Keith A. Reynolds 0:00
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Speaker 1 0:27
For the first time, it appears that CMS is not asking whether physician-led hospitals or physician-owned hospitals should be included, but rather, how do we include them in the delivery of care.

Austin Littrell 0:52
Welcome to Off the Chart, a business of medicine podcast, featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name's Austin Luttrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, Medical Economics senior editor Richard Perriton sat down with Dr. Carlos Cardenas, a practicing gastroenterologist, founder and chairman of DHR Health in the Rio Grande Valley, and president of physician-led healthcare for America. They're talking about what Dr. Cardenas calls a landmark moment for physician-owned hospitals. Why the Affordable Care Act froze competition in hospital markets for 15 years, and what the data actually shows about cost and quality at physician-led facilities. The conversation also covers the overutilization criticism, the state and federal rules governing physician ownership, and what it'll actually take to move the needle in Congress. And before we get into it, CMS is currently accepting public comments on the matter through june 9. You can find more information on how to submit a comment below, or by going to cms.gov With that said, Dr. Cardenas, thank you so much for joining us. Now, let's get into the episode.

Richard Payerchin 1:55
I'm Richard Payerchin, reporting for Medical Economics. With me today is Dr. Carlos Cardenas, a gastroenterologist and president of Physician-Led Healthcare for America, or PHA. Thank you for joining us today, Doctor.

Speaker 1 2:10
Really glad to be here, Richard. Thank you for having me.

Richard Payerchin 2:13
Can you introduce yourself and the organization?

Speaker 1 2:16
Sure, my name is Carlos Cardenas. I'm a practicing gastroenterologist in Deep South Texas, I have the honor of being the president of Physician-Led Healthcare for America this year.

Richard Payerchin 2:28
Can you talk a little bit about the size and scale of the organization?

Speaker 1 2:31
Sure, we have a large number of physician-owned hospitals of varying sizes and types that are across the United States, we, as PHA, are the national advocacy organization for advancing physician-led hospitals, their care models, and moving that across the country, because we know that physician-led healthcare benefits patients. Patients are at the center of everything that we do.

Richard Payerchin 2:59
And, Doctor, in a recent video, you used the phrase a landmark moment to describe a development happening within the rules of Medicare's team model. Can you explain what that

Speaker 1 3:11
is? Sure, the landmark moment is the fact that for the first time it appears that CMS is not asking whether physician-led hospitals or physician-owned hospitals should be included, but rather, how do we include them in the delivery of care, and in how we can better serve our patients, and at the same time provide the resources that help us to save money, deliver high quality care and continue to lead patients at the center of what we do.

Richard Payerchin 3:44
Can you explain how the Affordable Care Act regulated physician-owned hospitals?

Speaker 1 3:49
Sure, so with the passage of the Affordable Care Act, the area that you're referring to is Section 6001 What it did is it prohibited new physician-owned hospitals from being built, and it significantly restricted the ability to expand to a certain extent. I think what that really did is it put in a restraint, forbade rather free market competition.

Richard Payerchin 4:17
It's a great segue, because one of the questions I wanted to ask, with those rules in place, in your own words, how would you describe the economic environment for medical practice over the last 15 years?

Speaker 1 4:31
It froze competition in hospital markets. The last 15 years have demonstrated, I think, increasing costs and consolidation, and I think that that's what we're reckoning with now as a healthcare system. What we have provided, I think, all of this time is the opportunity to consider innovation and to consider that physician-led care, physician-owned care can be part of the solution. We're not saying that. We should be the replacement for, but what we should be is part of what's allowed that allows us to work in the marketplace, increase competition, that is what's driven, and it's at the heart of being American, and that leads to innovation that leads to the betterment of models that I think will help us to again continue to focus on the patient and what we can do for our patients to enhance the delivery of care, maintain high quality, and reduce cost by putting physicians who are at the bedside to work in the boardroom to make choices and decisions that help their patients, we can build systems around that that lead to increased savings, increased use of resources in a way that makes sense and allows us to be able to continue to deliver high-quality care, and this has been demonstrated already in studies that have been done now, looking at our models,

Richard Payerchin 6:02
I asked about the economic conditions, and I'm glad you brought in some of the clinical and patient relations conditions too, because obviously we write a lot about dollars and cents, but at the heart of that relationship, of course, is caring for people.

Speaker 1 6:16
Absolutely, it's this all begins and ends at the bedside, and when we think about our, our position in our communities as healthcare facilities and as physicians and providers of healthcare, how we fit into our communities, what I like to call the greater bedside, it's integral, and it has to continue that way, healthy communities are healthy not only when we deal with preventing disease and or treating illness and disease in our communities, but the other aspects of what happens in with a strong healthcare system and a healthy population is is a better community and an ability for a community to continue to develop and grow, and so I see them as intricately linked, and our ability to enhance the delivery of care and find ways to do it that are fiscally responsible, that at the same time allow for innovation and keeping the patient at the center of what we do, I think everybody wins.

Richard Payerchin 7:26
Can you describe when Medicare makes this request for information? Why is that so important?

