Medical ethics have indirectly regulated the patient-doctor relationship for thousands of years. Today’s health care policies are primarily designed to politically regulate that relationship in accordance to medical ethics with a great focus on the patient’s best interest. Recently, however, the emergence of many physician-owned specialty hospitals has ignited a controversial debate over the legitimacy of their entitlement to receive Medicare and Medicaid reimbursement; especially with their higher prices than their competitor public hospitals offering the same services. It was not until 2006 when supported data proved that physician-owned specialty hospitals function differently from equivalent public hospitals.This paper discusses the progression of that debate after 2006, presents an objective conclusion about the problem, and proposes a legislative solution for this situation.
Progression of the debate
In 2007, the House of Representatives passed the Children’s Health and Medicare Protection Act which included a provision that eliminated the whole hospital exception for all new or addition to existing physician-owned specialty hospitals (Perry, 2012). Next, in the same way, another similar provision was passed in 2008 (Perry, 2012). But, unfortunately, none of these bills were enacted (Perry, 2012) which attributed to a further growth of the threat to the ability of public hospitals to bring enough revenue to be able to afford their charitable community services.
According to Spatz et al. (2012), that conflict became more prominent with the enactment of the Patient Protection and Affordable Care Act (PPACA) in 2010; which largely increased the federal funding for community health centers to mainly help the uninsured and underinsured population. Although this increased funding enables this patients’ group access to primary care, it does not facilitate their access to specialty care (Spatz et al., 2012). This, undoubtedly, is very critical since quarter of patients who visit community health centers get referred to see specialists (Spatz et al., 2012); hence the urgent need for strong distinctive legislation to better care for these patients. Clearly, specialty hospitals have very limited incentives and interest in treating these patients who cannot afford their services. Moreover, as specialty hospitals selectively serve patients with low risk profiles and leave complicated risky cases for community hospitals, community hospitals’ revenues from these specialties and general profitability dramatically decreased. Evidently, this unfair competition left community hospitals unable to provide free services for the uninsured or underinsured patients (Spatz et al., 2012).
Finally, in 2010, section 6001 of PPACA put an end to the controversy of specialty hospitals by prohibiting all the existing 265 physician-owned and any new specialty hospitals from filing Medicare claims if the referring doctor has any financial relationship to the hospital...