Paul Berggreen, MD, is a gastroenterologist based in Phoenix. He serves as president of the American Independent Medical Practice Association and chief strategy officer of GI Alliance, a nationwide network of independent GI practices.
Dr. Berggreen’s work focuses largely on the sustainability of independent practice and advocates for policies that will lessen the administrative and financial burdens that have contributed to the decline of independent practitioners over the last 20 years.
He recently joined Becker’s to discuss AIMPA’s priorities and what he believes must change in order for independent practice to survive.
Editor’s note: This response has been lightly edited for clarity and length.
Question: What needs to change to give physicians an avenue to sustainably pursue independent practice?
Dr. Paul Berggreen: The priorities that AIMPA has right now are:
1. The Medicare Physician Fee Schedule. We have been advocating for a long-term fix to the annual declines in Medicare reimbursements for many years. What we have seen — and data from the American Medical Association shows that over the last 20 years — general inflation in the country has gone up year over year by about 70%. Payments to hospital systems have gone up about 70%. Payments to facilities such as nursing homes, etc., have gone up about 70%. Payments to physicians have gone up 10% over those 20 years. That correlates to a real inflation-adjusted decrease of 30% in that 20-year period for doing the exact same service. That math is unsustainable. We know the Medicare economic index, which is how much it costs to run a practice, is going up at, you know, “X percent” per year. How about we index the Medicare Physician Fee Schedule to that index? The practice expenses goes up, the payments from Medicare go up. We thought that was going to be in the “Big Beautiful Bill.” And initially it was, and then it was taken out, and then it was put back, and at the last minute, it was taken out. So now we’re stuck with no update to the Medicare Physician Fee Schedule again, which is going to further put pressure on independent practices. So that’s a real loss for the physician community.
2. Another priority here is the site of care differential. That’s tilting the financial playing field hard in favor of hospital systems. And we think that needs to go away. I know that there have been some limited efforts to change that in some situations, such as infusion centers, physician offices on campus, etc., but there needs to be a broad removal of the site of care differential payment, because that is crushing independent practices.
3. We need reform of the 340B drug program. The 340B is a drug program that is basically paid for by pharma and yields huge savings to facilities that fulfill certain criteria for access to Medicaid patients and utilization of these expensive pharmaceutical agents. That is a boon to hospital systems. Independent physicians do not have that same ability. So again, further tilting the playing field there.
4. Stark law. Stark law is a complicated piece of legislation that’s very old and is in dire need of modification. Hospital systems are able to utilize various mechanisms to make their payments to physicians much easier, and not operate with the same strictures that independent physician practices have to operate with in regard to Stark law.
5. This is a state-by-state issue, but certificates of need. The problem is certain states have this certificate-of-need law, and if, for example, you want to build a new endoscopy center, the state then can say, “No, you already have two endoscopy centers over here. You don’t need another one up here. You don’t get a certificate-of-need.” Well, what that does is favors entrenched players. That favors people who are already dominating a market for a service, and most often, those entrenched players are hospital systems. It stifles innovation. It stifles lower-cost entrance into a market. It’s basically putting up barriers to innovation.
Those are the five things that we’re after in AIMPA that should help foster competition and stop tilting the playing field in favor of hospital systems.
