Bill Overview
Title: Flexibility in Hospital Ownership Act
Description: This bill repeals provisions under the Stark law (i.e., the Physician Self-Referral Law) that (1) require rural providers and physician-owned hospitals to meet certain additional criteria in order to be excepted under the Stark law (e.g., restrictions on facility expansion), and (2) require physicians to provide certain notices to patients in conjunction with referrals for radiology services at group practices in order for such services to be considered excepted in-office ancillary services.
Sponsors: Rep. Spartz, Victoria [R-IN-5]
Target Audience
Population: Individuals who receive healthcare services in the United States
Estimated Size: 150000000
- Repealing these provisions may encourage more physicians to invest in or own hospitals. This change could potentially lead to an increase in the number of physician-owned hospitals.
- The bill removes restrictions for rural providers, which may impact rural communities by potentially increasing their access to locally provided healthcare services.
- If rural hospitals can expand their facilities more easily, people in rural areas might experience improved healthcare access and quality.
- Physicians who are currently limited by Stark Law provisions would have more flexibility, potentially increasing the attractiveness of entering or remaining in practice.
- Patients in physician-owned hospitals might experience changes in the services available or the cost of these services as hospitals adjust to the new ownership norms.
Reasoning
- The policy primarily benefits rural areas by allowing expansion of existing facilities, potentially improving healthcare access and quality.
- Physician-owned hospitals are relatively rare, so the direct impact on patients is limited to certain areas where such hospitals already exist or will be developed.
- The financial constraints suggest a controlled and gradual rollout, maximally impactful in strategically chosen areas.
- Urban areas may see little to no direct benefit as the policy focuses on rural flexibility.
- A significant portion of the U.S. receives healthcare from large networks not directly impacted by this policy, leading to variable impact within the target population.
Simulated Interviews
nurse (rural Texas)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Our hospital has struggled with funding and service availability.
- I hope this policy will let us expand and serve our community better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
physician (Chicago, Illinois)
Age: 38 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 4/20
Statement of Opinion:
- Removing these restrictions will let us invest more in our services.
- Patients can receive better care due to more investment in infrastructure.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
farmer (rural Kansas)
Age: 60 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- Access to healthcare is tough for us out here.
- If hospitals can expand, maybe we can get services closer to home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
software developer (New York City, New York)
Age: 29 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- I don't see how this affects me directly.
- Healthcare is usually quick and accessible for me here.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
healthcare policy analyst (San Francisco, California)
Age: 52 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- I'm cautiously optimistic about this policy improving rural healthcare.
- My role involves evaluating how these changes play out in practice.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
retired school teacher (rural Maine)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I hope this makes it easier to get good healthcare nearby.
- Trips to the hospital are a strain on me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
radiology technician (Phoenix, Arizona)
Age: 33 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- This change in notice requirements might make our workflows smoother.
- It's a minor but welcome improvement.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 6 |
hospital administrator (small town Pennsylvania)
Age: 55 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- We can finally look at expanding our facilities.
- The policy is a relief from some stringent regulations.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 9 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
elementary school teacher (suburban Ohio)
Age: 48 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 0.0 years
Commonness: 9/20
Statement of Opinion:
- The hospital I go to isn't physician-owned, so no direct effect.
- I hope it helps communities that need it more.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
truck driver (rural Colorado)
Age: 61 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- More hospital expansions mean better options around my stops.
- Easier access on the road benefits me a lot.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $75000000 (Low: $50000000, High: $100000000)
Year 2: $80000000 (Low: $60000000, High: $110000000)
Year 3: $85000000 (Low: $65000000, High: $120000000)
Year 5: $95000000 (Low: $75000000, High: $130000000)
Year 10: $120000000 (Low: $100000000, High: $150000000)
Year 100: $150000000 (Low: $125000000, High: $180000000)
Key Considerations
- The impact of physician-ownership on patient care quality and cost needs careful monitoring.
- Potential shifts in the healthcare service landscape, such as increased specialization in certain types of care, might arise.
- There is uncertainty about how many new physician-owned hospitals might emerge due to financial constraints and market saturation.