/30) The FTC's Noncompete Rule: Legal Challenges And Potential Solutions For Physician Markets – The FTC projects that the ban on noncompetes will lead to substantial reductions in health care costs, with estimated savings between $74 and $194 billion in physician services over the next decade. This article explores the implications of the new rule for physicians, examining how noncompetes have affected physician mobility, patient care, and health care consolidation trends. It also examines the legal challenges that have cast uncertainty over the implementation of FTC’s rule and discusses options for federal and state policymakers to build on and strengthen the noncompete ban in the context of health care markets.
Health Affairs (8/28) Rationalizing Physician Regulation – For more than 150 years, physicians shaped the regulatory environment in which they practiced medicine. Early regulatory steps, such as the establishment of educational standards by medical societies, were patient centered and physician led. By the 1970s, however, regulation was no longer patient centered or physician led; instead, the center of gravity had shifted to focus on regulating “the business of medicine”—and, not coincidentally, protecting incumbent medical providers at the expense of newcomers seeking to compete against them. This Health Affairs Forefront article highlights three distinct examples of this phenomenon, each enacted during a different decade; explain their implications for patients and other stakeholders; and suggest several policy options for improving matters.
STAT (8/28) UnitedHealth pledged a hands-off approach after buying a Connecticut medical group. Then it upended how doctors practice – UnitedHealth Group told the Connecticut primary care doctors everything they wanted to hear. Take our money, the company said, and together we can bring about a future where primary care leads. A future where doctors can take better care of their patients, and reap the financial rewards of improved health. We’ll handle the business side while you look after your patients. Instead, almost 10 years after UnitedHealth bought ProHealth Physicians, the primary care network is a shell of its former self. Doctors are retiring earlier than they planned, or leaving for competing practices. Patients with serious medical conditions struggle to make appointments, while others complain of mysterious diagnoses popping up in their charts. Disillusioned, many patients are leaving. STAT examined the aftermath of UnitedHealth’s acquisition of ProHealth to understand the human cost, on physicians and patients, of the conglomerate’s strategy to gobble up physician practices nationwide.
AMA (8/23) Is private practice collapsing? Congress can help stem the tide – It’s time for lawmakers to recognize the threats to independent medical practices and time to take “immediate and decisive actions” to stop driving physicians away from private practice, the AMA told Congress. “The fabric of our health care system, woven with the dedication and expertise of these practices, is unraveling under the compounding pressures of unsustainable financial models, burdensome regulations and systemic inequities,” the AMA said in a statement submitted to the House Ways and Means Committee for its hearing entitled, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.”
JAMA (8/23) Value-Based Contracting in Clinical Care – This study found saturation of the quality measure environment as a possible explanation: average physicians were incentivized to meet 57.08 different quality measures annually. Value-based contracting is intended to incentivize care improvement, but it is unlikely a clinician or practice can reasonably optimize against 50 or more measures at a time. Increased use of such levers may also carry unintended consequences. Clarity and salience are crucial to changing behavior, and the burden of extraneous information and processes has been increasingly associated with adverse outcomes, such as physician burnout. As payers increasingly shift toward value-based contracts, additional research is needed to understand how their ubiquity affects their benefits and how such contracts can be scaled sustainably for clinical care.
JAMA (8/22) Value-Based Payment and Vanishing Small Independent Practices – If policymakers believe the delivery system should maintain some independent practices, then a key challenge is to sustain these practices through value-based payment without requisite corporate backing or ownership. Public and private payers could subsidize these practices directly (through additional payments analogous to those for rural or critical access hospitals) or indirectly through the fee schedule (raising fees for independent sites of care). Payers could continue to promote “low-revenue,” physician-led ACOs by supplying them with more up-front capital, as Medicare plans to do in its recently announced Primary Care Flex Model. Payers could also reduce the threshold of minimum covered beneficiaries to participate, provided practices are able to manage these populations, to promote more equitable access to value-based payment models. Efforts are needed to lower other participation barriers that disproportionately affect smaller, independent practices, including simplifying the significant administrative complexity of the value-based payment landscape and shoring up technical assistance.
STAT (8/19) Private equity: health care’s vampire – The well-established harms of private takeovers of hospitals, nursing homes, and physicians’ practices call for strong action. Although 33 states ban corporations from practicing medicine, loopholes allow private equity firms to use financial levers to effectively control physicians. An outright ban on private equity ownership of doctors’ practices is the only surefire way to assure that these companies aren’t pulling medical strings. A similar ban should apply to hospitals and nursing homes, most of which were built with taxpayer dollars channeled through grants, tax exemptions, and capital payments that are folded into Medicare and Medicaid reimbursements. Mandating that private equity owners disclose their purchases, financial information, and service changes is also needed. Communities, not investors, should control essential health resources.
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