Speaker 1 0:00
We're passionate about saving private practice. We think it is the cornerstone of healthcare in the country. It should be reinforced. It should be supported, and not disintegrate.

Richard Payerchin 1:18
I'm Richard Payerchin, reporting for medical economics, with me today are three guests. Dr. Jack Feltz is president and a founding member of the U.S. Women's Health Alliance and an affiliate of Unified Women's Healthcare. Dr. Feltz, welcome.

Speaker 1 1:34
Thank you.

Richard Payerchin 1:35
Dr. Rebecca Herrero is an alliance member and president and CEO of Women's Health Associates of Southern Nevada, and an affiliate of Unified Women's Healthcare. Dr. Herrero, thank you also for joining us today.

Speaker 2 1:49
Thanks, glad to be here.

Richard Payerchin 1:51
And our third guest here is Attorney Dan Fryer, co-founder and co-managing partner of the law firm Fryer Levitt, which specializes in healthcare, life sciences, and the pharmacy industry. Thank you for being here today.

Speaker 3 2:05
Pleasure to be here.

Richard Payerchin 2:07
Some of our audience will be familiar with the U.S. Women's Health Alliance, but for those who are not, can you introduce the organization?

Speaker 1 2:15
Sure, be happy to. The U.S. Women's Health Alliance is a membership organization of privately practicing women's healthcare providers (OB/GYNs) who came together for the sole purpose of improving the care to women, making healthcare more affordable and more accessible for the millions of women across the country. Right, currently the U.S. Women's Health Alliance has practices giving providing care in 37 states, including the District of Columbia, has approximately 5,000 provider members, and provides care to over 10 million women.

Richard Payerchin 2:52
One thing I wanted to ask, because you are both established physicians, how would you describe the current business and financial environment for physicians in independent practice,

Speaker 2 3:02
it can be difficult across many specialties. There is a shortage of physicians, and particularly with OB/GYNs, because of our lifestyle, can be very difficult. Working during the day in an office, taking a call at night, and with younger physicians coming out of residency, having different needs, different asks regarding a work-life balance, it's it's just challenging right now. Challenging to find physician providers to care for all of the women across the nation that need to be cared for, and so with this becomes an access problem. We also know something dear and true to my heart is is that many women have you know work family conflicts because of child rearing responsibilities that kind of pull them out of the workforce or creates this internal strife regarding how to be a practicing physician, how to care for their patients best, but also how to be, you know, a mother and part of a family unit.

Richard Payerchin 4:06
I know that independent medical practice is a subject that is near and dear to the heart of our audience. Can you both take a moment to explain why you're passionate about it? Why are you strong advocates for independent practice? Sure.

Speaker 1 4:22
So, I mean, this goes back probably for me over 40 years when I began in practice, where the relationship with my patients was incredibly personal. Practices were small. independent businesses that allowed the physician and the patient to really have that bond that was special. I remember my first office that I opened. My mother helped sew the curtains. My father helped me build the. Reception desk, and I hung out a shingle and started providing care. Well, fast forward 40 years later, there have been enormous advances in healthcare. I still believe I give personalized care, as most of our private practicing physicians do, to our patients. But with this enormous corporatization of healthcare, vertical integration of hospital systems, big health plan corporations, practicing has become much more strained and more difficult to maintain that personalized relationship. Compete with these Goliaths to stay in practice. We fight for it every day. That's why we are part of Unified Women's Healthcare. That's why we are part of the U.S. Women's Health Alliance. But it is becoming more challenging every day,

Speaker 2 5:43
and I can echo exactly what Jack said or Dr. Phelps said in that I went into private practice so that I could have that long-term relationship with my patients. I'm sure Dr. Phelps has done the same when he was practicing obstetrics. You know, I'm now delivering patients that I delivered, and I love just getting in a room, an exam room with a patient, and you know, before we get to the nitty gritties of why they're there and what their concerns are, just bonding with them and said, "Hey, how are the kids? How are the grandkids? And that's what I love about it. In private practice, you have that opportunity. If you're a hospital based physician, a lot of times, it's a more of a transactional relationship where you see a patient once or twice, but then they go to somebody else. And in private practice, it's just building and maintaining those long-term relationships, getting to know a patient, and providing the healthcare that she needs.

