Physicians are facing increasing economic challenges that threaten their autonomy as healthcare consolidations.
One significant issue, according to James Krantz, MD, family medicine physician at Frederick, Md.-based Catoctin Medical Group, is the growing disparity between the facility fees hospitals can charge and those available to independent practices.
Hospitals are permitted to charge facility fees when medical services are performed in outpatient settings, even if the facility is far removed from its main campus. This allows the hospital to tack on additional charges for services that would cost less if performed at a private physician’s office.
Additionally, as health systems continue to acquire more physician-owned practices, they can not only charge hospital-level rates for the same services but also add expensive facility fees, increasing costs for patients.
These facility fees have contributed to the erosion of physician autonomy, Dr. Krantz told Becker's, and the introduction of nonclinical businesspeople into medicine decades ago helped set the stage for this decline.
"One very doable strategy to empower physicians is to make it more economically feasible to run a private practice," he said. "A change that could immediately affect this is to give physicians in private practice the same facility fees that hospital-owned practices routinely receive."
Private practice physicians are left at a disadvantage, as they cannot charge these facility fees.
"Hospitals can open their own practices or extensions and call them hospitals, benefiting from a 50% [facility fee] advantage that I don’t receive as a private practice physician," he said.
While equalizing facility fees could empower physicians, Dr. Krantz notes that this type of reform is unlikely to happen anytime soon. Any meaningful change would need to come from federal lawmakers, he said. and physicians lack the political power necessary to influence such decisions.
While hospitals have powerful and effective lobbies, "doctors are often infighting," Dr. Krantz said.
Other leaders are also concerned about the disparity, particularly amid the stark declines in physician pay.
"Resources for small groups are limited, and we see any increasing share of revenue is derived from facility fees and hospital fees versus doctor fees, which are declining," Harel Deutsch, MD, co-director of the RUSH Spine Center, told Becker's.
While it's "unlikely that equal facility fees will happen," Dr. Krantz expects more physicians will opt out as the "existing medical system deteriorates."
This opting out has already been seen with concierge care, he said, allowing patients who can afford it to turn to physicians who charge a fee for access "to have a more personalized experience without waiting in line."
Concierge care fees not are not covered by insurance and can range from annual fees of $199 for Amazon's One Medical to $10,000 or more for top-branded practices such as Boston-based Massachusetts General Hospital's concierge service.
There are 5,000 to 7,000 physicians and practices providing concierge care in the U.S., according to Concierge Medicine Today, and the market is expected to grow in revenue by 10.4% annually through 2030.