Bill Overview
Title: Patient Access to Higher Quality Health Care Act of 2022
Description: 2022 This bill repeals provisions under the Stark law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals.
Sponsors: Sen. Lankford, James [R-OK]
Target Audience
Population: Individuals under Medicare globally
Estimated Size: 62000000
- The bill concerns amendments to the Stark law, which regulates physician self-referrals within Medicare.
- It focuses on physician-owned hospitals and their ability to participate in Medicare without the Stark law's limitations.
- The stakeholders primarily include healthcare providers such as physicians and hospitals, especially those that are or may become physician-owned.
- Patients under Medicare, particularly those who might seek care from physician-owned hospitals, will be directly affected.
- Medicare beneficiaries make up a significant portion of the U.S. population, primarily seniors aged 65 and over and some younger individuals with disabilities.
Reasoning
- Since the policy impacts Medicare beneficiaries and physician-owned hospitals, I chose a mix of individuals including seniors and healthcare professionals who would be directly impacted by this change.
- A variety of responses have been included to reflect differing levels of benefit realization, from those with high expected benefits to those minimally impacted.
- Also included are individuals with an insider healthcare perspective, who might provide insights into broader sector adjustments.
- I aimed to balance the interviews between those positively impacted (mainly retirees with potential for better hospital care access) and those with neutral or slightly negative perceptions (mainly due to concerns about healthcare quality or integrity impacts).
Simulated Interviews
Retired school teacher (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I believe improvements in access to care are always welcome.
- If physician-owned hospitals offer better services or are more conveniently located, this might be beneficial to myself and others like me.
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 | 6 |
| Year 20 | 7 | 5 |
Retired engineer (California)
Age: 65 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- I am not sure how this change will impact me directly.
- New hospitals might improve some areas, but quality matters more than ownership in my view.
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 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Hospital administrator (Texas)
Age: 60 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- Potential increased competition might benefit patients, but there are concerns regarding ethical implications.
- Physician ownership could lead to biased service priorities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 5 | 7 |
| Year 10 | 6 | 7 |
| Year 20 | 6 | 6 |
Retired postal worker (Ohio)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- If new hospitals open nearer to my location, that could drastically improve my health management.
- I hope these aren't just money-making ventures that compromise care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Retired nurse (New York)
Age: 75 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- Physician-owned facilities could bring innovation, but transparency is crucial.
- I'm on Medicare and any policy impacting hospitals impacts me.
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 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Retired factory worker (Michigan)
Age: 69 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 16/20
Statement of Opinion:
- Changes in hospital management don't always favor patients.
- Larger networks care more about the community. Will physician-owned do the same?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Healthcare consultant (Illinois)
Age: 66 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- This could streamline services, but must be balanced with regulatory oversight.
- Consulting on managed care makes me wary of oversights in practice.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Retired military officer (Arizona)
Age: 74 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- Improved access via new hospitals sounds promising.
- Ensuring veterans are included in the developmental plans is a priority.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Home healthcare worker (Washington)
Age: 63 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 17/20
Statement of Opinion:
- Patients having more options is usually good, but it depends on real performance.
- Supporting patients while ensuring quality of care remains constant will be key.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Volunteer healthcare advocate (Georgia)
Age: 70 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- Opening up new pathways in healthcare is necessary.
- It's crucial that these hospitals do not overshadow non-physician owned options.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 8 | 6 |
Cost Estimates
Year 1: $400000000 (Low: $300000000, High: $500000000)
Year 2: $410000000 (Low: $310000000, High: $510000000)
Year 3: $420000000 (Low: $320000000, High: $520000000)
Year 5: $440000000 (Low: $340000000, High: $540000000)
Year 10: $480000000 (Low: $380000000, High: $580000000)
Year 100: $650000000 (Low: $550000000, High: $750000000)
Key Considerations
- The increased ability for physician-owned hospitals to expand may shift market dynamics and increase healthcare spending by potentially creating an incentive for higher utilization.
- Current caps and limitations are designed to reduce unnecessary referrals for financial gain, repealing them could lead to increased spending in Medicare.
- Monitoring of new physician-owned hospital activities will be critical to prevent substantial increases in unnecessary Medicare spending.