Speaker 1 7:31
It's about being included, it's about being at the table to help craft policy, provide ideas about innovation, to be able to provide our government with the same tools that we have that we use at the bedside when we care for our patients, and so it helps to bring the two together, and that's why I like to refer to our community as the greater bedside, because it's like we're treating a patient and the patient is our community, but it begins from the same principles that we have when we care for every single person who comes to us as physicians, we take those things that made us go into the field to begin with and apply them to the community at large, and I think that that is fertile ground for innovation and finding better ways to do things, and I think these recent events I think are an affirmation that we're on the right track.

Richard Payerchin 8:24
I really like, I like that phrase about the greater bedside and the notion of applying some of those healing principles to the community, only because, or not least because maybe fair competition just leads to better overall results for everyone.

Speaker 1 8:38
Well, and I think that competition is an interesting concept in and of itself. I think most people try to think of it in a fiscal sense, but I like to think of it more than just the fiscal sense. The fiscal sense is very, very important. Don't get me wrong, I mean, that's what leads to economies of scale, it's what leads to being responsible and fiscally conservative about how you spend your dollars, and I think we were alluding to this when you and I were talking earlier, that it's really responsible now in an era where we've had shrinking resources to be able to do the most with what we have, and so we've got to think about better ways to deliver care that keeps our communities whole and our patients healthy, and so all the strategies are important that are being looked at, that as physician ownership, physician ownership model provides one aspect of how we can do, how we can do this, and how we can improve the dialog and find innovation where we can work together to make a healthier, greater bedside, so

Keith A. Reynolds 9:49
Hey there, Keith Reynolds here, and welcome to the p2 management minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today, whether that means speeding up check-in, lifting stuff. App morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom, they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want to feature it. Shoot me an email at K reynolds@mjlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

Richard Payerchin 10:37
A 2023 study cited by PHA found that Medicare could have saved more than $1 billion on the 20 most expensive conditions if care had been delivered at physician-owned hospitals. How credible is that finding, and what really drives those cost differences?

Speaker 1 10:58
Well, I think it's a lot of what we're talking about. I think that the study that was done was, was, was very credible, it, and, and what is being looked at now, in the larger sense, in the, in the team, as you know, approach to this is that we're looking at procedures that we can look and measure to see how you might scale something that would help us to increase better use of resources, and do we maintain outcomes? Can we improve outcomes in that, and that patients at the end are receiving high-quality care, and we're preventing readmissions, and the other things that add to cost by including the decision makers, rather the physicians, and who are actually delivering care in the process of creating the model to deliver the care, and then measuring it. I think that's where we find the economies, and we find the savings, and we find that we can enhance quality, and so I think that to a certain extent the request for information and for how can we do this is a nod to some of that, and participating in the teams concept lets us focus on high resource use and or frequent diagnoses, and it's a start, but we've got to start if we're going to finish, and that's where we we can find what things work and what things don't, and so I think there's that opportunity, and for the first time we're actually being asked to participate and be at the table to talk about

Richard Payerchin 12:34
it, because we're going to, we're going to go from cost savings to one of the criticisms, frankly, that has been leveled at physician ownership of hospitals, and that is over utilization that in fact could drive costs up. How do you address that concern?

Speaker 1 12:50
Well, I think that that was looked at in that, and in a large study where they found no evidence of basically no difference between physician-led slash physician-owned hospitals and traditional hospital care models that the populations that were being served were basically the same, and given all of that, physician-led hospitals, physician-owned hospitals were, you know, check the check the column when it came to saving, saving money at the same time, delivering high-quality care with better resource management, and at the end of the day, I think that the data itself has spoken, and that's part of why I think we got the ask

Richard Payerchin 13:34
again. Not to belabor the point about potential criticisms, but I did want to ask you to what I like to call the fruit question, so to speak,

Speaker 1 13:42
okay?

Richard Payerchin 13:44
That

Speaker 1 13:45
is cherry picking. The answer is real simple: no. I think the studies have shown that there is no, no, no cherry picking. I can, I can tell you from looking at our vantage point in South Texas, we have never denied a single patient who's come to our door, regardless of their ability to pay. Period.

Richard Payerchin 14:06
Is that a risk, though?

Speaker 1 14:07
Well, I think that there can be a risk for over utilization. I think in any model, and so I think that that's why, in the last probably in the last couple of years, a couple of decades, we have come under increasing scrutiny, and a variety of regulations have been put in place that I think have helped to move us to better utilization than we probably had when I started my career, and so I think to a certain extent that's that's that, but by the same token, we draw a line when it comes to what is the right thing to do for the patient, and that's where we can, we can, we can go too far on the other side of that equation, but we need to find the balance, and that's why it's so important to have physicians at the table to help us to make those. Policy decisions and create the models of the future that again focus on what we do at the bedside. What are the outcomes? What does it cost to do what we need to do, and what can we do to try to improve on all aspects of the equation.

Richard Payerchin 15:15
There are states that have corporate practice of medicine laws that require physician ownership of medical practices, and yet there have been federal regulations in place that limit physician ownership of hospitals. How do you reconcile that?

