Recent Health Care Reform's Tragic Consequences for Private Practice Physicians

Author:Jordan Rauch
Position:Student at Capital University Law School. I would like to thank Attorney Jim Flynn, Professor Jeff Snapp, and Justin Schiff for their invaluable patience and insight during the writing of this article. More importantly, I want to express my deepest gratitude to my beautiful wife Georgia and daughter McKinley for tolerating my hours away from...
Pages:933-961
SUMMARY

This comment predicts two outcomes due predominately to the new administrative duties brought about by recent federal health care promulgations: the first is the continued transition of small physician- owned practices into hospital systems; the second is the rise of cash-based medical practice models.

 
FREE EXCERPT
RECENT HEALTH CARE REFORM’S TRAGIC
CONSEQUENCES FOR PRIVATE PRACTICE PHYSICIANS
JORDAN RAUCH*
I. INTRODUCTION
The iconic image of the local, independent doctor many Americans
hold dear may become a thing of the past. Phrases like “You can pay me
what you can when you can” will be replaced by corporate collection
notices. Family physicians shackled by red tape and bureaucracy may
become the new face of family medicine in America.
This shift will move forward in large part due to recent health care
reform instituted by the federal government. While not the primary
purpose of the new enactments, the newly created administrative tasks for
medical professionals will become so burdensome that small physician-
owned practices will be forced to adapt. The independent physicians will
effectively be forced into employment through hospital systems or change
their medical practice’s model. The new administrative burdens will
dictate this decision unless physicians are willing to accept an income
substantially lower than they previously earned. This drop in income will
be attributed to increases in overhead to ensure compliance with the newly
required administrative duties and to decreases in patient volume due to
more of the physicians’ time being allocated to administrative duties.
This comment predicts two outcomes due predominately to the new
administrative duties brought about by recent federal health care
promulgations: the first is the continued transition of small physician-
owned practices into hospital systems;1 the second is the rise of cash-based
medical practice models.2
This Comment will analyze the effect of recent legislation—the
American Recovery and Reinvestment Act (ARRA), the Center for
Copyright © 2015, Jordan Rauch.
*Student at Capital University Law School. I would like to thank Attorney Jim Flynn,
Professor Jeff Snapp, and Justin Schiff for their invaluable patience and insight during the
writing of this article. More importantly, I want to express my deepest gratitude to my
beautiful wife Georgia and daughter McKinley for tolerating my hours away from home to
complete this piece. Without the support of all those mentioned, this endeavor would not
have come to fruition.
1 See infra Part IV.A.
2 See infra Part IV.B.
934 CAPITAL UNIVERSITY LAW REVIEW [43:933
Medicare and Medicaid Services’ (CMS) 2009 Final Rule, and the Patient
Protection and Affordable Care Act (ACA)—on administrative duties of
small medical practices owned by the independent physicians. Initial
discussions regarding the health care landscape under both the Clinton and
Bush administrations will set a backdrop for the recent health care reform.3
This Comment will then discuss the events surrounding the passage of the
ACA, along with the pertinent provisions affecting small medical
practices.4 This Comment will then analyze the identified ACA provisions
along with provisions of ARRA and CMS’s 2009 Final Rule.5
The discussion and analysis are categorized in two ways.6 Recent
implementations directly affecting administrative tasks of physician
practices are discussed, followed by an analysis of the provisions that will
constructively compel adherence.7 After this analysis, this comment will
analyze the predicted ramifications of these provisions on small private
medical practices.8
II. BACKGROUND
A. The Clinton Years
In the years leading up to Bill Clinton’s 1992 presidential campaign,
health insurance reform was thrust into the national spotlight.9 The
heightened interest stemmed from a drastic increase in private insurance
premiums and a growing uninsured population.10 Shortly after President
Clinton’s inauguration, he began taking steps towards health insurance
reform.11
In the month of his inauguration, President Clinton created the
President’s Task Force on National Health Care Reform.12 Despite the
initial haste, it took President Clinton over a year and a half to introduce
3 See infra Part II.A–B.
4 See infra Part II.C.
5 See infra Part III.
6 See infra Parts III.A–B.
7 See infra Parts III.A–B.
8 See infra Part IV.
9 See PAUL STARR, REMEDY AND REACTION 79 (2011).
10 Id. (“From 1987 to 1993, private insurance premiums jumped 90 percent, while
wages increased only 28 percent, with the result that fewer Americans cou ld afford health
coverage. Despite the limited expansion of Medicaid eligibility, the uninsured population
rose to 38.6 million in 1992, an increase of 5.2 million from 1989.”).
11 Id. at 81.
12 Id.

To continue reading

FREE SIGN UP