Dr. Jha returns to Washington, briefly
Dr. Ashish K. Jha, dean of the Brown University School of
Public Health, addresses members of the House Committee on Ways and Means.
While the
array of forces driving the demise of independent physicians in the United
States is complex, Congress can take multiple key actions to support private
health care providers and enable them to focus on patient care.
That’s according to Dr. Ashish K. Jha, dean of the Brown
University School of Public health.
The top of his list? Ensure that Medicare pays private
physicians the same amount that it pays health care systems for the same
medical services.
“I think Congressional action on site-neutral payments is essential,” Jha told members of Congress on Thursday, May 23. “It just makes no sense to pay more for the same care, in the same location, just because the ownership of that practice has changed.”
Jha spoke as a witness in a Congressional hearing on how the
federal government can address the decrease of small, independent physician
practices nationally. He was one among a panel of experts who testified in a
U.S. House of Representatives Committee on Ways and Means subcommittee
hearing titled “The Collapse of Private Practice: Examining the Challenges
Facing Independent Medicine.”
In addition to serving at Brown as School of Public
Health dean and a professor of health services, policy and practice, Jha is a
practicing physician who has spent much of his clinical career caring for
military veterans in the Veterans Affairs Health Care system. In those
different capacities, Jha told Congress, he has witnessed the collapse of small
physician practices and the resulting impacts on both patients and providers.
A major factor in the decline of private practice, Jha
said, is a payment system through which Medicare pays more when a patient
receives care at a hospital or a health care system than at an independent
practice.
“This totally perverts the marketplace,” he said. “There
is now this very large incentive for hospitals to buy up physician practices,
and that doesn’t increase access, it doesn’t increase quality — all it does is
allow Medicare to pay a lot more, and consumers to pay a lot more through
private insurance.”
Another major burden facing independent physicians, Jha
said, is the commercial takeover of Medicare via the Medicare Advantage
program, which requires complicated documentation from physicians, increases
the chances that recommended treatments will be denied and hampers doctors’
ability to provide care.
Jha also recommended vigorous federal enforcement of
anti-trust laws to reduce the consolidation of physician practices by private
equity firms; legislation focused on transparency around medical practice
ownership; and adjustments to physician pay rates to keep up with inflation.
“My belief if that if we do all these things, we can have
a dynamic health care system where independent practices can thrive and
flourish, and patients can have more choices, lower costs and better care,” Jha
concluded.
