CMS required in June that hospitals and ASCs disclose to patients any ownership stake in a facility by a referring physician. Opponents of physician-ownership have called for this regulation for some time as they wring their hands and allege that doctors refer patients out of financial interest to those facilities in which the referring physician has an ownership stake rather than base the referral on what is the best treatment option for patients. Disproved by numerous public and private studies, the claim runs counter to common sense. The requirements for pre-approval of procedures by insurers, oversight by CMS, reimbursement rules and legal liability provide patients with protection. What is often overlooked is that this malicious allegation vilifies physicians. As a group it calls into question the ethics of professionals who have sworn an oath to use all of their abilities to protect and cure patients.
While opponents of physician ownership actually seek to restrict patient choice and access to high quality care by eliminating physician-owned hospitals, the disclosure requirement is actually good for patient choice. It provides physicians with the opportunity to spend more time with their patients discussing the patient’s treatment. That time can be spent explaining and reviewing referrals and answering patient questions about why a procedure should be done at a particular facility. The regulation affords patients the opportunity to learn that physician-owned facilities deliver higher quality care in patient-focused environments, lower infection rates, lower complication rates, shorter stays and higher patient satisfaction rates.
Robert Welti, MD, the medical director for Regent Surgical Health (for which I am chief operations officer) recommends patients ask their doctors why a facility is being recommended and that patients check on a facility’s performance through HealthGrades, Consumer Reports and other reliable information sources.
As for disclosure, at Regent we provide patients with a disclosure packet that outlines a full overview of the patient’s rights, options and choices:
- Patients are given verbal and written notice of their rights regarding their treatment and treatment options.
- Patients are informed of any physician ownership and the level of that ownership.
- Patients receive notification of their treatment options and their rights in advance of any treatment or procedure.
- Patient’s rights are delivered in methods that the patient understands, whether that means compensating for a disability (blindness; hearing loss, etc.), translation into most common languages and/or use of easy-to-understand language.
- Regent does not allow notification of patient rights the same day as a procedure unless the procedure is medically necessary and the physician making the referral signs off that medical necessity required such action.
- A patient’s advanced directive is obtained if not already on file. (If the patient does not have an advanced directive, the nature and purpose of the document is explained.)
- Patients are asked and it is confirmed that that they were notified of their rights.
- All of the information discussed above is posted in the facilities.
Note: To learn more about the specific CMS rule and its language, click here for the article Physician-Owned Hospitals and Physician Owners Must Disclose Ownership to Patients by Scott Becker, JD, CPA, and Amber Walsh, JD, of McGuireWoods.
With the availability of information on the Internet from sources such as HealthGrades, Consumer Reports, the Department of Health & Human Services and other outlets, patients and their families have greater access to information about their condition, treatment options, the latest relevant technology, facilities and physicians. However, patients and family members performing the research should confirm the details, ratings and information found online.
In the case of the disclosure requirement, the rule of unintended consequences may result in patients learning more about the availability of high quality care at physician-owned hospitals and centers. By spending time with the patient as part of a disclosure process, physicians can help patients plan and schedule their treatment at a time and place appropriate to their condition and convenient for them and their families. An informed patient is good for healthcare and the result of the disclosure rule may be that patients learn in greater numbers than ever before that physician-owned hospitals are good for healthcare, too.
Ms. Deno is chief operations officer for Regent Surgical Health’s Eastern Region. She oversees quality improvement for the entire corporation and operations for Regent’s eastern region centers. She also provides education for the company’s nursing directors. A 32-year healthcare veteran, Ms. Deno received her bachelor’s degree in nursing from Bethel College of Nursing. Learn more about Regent Surgical Health at www.regentsurgicalhealth.com.
