Senator James Lankford (R-OK) participated in a Senate Finance Committee hearing entitled, “Bolstering Chronic Care through Medicare Physician Payment,” where he talked about the importance of encouraging more physician-owned hospitals (POHs) to allow for greater access to healthcare across Oklahoma.
CLICK HERE to watch a video of the hearing.
Witnesses included: Patricia L. Turner, MD, MBA, FACS, Executive Director and Chief Executive Officer of the American College of Surgeons and a clinical professor at the University of Chicago; Melanie Matthews, MSN, Chief Executive Officer of Physicians of Southwest Washington; Dr. Amol Navathe, Associate Professor, Perelman School of Medicine and The Wharton School, University of Pennsylvania; Steven Furr, MD, FAAP, MD, President, American Academy of Family Physicians
POHs represent less than five percent of the 5,700 hospitals nationwide. However, POHs have a successful track record of providing individualized and innovative quality care, and they meet a growing demand for health care services, especially in rural areas. Seventy-three percent of POHs with a Centers for Medicare & Medicaid Services (CMS) overall hospital quality star rating earned three or more stars in the program; 26 percent of them have earned five stars.
Lankford introduced the Patient Access to Higher Quality Health Care Act,which removes the Affordable Care Act’s (ACA) ban on the creation and expansion of new POHs and allows POHs to participate in Medicare and Medicaid. Lankford and Dr. Brian J. Miller published an opinion piece in the Wall Street Journal about the importance of including physician-owned hospitals in the litany of quality nonprofit and community-based health care options available to Oklahomans and people around the nation.
Senator Lankford also today discussed the difficulties many rural Oklahoma health providers experience with Medicare Advantage plans’ frequent use of prior authorization, Medicare savings potential with the use of Alternative Payment Models, such as Accountable Care Organizations, of which Oklahoma has 34, and the existing loopholes in the Medicare hospice payment system.
Excerpt
Lankford: We have not talked about physician-owned hospitals, but that continues to be an issue, long term, with allowing physicians and hospitals to continue to be able to grow and to be able to take care of their patients. I do want to talk a little bit about this prior authorization, doctor. You’ve mentioned this a couple of times as well. We have hospitals in my state that are just no longer taking Medicare Advantage because of the prior authorization, an issue on that. How does that get resolved? What do you see as a solution to that?
Dr. Furr: And you’re seeing physicians refusing to take them along with that. And it’s a huge hassle. It takes a huge amount of time. I think physicians need to be at a practice and again, it’s for big budget items. We don’t I don’t have a problem with prior authorization. But when it comes to basic drugs and basic things we need to do, just to give you a perfect example. If I get a patient with acute abdomen, it’s easier to send them to the emergency room because they don’t have to get a prior authorization to do their CT scan. Then for me to do it in my office, because it could take me a day or two to get that done. So the prior authorizations, which control calls in many ways, are actually increasing cost. And sometimes the best drug might be a more expensive drug, but it’s better for the patient because it might lower their cardiovascular risk along with taking care of their diabetes or their hypertension. So those are all issues with prior authorization that keep us from providing the best care that we can and actually drive up cost.
