Saving Private Practice

August 31, 2024

Is private practice collapsing? Congress can help stem the tide
AMA
By Tanya Albert Henry
Aug 23, 2024

It’s time for lawmakers to recognize the threats to independent medical practices and time to take “immediate and decisive actions” to stop driving physicians away from private practice, the AMA told Congress.

“The fabric of our health care system, woven with the dedication and expertise of these practices, is unraveling under the compounding pressures of unsustainable financial models, burdensome regulations and systemic inequities,” the AMA said in a statement submitted to the House Ways and Means Committee (PDF) for its hearing entitled, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.”

The AMA urged Congress to pass comprehensive legislative reforms that create:

• Equitable payment models.
• Reduced administrative burdens.
• Expanded support for rural and underserved areas.
• A health care infrastructure secured from emerging threats.

Re: The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine
STATEMENT of the American Medical Association
U.S. House of Representatives Committee on Ways and Means
May 23, 2024

The American Medical Association (AMA) appreciates the opportunity to submit the following Statement for the Record to the U.S. House Committee on Ways and Means as part of the hearing entitled, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.” The AMA commends the Committee for addressing this critical issue that threatens the very existence of private medical practices. The AMA is fighting tirelessly to combat the financial and regulatory challenges that jeopardize the survival of these practices. The situation is dire and multifaceted, involving not only the fallout from the COVID-19 pandemic, but also drastic cuts in physician practice payments relative to inflation, surging practice costs, and overwhelming administrative burdens. These payment reductions and burdens are forcing more and more physicians to either close their doors or merge with larger health care systems, severely limiting competition and patient choice. While the pandemic has amplified existing financial pressures and highlighted the urgent need for continued legislative intervention, the relentless cuts in physician practice payments present an immediate and existential threat to private practices.

CONCLUSION 

The AMA implores Congress and all stakeholders to recognize the imminent and severe threats to independent medical practices. The fabric of our health care system, woven with the dedication and expertise of these practices, is unraveling under the compounding pressures of unsustainable financial models, burdensome regulations, and systemic inequities. We urge immediate and decisive action to correct the course with comprehensive legislative reforms that ensure equitable payment models, reduce administrative burdens, expand support for rural and underserved areas, and secure our health care infrastructure against emerging threats. The AMA and physician community stand ready to work with Congress to preserve the legacy and future of independent physician practices, ensuring that they continue to provide high-quality, personalized care to all communities across the nation. This is not just a call for action; it is a plea to safeguard the heart of American health care before it is too late.

 

Comment by: Don McCanne

For well over half a century, the AMA has seemed to be opposed to government involvement in health care such as through a national health care program like single payer Medicare for All. Although the original Medicare program was accepted because it did provide coverage to all of our senior citizens, including those previously unable to afford medical care, there was some reluctance because of concerns about the government being involved in ensuring adequate funding and appropriate regulatory oversight. There was still strong support for private funding through cash payments or private insurance, especially employer-sponsored plans. There was also the recognition of a need for funding care for the truly indigent, such as Medicaid and other government programs.

So what has happened to this system that the AMA refused to replace with a comprehensive system for everyone? The physicians believed that, as long as they remained in control, they could continue to practice on their own terms, taking good care of the physicians, even though the patients may not have fared as well without more comprehensive government oversight.

But look at what has happened as they encouraged the private sector to maintain and expand control of health care in America. Private equity has moved in and managed to convert the primary mission of the health care system from maintaining the health of the patients to placing the creation of individual wealth of the owners as the highest priority. The private insurance industry has been particularly adept at gaining control of the medical-industrial complex with a private regulatory system that is designed to move those health dollars to their own coffers. The physicians who believed that they could continue to practice on their own terms have now found out that their terms are being dictated to them as they have actually been placed in a position of themselves being chattel that are bought and sold by this nefarious industry.

Now how does the AMA feel about the government being involved in the provision of health care? The system is such a disaster that has created a massive burnout of the profession that they are actually going to Congress – the government! – to plead that the government finally does something about it.

It is interesting that most of the requests are not simply to increase their net income, but also to make the system work better by creating an environment in which physicians are more comfortable in caring for their patients. Many of the these proposed changes will create a health care environment that does improve care for the patients as well. You see, though physicians want a system that works well for them, they are not opposed to a system that works well for the patients.

As you examine the list of improvements that the physicians are requesting (See Statement to Congress), you can see that the list could be readily modified to create a system that works well for both physicians and their patients. And we already know that enacting and implementing a single payer Medicare for All system would be the most effective for all parties concerned.

We really do want the government involved, and the AMA has now opened the doors as they stand ready to work with Congress. As they say in their Statement to Congress, “This is not just a call for action; it is a plea to safeguard the heart of American health care before it is too late.”