The healthcare industry doesn't fit a uniform mold across the nation. California, Massachusetts, New Jersey and Texas certainly stand out among the pack. Here are some differences in healthcare depending on the region.
California
Corporate Practice of Medicine
The Corporate Practice of Medicine requires physicians make decisions independently. The law is intended to prohibit corporations from influencing clinical decisions. Because corporations are not licensed medical providers, they could negatively affect healthcare and sway physicians based on commercial purposes.
The Medical Board of California cites the following decisions as illegal if made by unlicensed personnel:
- Deciding appropriate diagnostic tests
- Deciding appropriate referrals to other physicians
- Overseeing overall care of patient
- Deciding the number of patients physicians must see
- Deciding coding and billing procedures for patient care services
- Hiring or firing physicians
The above represent only a few examples of decisions that physicians must make autonomously. California is often cited as the strictest follower of the CPOM.
This law presents some challenges for physician business ventures when physicians engage in work with unlicensed-owned businesses, according to law firm Nelson Hardiman. California offers the option of a contractual relationship, and outlines legal rights of professional medical corporations and management services organizations.
Massachusetts
Healthcare reform
By the time President Obama signed the Affordable Care Act into effect in March 2010, Massachusetts had already experienced four years of healthcare reform, according to The Henry J. Kaiser Family Foundation. In fact, the ACA was modeled after the healthcare reforms Massachusetts passed in 2006.
Massachusetts legislators sought to offer health insurance coverage to all residents, hinting at a universal-type coverage plan. The state established the Commonwealth Health Insurance Connector, a health insurance exchange website. Another reform affected the private insurance market, which prohibited payers from denying plans to eligible applicants because of health status. Massachusetts expanded its Medicaid and Children's Health Insurance Program and required employers with at least 11 employees to pay toward health insurance coverage. Lastly, the state fined any residents failing to buy health insurance.
Within the year of enactment, Massachusetts saw a staggering decrease in the amount of uninsured residents. Compared to the national average of 18.4 percent uninsured in 2010, Massachusetts had only 6.3 percent uninsured.
Residents in the state also take advantage of more preventive care services and underserved communities receive better healthcare access, compared to before the reform.
With all the reform however, Massachusetts' health spending clocked in at 15 percent higher than the national average in 2012. After ACA implementation, Massachusetts had to adapt its reform polices to adhere to the federal legislation. Still, the state serves as an existing example of successfully implementing a model of shared responsibility.
Massachusetts boasted the lowest rate of uninsured residents in the country, at 3.28 percent in 2014, according to WalletHub.
New Jersey
Out-of-network fees
New Jersey legislators proposed the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act to protect consumers from excessive medical costs for out-of-network visits, according to NorthJersey.com. The bill was introduced to address the issue of consumers unintentionally seeing physicians out-of-network and consequently receiving surprise medical costs.
Payers and medical providers take issue with the legislation as it calls for payer-physician negotiation over disputed payments. The legislation fell flat in December 2015, when it didn't receive enough support.
The Codey Law
Passed in 1991, the Codey Law mirrored the federal Stark Law and focused on physician self-referral. The law prohibited physician referrals of patients for which the physician possessed a beneficial interest. Although initial exceptions protected ambulatory surgery centers, two court cases, Garcia v. Health Net of New Jersey, Inc. in 2007 and Endo Surgi Center, P.C. v. Liberty Mutual Insurance Company sparked concern about the exemptions of ASCs from the Codey Law.
The fallout of the Codey Law amendments in 2009 allowed exceptions for some physician referrals to their own ASCs. The amendments barred the creation of new physician-owned ASCs, with some exceptions. Hospitals and medical schools could still create new ASCs with physicians. The new law also required all ASCs to receive accreditation. New Jersey ASCs face more restrictions than in other states.
Texas
Tort reform
On Sept. 1, 2003, Texas enacted a law that caps the monetary damages plaintiffs may receive for medical malpractice cases. Although other states also enacted limits on damages available to medical malpractice plaintiffs, most cap only non-economic damages. As a result of this legislation, many physicians decided to set up shop in Texas as it protects them from lawsuits in which patients seek a preposterous amount of money for minor complications.
The legislation has caused much controversy, with supporters arguing the law eases physicians' concerns about being sued and lowers malpractice insurance premiums, according to Insurance Journal. Opponents argue the law prohibits worthy plaintiffs from receiving fair compensation for serious injuries or deaths, as many attorneys stray away from the cases.
The number of medical malpractice suits and payouts have significantly decreased since enacting the law, according to Insurance Journal.
Texas Medical Liability Trust
The Texas legislature established the Texas Medical Liability Trust in 1979. The TMLT provides medical liability coverage, or medical malpractice insurance, to physician policyholders. The trust insures more than 14,500 physicians, according to Texas Medical Association. Trusts are unregulated by state insurance departments.
Regional healthcare statistics
Active physicians in 2014
The following are a sampling of states' licensed physician concentrations, according to "A Census of Actively Licensed Physicians in the United States, 2014."
United States
- Licensed physicians — 916,264
- Physicians per 100,000 population — 287
California
- Licensed physicians — 143,427
- Physicians per 100,000 population — 370
Illinois
- Licensed physicians — 43,835
- Physicians per 100,000 population — 340
Florida
- Licensed physicians — 71,024
- Physicians per 100,000 population — 357
Massachusetts
- Licensed physicians — 33,965
- Physicians per 100,000 population — 504
New Jersey
- Licensed physicians — 35,842
- Physicians per 100,000 population — 401
New York
- Licensed physicians — 91,744
- Physicians per 100,000 population — 465
Texas
- Licensed physicians — 72,601
- Physicians per 100,000 population — 269
Vermont
- Licensed physicians — 3,171
- Physicians per 100,000 population — 506
Wyoming
- Licensed physicians — 3,360
- Physicians per 100,000 population — 575
Physician pay
The following lists the highest-earning and lowest-earning states for physician pay, according to Medscape's Physician Compensation Report 2015.
5 top-earning states
- North Dakota — $330,000
- Alaska — $330,000
- Wyoming — $312,000
- Wisconsin — $309,000
- Oklahoma — $304,000
5 lowest-earning states
- Washington, D.C. — $186,000
- Rhode Island — $217,000
- Maryland — $237,000
- New Mexico — $243,000
- Massachusetts — $248,000
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