Amid increasing consolidation in the gastroenterology industry, many leaders are pushing for changes that would allow private practices to remain intact.
For Paul Berggreen, MD, a Phoenix-based gastroenterologist, president of the American Independent Medical Practice Association and chief strategy officer of GI Alliance, the survival of independent physician practices hinges on more than just passion for patient care. It requires systemic policy change.
Over the last two decades, Dr. Berggreen has watched independent practice erode under mounting financial and administrative strain.
“It’s unsustainable,” he said. “We can’t keep running practices at a loss and expect them to survive.”
Dr. Berggreen joined Becker’s to discuss five changes AIMPA is pushing to level the playing field for independent physicians.
1. Fix Medicare physician pay
The top priority, according to Dr. Berggreen, is a structural overhaul of the Medicare Physician Fee Schedule. Instead of allowing reimbursements to stagnate while practice costs climb, AIMPA wants payments indexed to the Medicare Economic Index, the measure of what it costs to operate a practice.
“We thought that was going to be in the ‘Big Beautiful Bill,’” he said, referring to recent legislation. “It was in, then out, then back in, and at the last minute, taken out again. Now we’re facing yet another year without an update, and that’s devastating for independent practices.”
2. Eliminate the site-of-care differential
Dr. Berggreen argues that current payment policies unfairly advantage hospital systems by reimbursing them at higher rates than independent physicians for the same service, purely based on location. While some targeted reforms have addressed this in specific scenarios, such as infusion centers, AIMPA wants a sweeping elimination of site-based payment differences.
“This is crushing independent practices,” he said. “There’s no justification for paying more just because care is delivered in a hospital-owned building.”
3. Reform the 340B drug program
The 340B program, designed to help hospitals serving low-income patients access discounted drugs, has become another competitive disadvantage for independent physicians.
“It’s a boon to hospital systems,” Dr. Berggreen said. “Independent doctors simply don’t have the same ability to leverage those discounts, which tilts the field even further against us.”
4. Modernize Stark law
Originally intended to prevent physician self-referral for financial gain, Stark law has become a cumbersome barrier for independent physicians, Dr. Berggreen said. Hospitals, he argues, have found ways to work within or around these restrictions more easily than private practices.
“It’s outdated and in desperate need of reform,” he said. “Right now, it’s another example of how the rules are harder on independents than on large health systems.”
5. Remove barriers from certificate-of-need laws
In certain states, certificate-of-need laws require providers to get state approval before opening new facilities. Dr. Berggreen says these laws often protect established hospital systems from competition and block lower-cost, innovative care models from entering the market.
“If you want to build a new endoscopy center, the state can just say, ‘We already have enough.’ That favors entrenched players — and those players are almost always hospitals,” he said. “It stifles innovation and patient choice.”
