WEB EXTRA!
WEB EXTRA! Chair of AAFP delegation to AMA
announces council run BY CINDY BORGMEYER
Members of the AAFP delegation to the AMA expected few surprises at the 2004 interim meeting of the House of Delegates Dec. 4 - 7 in Atlanta and, by and large, they weren't disappointed. AMA delegates at the meeting renewed their commitment to push for meaningful medical liability reform, an equitable "fix" for the Medicare physician payment formula and confidentiality of peer review processes.
What was disappointing, however: AMA delegates handily adopted several measures related to physicians' interests in so-called specialty hospitals despite protests from members of the AAFP delegation.
"The only people who testified for the community hospitals and against the specialty hospitals were family physicians Larry Anderson, M.D., and Daniel Heinemann. M.D.," said Daniel Ostergaard, M.D., AAFP vice president of international and interprofessional activities, who attended the meeting. "There was no sympathy whatsoever for the community hospitals."
At issue was AMA Board of Trustees Report 15, a lengthy document sporting 11 recommendations. Overall, the report recommends encouraging competition between community hospitals and specialty, or limited-care, hospitals "as a means of promoting the delivery of high-quality, cost-effective health care."
Unfair competition
But the playing field for the two types of facilities is far from level, Ostergaard contended.
"The majority of people in this country get their care in the community hospitals, particularly those in the smaller cities," Ostergaard said. "The creation of specialty hospitals has the potential to take patients away from the community hospitals -- patients who have Medicare or other insurance and whose financial reimbursements support community hospitals.
"Community hospitals cost-shift from the emergency room -- which loses money -- and all the indigent care that these hospitals take care of. The specialty hospitals aren't going to be taking care of indigents. The only way community hospitals can pay for the care they provide as the safety net for all people is through orthopedic and cardiovascular and those kinds of procedures. If those procedures are skimmed off by the specialty hospitals -- there's no money left."
And while some data may indicate specialty hospitals garner better outcomes on the limited types of procedures they do perform, such claims should be taken with a grain of salt, Ostergaard noted. The limited-care facilities don't care for the sickest patients, he said, and "they certainly don't take care of the whole patient, including their hypertension and everything else."
For more about the impact of specialty hospitals on communities and their full-service hospitals, go to http://www.aha.org/ahapolicyforum/trendwatch/twsept2004.html to download a PDF version of the American Hospital Association's September 2004 TrendWatch, which discusses this topic. Help using PDF documents is at http://www.aafp.org/pdf.xml.
"Corporate practice of medicine"
According to Anderson of Wellington, Kan., an AAFP delegate to the AMA, testimony was largely limited to three recommendations in the report. It was those areas that he and Heinemann took issue with. Namely, the report calls for the AMA to:
While that last recommendation ostensibly aims to eliminate interference with the doctor-patient relationship and end control of physician referrals by the hospitals or health systems employing those physicians -- what the AMA calls "corporate practice of medicine" -- the association is really trying to protect physicians' ability to self-refer, said Anderson.
"The AMA says 'We want competition,' but then says 'We don't want corporate medicine,' Anderson explained. "What they're really saying is 'We want competition, but we don't want anybody competing with our way of doing it.'"
Unintended consequence
The unintended consequence of prohibiting corporate practice of medicine would be the elimination of all arrangements in which physicians are employed by such systems, a prospect Heinemann, a former member of the AAFP Board of Directors who practices in Canton, S.D., finds untenable.
"The law in South Dakota (dealing with corporate practice of medicine) was modified when the prohibition was brought forward by (physicians working in) small rural hospitals who found it difficult to handle the business part of medicine," Heinemann explained. In his state and others, he said, such arrangements have allowed more physicians to remain in practice.
"There are probably only about 100 of these specialty hospitals throughout the country," said Anderson. "If each of them is owned by, say, 30 docs -- that's 3,000 doctor owners.
"A lot more physicians than that are employed by hospitals, so we did get that concession," he added, referring to the fact that delegates voted to refer that particular recommendation to the AMA Board of Trustees for further scrutiny.
The remaining 10 recommendations were adopted at the meeting.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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