President Donald Trump's executive order on price transparency will support the transition to value-based care and enable patients to compare care costs across settings, according to independent physician Mara Holton, MD.
Dr. Holton is an independent urologist at Annapolis, Md.-based Anne Arundel Medical Center, as well as health policy committee vice chair of the Large Urology Group Practice Association, which advocates on behalf of independent physicians.
Dr. Holton told Becker's ASC Review how the recent executive order will affect patients, hospitals and independent physicians.
Note: Responses were lightly edited for style and clarity.
Question: Is President Trump's executive order on price transparency a good thing for independent physicians? Why or why not?
Dr. Mara Holton: The executive order on price transparency, most significantly, represents an opportunity for patients to evaluate the actual cost of equivalent care in different settings. The opacity of the pricing system has created distortions in the marketplace that have promoted behaviors, such as hospital acquisition and vertical integration, which have further accelerated the rise in healthcare costs. Furthermore, it has been largely unknown (and unknowable) to patients that these steep rises are disproportionately attributable to hospital costs. As an example, a Health Affairs study found that, between 2007 to 2014, hospital prices for outpatient care grew at 25 percent, while physician prices only grew 6 percent. Similarly, the price of inpatient care increased over the same interval by almost three times that of physician prices.
Initiatives of this type are critical components toward leveling the playing field between hospitals and independent practices, ensuring that care can be delivered in the most effective and most cost-efficient setting. It has been a long-standing fundamental of LUGPA's advocacy goals to demonstrate the value independent practices can offer in the setting of escalating healthcare costs and to parlay those strengths into opportunities for additional savings going forward.
Q: What should independent physicians start doing today to get ahead of this executive order and its implications?
MH: We expect the hospital lobby to push back vigorously against the executive order. Clearly, suppression of objective cost data has enabled, in many cases, a monopolistic advantage, which has then been further promoted by continued consolidation and acquisition of providers by hospitals and hospital systems. Independent physicians, including members of LUGPA, are prepared to endorse this executive order and explicate the critical significance of price transparency in fostering a healthcare system that prioritizes patients' rights to informed healthcare decision-making. Whether this advocacy takes place in formal or informal settings, I encourage all independent physicians to remain proactive in ensuring that our viewpoints continue to be heard as advocates, not only for the independent practice of medicine, but most importantly, for the patients who consume care. True price transparency will be an invaluable component in supporting the delivery of high-quality, efficient care in this country.
Q: How does the executive order relate to the biggest issues independent physicians are facing?
MH: The question of price transparency is inextricably linked to the most pressing issue facing independent physicians today: the increasing rate of hospital consolidations and mergers, including acquisitions of independent practices across the country. The 2018 AMA Physician Practice Benchmark Study found a continued shift toward consolidation, identifying, for the first time ever, more U.S. physicians working as employees (47.4 percent) rather than as owners of independent practices (45.9 percent). According to Axios' "Vitals," consolidations have largely driven this increase in physician employment, as hospitals have sought to maintain and raise their market shares. This trend raises prices and erodes competition, making it increasingly difficult, and sometimes impossible, to compete in an industry dominated by hospital monopolies. The national mandate toward value-based care makes it imperative that initiatives nurture independent practices as the most fecund incubators of innovative and efficient mechanisms for delivery of care. This executive order will help foment a competitive healthcare marketplace that enhances opportunities to recognize and expand the provision of value-based and cost-effective care.
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