Richard Payerchin 6:39
As I understand it, you worked with members of the alliance to craft some legislation, and members also had traveled to Washington in recent days to meet with lawmakers about the Independent Medical Practice Sustainability and Patient Access Act. What happened with that trip, and what is happening with the legislation?

Speaker 3 7:00
So this this trip and this legislation is the culmination of a lot of work, a lot of time and energy spent by the U.S. Women's Health Alliance. Dr. Feltz mentioned that the goal, the purpose of the alliance is it's very patient centric, but in order to be patient centric, the individuals that are on the front lines of treating those patients have to be treated fairly, and in almost every conversation that happens about reimbursement, about the care of patients, physicians are left out of the conversation. And physicians obviously are the only the only element within the system that actually know how to treat patients. And so I've been very, very blessed with the ability to work with the amazing team at the Alliance, the the the advocacy committee, along with the the board as a whole, to work with them to help develop this proposed legislation. We've been down a couple times to Congress, and they're receptive to the concept of legislation, this is not a this is not a fast process, but we found a number of people very receptive to it, some staffers that really understand it and can explain it to to their representatives, some representatives we met with, so it's it's gaining momentum.

Richard Payerchin 8:17
Regulating anti-competitive hospital conduct, what's an example of that, and what would be a good regulatory solution?

Speaker 3 8:26
So, first of all, we're not anti-hospital. Hospitals are necessary; they're necessary part of the system. But the way that the reimbursement model has been crafted over the years, the same treatment that a physician can provide at a relatively modest level, terms of cost, could can cost 510, 12 times more in a hospital setting, and hospitals get huge amount of reimbursement for the very same procedures, and physicians get very low reimbursement often for that procedure. So what's happened is hospitals, because they make so much money with these procedures, they've had the ability to recruit physicians out of private practice, and it's very hard for private practices to compete with that because they can't afford to pay those physicians what hospitals can in the short term, right? Because it's all short term. Hospitals are they're they're essentially luring physicians out of private practice to get to shore up their referral source, and the physicians are are joining the hospitals. And in many instances, in many cases, in many areas around the country, there are no more private practicing physicians, and it's entirely because there's an unfair competitive advantage that hospital that that hospitals have. Another example, briefly, is that hospitals, not-for-profit hospitals, can can provide loan forgiveness on student on medical student debt. So, if a medical student or resident is coming out of residency and deciding where they're going to go practice, and they know that they they may want to practice with a private practice. But they know that if they go to a hospital, they can get their medical school debt forgiven. It's it's almost impossible to compete with that. It's really the patients, right? Because once the private practices in a particular area have evaporated, patient choice is eliminated, right? Access to care is is is reduced. Patients now don't have a choice. They have to go to a hospital-based physician, and there are some disadvantages to that. Disadvantages to not having that choice.

Speaker 1 10:27
I would add to that. Number one, it is really about the patient's access and affordability. Patient copays, deductibles go up. Their benefits plan becomes more expensive. You see double-digit inflation in in in their insurance, and and the leading cause of of bankruptcy in America is healthcare debt, family bankruptcies, healthcare debt, and there's no surprise. The issue is if you're getting the same quality of care, which most studies, many studies have shown, there's no difference in care between a hospital-based physician and an independent practicing physician, so why would you pay 20% 50% 70% more for that care and then go into incredible debt because of it? So this is what our independent physicians are fighting against. It's not that we don't enjoy our hospitals; we don't enjoy our hospital-employed colleagues. We just think an even playing field will create innovation, fair competition, which is always good for patients. And those patients, by the way, are all of our families across the country.