Speaker 1 15:31
Well, there are, I think, there are a variety of models that have come up in, if you look at across the country, if you go back in history, and you look at the first hospitals that were founded in the United States, and I bet you, if you go look in almost every state's history, you will find that the very first hospitals were founded by physicians and their family members, in many cases, where, in some cases, the physician and his wife, who may or may not have been his nurse, and they worked together, and they had 346, bedrooms or rooms where they would have patients and keep them in their homes, which were some of the first hospitals in the country. I know that was true in our area, and I think that's very true in a large number of areas across the country, and so this is not a new concept. This is an old concept. It's about getting back to basics. It's about the patient and physician relationship, which is a sacrosanct relationship. It's where things begin and end the beginning is that trust between physician and patient, and doing the best that we can for our patients, and that means developing the care structures that we need, that led to the creation of hospitals, that led to the creation of clinics. As time has gone on, and technology has advanced, it's cost us more to be able to do these things. The rules and regulations, as you alluded to, have changed from state to state. Some states are certificate of need states, where you have to display a true need in your community to have a hospital, and other states that we don't have that restriction. Some states have the restriction against the corporate practice of medicine, whereas other states do not have that restriction, so it's different from coast to coast, and so some things are relegated to the states for regulation and rulemaking, where across the country Medicare is, is, is from coast to coast, and there are certain regulations that apply to Medicare recipients, so it's trying to navigate this, and so moving into a system that comes driven by the federal government is one way to approach it, but I think, as you're alluding to, I think it may be different when we try to go state to state, but it certainly would help to open the dialog.

Richard Payerchin 18:07
There has been legislation introduced that would change those rules regarding physician ownership of hospitals, and yet that legislation really hasn't gone anywhere. I guess Medicare is one thing. What's it going to take to get action in Congress?

Speaker 1 18:22
I think we're beginning to see some movement there within the group, just working, looking at the political side of it. I think that the more people we can educate about what we do and how we do it, get them to visit our facilities, I think makes a big difference when people have an idea of what they think something is, but then when they come and see it in person and see what it might mean to their constituents, say for example a physician-led facility isn't, isn't, is in their, is in their district, but if it's not in their district, maybe it's something they can think about for their district, and so I think that the, it's, it's, it sounds pretty basic, but I think it's really politics at the most basic level, and that's informational, and that we aren't, you know, as a group easily pigeonholed that we have a variety of facilities that make up who we, we are as PHA, as an organization, but that the concept of physician ownership is not a new concept, it's a really old concept, and it's about getting back to basics, and this is about getting back to basics, because it's where we can find economies scale, if we can make it available to more, and it again, I think it goes at, if you want high-quality care, it needs to be personal, it needs to be done in a way that enhances a patient's outcome, and how we can do that in the most efficient way possible, because we have limited resources, and we have to be good stewards of the monies that are, that are, that are taken in taxes. And applied to health care

Richard Payerchin 20:02
when the Medicare inpatient rule comes out later this year. If the request for information results in no change, what happens next?

Speaker 1 20:12
First of all, I would say, thank you for including us in the discussion and looking to us for possible innovations, and and then I think we continue to do what we're talking about, and that is to continue to educate, continue to inform, continue to advocate for a model that includes physician-led care, because I think that what we're seeing is a move to that, because the data is definitely pointing in that direction, and we have an opportunity to maybe try some things under the veil of CMMI, the and the teams, the teams experiment, because I would be more concerned about what happens after teams. Can we continue, because we're, you know, to a certain extent, are we going to be allowed to expand? Are we going to be allowed to do these other things? So I think that those are questions that that we need to get think about answers for, but in, but conceptually I think that this is a big step, because it's about having all the players in, in, in the marketplace together to figure out how to, how to make health care better, how to do things that impact again the patient, and what we can do together to try to do the best we can with the resources we have.

Richard Payerchin 21:28
Medical economics, traditionally we serve an audience of primary care physicians. What would you like to say to them, or what would you like them to know?

Speaker 1 21:36
What I'd like to say to our primary care physicians is that they are, they are the base of the pyramid, they are who we are as a community of physicians. They are our base. They deal with the issues with our patients every single day, on both the community level and on the personal level, and they do it every day. And they are, I think, the backbone of what is health care in America is our primary care physicians, and we need to have them available to be able to participate in the models that we create

Austin Littrell 22:22
once again, that was Dr. Carlos Cardenas, a gastroenterologist, founder and chairman of DHR Health, and president of Physician-Led Healthcare for America, speaking with Medical Economics senior editor Richard Perishin. And don't forget, CMS is currently accepting public comments through june 9. You can find more information on how to submit a comment down below, or by going to cms.gov On behalf of the whole Medical Economics and Physicians Practice teams, I'd like to thank you for listening to the show, and ask you, please subscribe, so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts, and if you'd like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six days of the week, subscribe to our newsletters@medicaleconomics.com and Physicians practice.com Off the chart, a Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Latrobe. Medical Economics and Physicians Practice are both members of the MJH Life Sciences Family, thank you.

Speaker 2 23:23
Thank you.

Transcribed by https://otter.ai