TMA Presses Congress to Preserve Independent Practice Viability
By Alisa Pierce

Administrative hassle, cyberattacks, and other threats to physician practice viability have caught the attention of federal lawmakers, with the Texas Medical Association weighing in heavily on the impacts on physician practices following a May 23 hearing, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.”  

After the U.S. House of Representatives Committee on Ways and Means Subcommittee on Health hearing, which highlighted the impact of health care consolidation on private practices and discussed the flawed Medicare Physician Fee Schedule amid rising costs and other problems, TMA called for a slate of federal solutions in a June 6 comment letter. 

“As Congress further explores challenges that threaten the independent practice of medicine, TMA asks you to consider the consequences of payment reductions, administrative complexities, and the impact of the health insurance market and hospital consolidation on small, solo, and often rural practices,” TMA President G. Ray Callas, MD, wrote. “TMA asserts that inaction will accelerate the decrease in independent physician practice across the United States, ultimately reducing care and increasing costs for patients.” 

In its letter, TMA pressed Congress to find fixes for longstanding issues plaguing physician practices, including: 

• Legislation that will provide a positive, stable, and predictable Medicare physician payment system; 
• Interventions that address the problems of the health care environment, rather than interventions designed to help an individual physician withstand a dysfunctional care environment; and 
• Research into prior authorization burdens and additional modernizations to ensure patients receive physician-directed medically necessary care. 

“The health care marketplace is increasingly hostile to solo, small, and independent practices through factors such as low payment rates that fail to keep up with inflation, increasing administrative burdens, the inability to find and retain staff, and exclusion from health plan networks due to market consolidation and vertical integration. These factors can result in decreased patient access to physician services,” Dr. Callas said. 

During the hearing, the subcommittee also examined the hassles imposed on physicians by Medicare regulations like the Merit-Based Incentive Payment System. Chris Kean, chief operating officer of TSAOG Orthopaedics & Spine in San Antonio, shared with Texas Medicine Today that such regulations put pressure on independent practices that often do not have the resources to manage them “as effectively as larger health systems.” 

Ms. Kean testified during the hearing on behalf of independent physicians after years of watching TSAOG physicians “struggle with or lose the battle” for private practice. 

The committee also examined federal solutions to address Medicare’s payment structure, which Ms. Kean said favors hospitals over independent practices.  

“Financially, the source of revenue for [physicians] is fixed, decreasing, and largely not in their control. Congress not dealing with the annual issue of Medicare pay cuts to physicians, and lack of permanent payment reform, has exhausted an already burned-out population of physicians,” she testified. 

Worsening burnout, prior authorization “has been an absolute disaster,” she added. “It does absolutely nothing to improve care, but it does allow insurance carriers to deny care.”

TMA strongly supports several pieces of legislation that would reform the Medicare physician payment system, reduce administrative hurdles, and improve access to care. 

At the top of the slate, the Strengthening Medicare for Patients and Providers Act, House Resolution 2474, would ensure physicians receive inflationary updates, just like other Medicare clinicians receive. In addition:  

• The recently reintroduced Improving Seniors’ Timely Access to Care Act, House Resolution 3173, would streamline and standardize the use of prior authorization within Medicare Advantage by establishing an electronic prior authorization process and requiring increased transparency from health plans.   
• The Patient Access to Higher Quality Health Care Act, House Resolution 977 by U.S. Rep. Michael Burgess (R-Texas), would overturn the federal ban on creating and expanding physician-owned hospitals.   
• The bipartisan No Fees for EFTs Act, House Resolution 6487, would prohibit payers from imposing electric fund transfers (EFTs). 

Ms. Kean is hopeful that federal legislation will change the landscape for struggling independent physicians. 

“Independent physicians are in the trenches,” she told Texas Medicine Today. 

For help with your private practice, visit TMA’s independent physician webpage. For expert guidance on payer network status, prompt-pay, payment, and other issues, visit TMA’s Physician Payment Resource Center.