Speaker 2 11:35
Just personally, as a practicing physician, patients are so much more satisfied with the procedures when they're able to be done in the office, and of course these are going to be you know relatively low low complex low low risk procedures. But if they can do it in an office setting in which they're familiar with the staff, they're already familiar with the setting because they've been in the office. They enjoy it more, and as Dr. Phelps pointed out, the copays or the patient responsibility is significantly less because they don't have the high bill for the surgical center or for the hospital. These are going to be done in many cases without an anesthesiologist, and so for many reasons, patients are generally much more satisfied with these type of procedures if they are performed in a physician's office rather than in a hospital setting.

Keith A. Reynolds 12:34
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 staff 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 kreynolds@mjhlifesciences.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 13:25
Hearing the remark and considering the possibility that there are parts of the country where there are simply no independent physicians left, and again, I don't know that necessarily any kind of handout or favorable or favoritism is necessary as long as you create fair market conditions, it sounds like physicians would compete well in those you know fair conditions.

Speaker 1 13:47
Yeah, I think that's exactly correct. I think most independent physicians are large organizations, unified the U.S. Women's Health Alliance. I mean, that's why I think our membership has grown so dramatically because we just want fair conditions to continue to be in our offices taking care of patients. You know, going to Capitol Hill as Dr. Vera, myself, and and and Dan Fryer do, you know, takes us out of our office, which we don't like because we'd rather be in the office seeing our patients. But if we don't get involved, if we don't become part of the solution, then private practice will disappear. Dr. Herrera and myself, we can both be in the office now, seeing patients. Instead, we're on this interview. Instead, we're on Capitol Hill with many of our colleagues because we're passionate about saving private practice. We think it is the cornerstone of healthcare in the country, we believe that it should not, it should be reinforced, it should be supported, and not disintegrate. And so, we're very passionate on behalf of our patients to make one point. Both Dr. Rio myself, we could easily become hospital-employed physicians. Potentially, our salaries would go up because of that. It's not because we don't have choices. We don't want those choices because we do not believe they're in the best interest of our patients. We believe private practice is in the best interest of our patients, and that's why we fight this battle every day on behalf of doctors across the country and the patients they care for to stay in private practice. It is in no way, shape, or form, our only choice, but we believe it's the best choice for our patients.

Speaker 2 15:26
And you know, I know when I myself seek out medical care, I seek out private practice providers for the reasons that Dr. Phelps outlined. I believe that I'm getting more personalized care that is in my best interest. Once again, not stating that those that work for a hospital system are bad physicians or poor physicians who are not going to give out good care, but that's just not the kind of care that I want for myself. The

Richard Payerchin 15:52
legislation also deals with proposals that would stabilize physician payment. What would you like to see?

Speaker 3 16:00
So, yeah, the couple things that that legislation does to address hospital disparities. Number one, it it shores up some definitions that that are inside already existing laws. So, for example, there's a law, the anti kickback statute and Stark separate law that that essentially require physicians to be paid fair market value for from hospitals, because if they're paid more than fair market value, the idea is that they're being paid to make referrals, and that's not legal. And so, one of the things that the legislation proposes is to redefine or clarify the meaning of what's commercially reasonable and fair market value, but without getting into too much debt or depth on this, the the idea that that that a hospital can effectively lose money paying a physician on the professional fees that they generate year over year over year and call that commercially reasonable doesn't doesn't make sense to us, and we want the legislation to make that very clear. Another part of the legislation deals with with outpatient procedures, and there are there are a bunch of a number of procedures that can be done both in an office setting or an ASC setting or a hospital outpatient department setting. And in those instances, we're asking that the the the delta between what physicians get reimbursed in their office for that procedure versus what a hospital gets reimbursed in an outpatient department that that delta be be narrowed a bit. We've elected not to seek a reduction in what the hospital gets paid. There's all sorts of proposed legislation already out there to reduce that amount of money to make it to reduce the disparity between different locations where services provide provided. We've decided not to take that route in this legislation, although we're not opposed to what I've just said. Our route is pay physicians a little bit more. Now, what we believe that will result in is a reduction in total cost of care, and and this is where we're sort of outside the box because the concept is if you pay physicians a little bit more for the procedures that can be done in an HOPD, a hospital outpatient department, that more physicians will be able to stay in private practice, and if more physicians can stay in private practice, they won't enter into these relationships with hospitals where they are pressured to refer to the hospital, which is a higher cost solution for patients. So more patients under this idea will will stay with their their more patients will be able to stay with their physicians in private practice, and at a lower cost because the doctors are getting a little bit more money, enough to keep them in business and not force them into the arms of the hospitals, and it creates a competitive environment where hospitals exist alongside private practices, which has always been the way things worked best.

