Position paper highlights need for maintaining patients over profit, protecting patient-physician relationship
Sept. 17, 2021 (ACP) – The American College of Physicians is reemphasizing the importance of putting patients over profit in a new policy paper highlighting the potential impact that the growing number of for-profit and private equity investments in medicine may have on patient care.
“The U.S. health care system has become more profit-oriented in the last few decades. There's been a lot of integration and consolidation in the health care sector, including the Aetna-CVS merger, and private equity companies are taking a bigger interest in health care,” said Ryan Crowley, ACP senior associate of health policy.
Proponents argue that such commercialization in health care will encourage innovation, boost efficiency and provide financial stability for doctors and practices. Physicians should be able to make a reasonable income while providing high-quality care to patients, but problems can arise when business interests get in the way of patient-physician trust or impede access to affordable care.
The paper, which appears in the Annals of Internal Medicine, calls for more research on how these deals affect profits, patients, physicians and the health care system as a whole. Until then, transparency, oversight and a sense of mission are greatly needed, Crowley said.
For starters, efforts aimed at strengthening the patient-physician relationship can help mitigate some of the potential negative effects of commercialization in health care, he said. This includes ensuring that all Americans have access to health care; expanding evidence-based, patient-centered, shared decision-making tools; and making sure that price and quality are transparent.
Downstream effects of a business-oriented health care system also need to be considered, Crowley said. “There's evidence that private equity groups have invested in emergency department staffing firms to take advantage of big out-of-network payments, which helped trigger the surprise billing crisis.”
To level the playing field, all Medicare-participating hospitals should adopt uniform pricing, billing and collection policies regardless of tax status. Moreover, for-profit hospitals should be required to implement financial assistance programs so that low-income or uninsured patients are not stuck with massive bills, Crowley said.
Nonprofit hospitals are obligated to provide community benefit in exchange for tax breaks, but they may not be investing in ways that address the true needs of the community, Crowley explained. These hospitals should be required to provide measurable benefits to the community in exchange for their nonprofit status or risk having that status revoked, the paper states.
“Sufficient payment may prevent hospitals or physician practices from integrating or consolidating in the first place,” Crowley noted.
Public health officials and regulators should step up their scrutiny of all mergers and acquisitions in health care and provide oversight of further conversion of nonprofit systems to for-profit ones and vice versa, Crowley said.
It is also important to require state government officials to oversee all insurer conversions including conversions to mutual benefit organizations, the paper states. Sufficient public notice and public hearings should be part of this process.
“We need to be sure that profits never become more important than patient care in the practice of medicine,” Dr. Thomas G. Cooney, chair of the ACP Board of Regents, said in a news release. “Physicians, hospitals, and other health care organizations can, and should, earn a reasonable income as long as they are fulfilling their responsibility to provide high-quality patient care. We just need to have the appropriate guardrails in place to protect against outsized influence of profits.”
The position paper, “Financial Profit in Medicine: A Position Paper From the American College of Physicians,” is available on the Annals of Internal Medicine website.