On May 23, 2024, the House Committee on Ways and Means Health Subcommittee held a hearing entitled, The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine. The purpose of the hearing was to identify the financial and regulatory burdens facing independent medical providers and explore how these continued challenges result in consolidated health care systems and barriers to patient care. Witnesses represented family practitioners, specialists in orthopedics and dermatology, and the public health sector.
Subcommittee members agreed that the decrease of physicians in private practice is a negative trend, and they discussed the reasons for this shift, including consolidation, increased operating costs, inflation, Medicare physician payment rates, and private equity in health care. Specifically, Subcommittee members asked about administrative burdens for physicians, including prior authorization, reporting requirements, and the Medicare Merit-based Incentive Payment System (MIPS). Members on both sides also asked about physician practices in rural and underserved communities and how to ensure these communities have access to physician care. They also highlighted the impact of workforce shortages and asked the witnesses how to increase competition, and therefore limit consolidation, for physician practices.
Witnesses discussed the widespread acquisition of physician practices by hospitals and health systems. They emphasized the pressures that physicians face that force them to join these larger groups, including inflation and, specifically, the failure of the Medicare Physician Fee Schedule to keep pace with inflation. Witnesses also highlighted administrative burdens contributing to physician burnout. In response to questions about how to address the challenges contributing to consolidation, witnesses stated that prior authorization (particularly for Medicare Advantage), unfair payment rates, medical record burdens, and site neutrality all need to be addressed.
ACOFP submitted a Statement for the Record for this hearing, which highlighted specific issues facing osteopathic family physicians in private practice alongside critical legislation championed by ACOFP.