Speaker 1 18:56
Yeah, I'll add to that because I think the the importance of what Dan just said is is is pivotal. Together, where there's a community need for a subspecialist, that's fine. That's a hospital employed model that has to occur. But where there's plenty of community physicians, hospitals and private practicing physicians should work together to come up with solutions how to improve care, make care more accessible, and make care more affordable. Instead, there's an enormous amount of time, resources, and energy wasted on this ridiculous, unfair competitive landscape. This vertical integration that's happening, benefiting no one, certainly not benefiting our patients, and I don't think at the end it's certainly not benefiting private practitioners. But I don't think at the end it's going to benefit hospitals. Congress is clear that they can't see this healthcare inflation continue, so let's spend our resources working together, hospitals, private practicing physicians, to improve the care we give versus competing, and no one wins.

Richard Payerchin 19:57
Medicare has published rules of the new. Team payment model with a request for information about physician-owned hospitals. Do you think expansion of physician-owned hospitals could lead to improvements, say at the local level, the regional level, or even at the national level?

Speaker 3 20:15
Physician-owned hospitals have have have been a hot-button item, mostly because of a fear that physicians will have an incentive to refer to the hospital for services that patients don't need. Right, that that that ownership relationship will create a conflict of interest. I don't agree with that. I think right now there is already a massive conflict of interest that needs to be dealt with when you have a physician whose employment by a hospital depends to some extent on the the tacit understanding that they must refer to the hospital, and they get judged on on patient leakage outside of the hospital system, and they risk losing their jobs if they don't play that game. I think that is a much greater problem. I think allowing careful physician ownership of certain types of hospital systems in certain types of situations will create a competitive environment with traditional not-for-profit hospitals that are run by essentially by a board that's a community board. Very very little physician involvement in those things. I think it creates a competitive environment, and I think it actually reduces the likelihood of a a self interested referral if done properly.

Speaker 2 21:33
And I agree with that point. I know where I'm located in Nevada. We previously had a physician owned hospital here for obstetrics and gynecology. It was very specific. It was not a hospital for all medical concerns. If a patient gets pregnant, you know there is a single outcome. She is eventually going to deliver. And so, how do you say that there's going to be increased referrals when everybody who is pregnant is eventually going to deliver, and so it would be you know physicians investing, and I don't mean financially, but investing time, energy into this hospital to make it you know a stellar hospital. Same thing with gynecologic surgeries, you know, as was stated earlier by Dan, we need our hospitals, but you know just for appropriate referrals, sending them to the hospitals, but then physicians could be incentivized to keep the procedures that are appropriate in the office to stay in the office. Obviously, I'm talking about a very narrow focus here as an OB/GYN as well as Dr. Feltz, but I'm sure there's cases for physician-owned hospitals in other cases as well,

Speaker 1 22:41
you know, as OB/GYNs, probably 30 years ago, we were really specialists purely in reproductive organ health. That whole dynamic has changed. I don't even call myself an OB/GYN anymore. I call myself a women's healthcare specialist because we are really trying to look at the whole health, from beginning to end, of a woman's life cycle, birth through menopause and beyond, and that's really important that we are able to do that and not just be parts changers as some specialties. That's what they do, and they do it well. We're in a whole different ballpark, and women drive the health of their family in a big way. Probably 80% of the healthcare dollars are spent by women's decision for herself, her children, her spouse, and so private practitioners are best positioned, as Rebecca said. I have patients that I've been taking care for over 40 years, from their adolescence through their menopause, and it's a relationship that, if it's lost, it would be it would be just a crying shame, and and so it's not just about the healthcare dollars being less expensive, affordability, access. It's a it's about the comfort, you know. Hippocrates once said, the father of modern medicine said, treat sometimes comfort always. As private practitioners, we really have relationships that can comfort, and we can drive those patients' health habits to be better, and the health habits of their families, which is not only better for our society, but it's very cost-effective for our society as well, so we are really at a tipping point, especially in women's healthcare. We'll fight to save it, but we need legislative help. We need help from our communities. We need help from our patients to fight this battle. We cannot do it alone.

Speaker 2 24:34
He's absolutely correct. That I can't tell you how many times patients come in and they're like, even for themselves or perhaps for their spouse, they need a cardiologist, and they're asking, you know, us, you know, who do we trust in our communities? And that's like he said, women are the drivers of you know the healthcare dollars and where people are going to see other you know other providers. I know, like I said previously, because of my perhaps bias, I like private practice physicians. I will inevitably send if somebody needs a cardiology referral. I will send them to a cardiologist who is still in private practice, if I can.

Richard Payerchin 25:15
What are you hearing from your peers about the place of independent practice in U.S. healthcare? Is there still interest out there?

Speaker 1 25:22
There's enormous interest in independent practice. I think that many residents, if educated appropriately, would rather have the autonomy of independent practice. Physicians who are in practice would rather stay in practice. We just had as our keynote speaker at our U.S. Women's Health Alliance meeting, the Speaker of the House of Delegates for the AMA, who was in private practice and and couldn't afford to stay anymore. She's now fighting the battle for independent practice. I think there's incredible desire to to stay in private practice, to be in private practice. The model doesn't work though. The economic model is stacked against private practitioners, so they're not leaving private practice in most cases because they would prefer to be in a in a in an integrated hospital system. They're leaving because they've run out of choices to be able to afford to give the exceptional care that they so desire to do so. So I don't think it's an enthusiasm to stay in private practice. I think it's a practical reality that they cannot stay in private practice.

Speaker 2 26:28
And I think we are seeing some in certain pockets of physicians leaving hospital systems and joining private practice if it's economically feasible, just because they're frustrated by the administration of some of the hospital systems regarding you know time off and lack of autonomy and lack of ability to refer to whom they want, and I think you know at the beginning they see you know dollar signs or they see other things that may have lured them to the hospital, but once they're there, it's not roses, and so they are trying to transition into a private practice setting if they're able to.

Speaker 1 27:07
I would invite any and every hospital health plan executive, CEO, or otherwise to talk to us about the opportunity to work together to allow prosperity for all stakeholders, while we maintain the highest level of care, the most affordable care, and the most accessible care, I think there's a pathway forward. If we get out of this rut of this deadly competition, whether it's hospital against hospital, whether it's hospital against private practitioner, I think that's a losing formula, and I invite any healthcare health plan executive or hospital executive to talk to us about solutions for both parties to prosper while patients get the best care.

Austin Littrell 28:04
Once again, that was a conversation between Medical Economics Senior Editor Richard Payerton and Dr. Jack Feltz, President of the U.S. Women's Health Alliance, Dr. Rebecca Herrero, President and CEO of Women's Health Associates of Southern Nevada, and Attorney Daniel Fryer, co-managing partner of Fryer Leavitt. My name is Alton Latrell, and 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 a week. Subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart, a business of medicine podcast, is executive produced by Chris Malini and Keith Reynolds, and produced by Austin Latrell. Medical Economics and Physicians Practice are both members of the MJH Life Sciences family. Thank you.

Transcribed by https://otter.ai