• Two Texas Representatives, Michael Burgess (R-TX-26), and Vicente Gonzalez (D-TX15), introduced H.R. 3062, the Patient Access to Higher Quality Health Care Act of 2019.
  • The bill would repeal certain sections of the Affordable Care Act that prevents physicians from opening new physician owned hospitals.
  • This bill was introduced in the last congress and was supported by a bipartisan group of 75 cosponsors, but never advanced out of Committee.

Rep. Michael Burgess, the Ranking Member on the House Energy and Commerce Committee’s Health Subcommittee, introduced legislation to remove the statutory prohibition on new physician-owned hospitals. Rep. Burgess is a physician by training. Rep. Vicente Gonzalez is also sponsoring the bill. In total, the legislation has 16 cosponsors. H.R. 3062, the Patient Access to Higher Quality Health Care Act of 2019, would repeal Sections 6001 and 10601 of the Affordable Care Act, and Section 1106 of the Health Care and Education Reconciliation Act of 2010.

Anti-kickback laws prohibit providers from referring patients to facilities where the physician has a financial interest. However, there was an exemption for physician owned hospitals (POH). The ACA removed this exemption for new POHs created after 2010. It also prevented existing POHs from expanding the size of their hospital and increasing the ownership share of physicians unless they receive an exemption from the Department of Health and Human Services (HHS).

The ACA also requires physician owned hospitals to submit an annual conflict of interest report to HHS. The ACA requires POHs to provide emergency services or notify patients if they are unable to provide 24/7 emergency services. These requirements can be avoided if a hospital chooses not to see Medicare patients. Many POHs have gone this route, leading critics of the ACA provision to argue that it reduces access to care. Supporters of the provision argue that it protects patients and CMS from paying unnecessary costs for referrals, as physicians with an ownership stake have a vested interest in increasing hospital revenue.

The legislation would eliminate the ACA’s provisions that effectively prohibit new POHs. It is not clear if the bill will advance further than it did in the previous Congress or if there is similar interest for this initiative in the Senate.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,

Kirk Reinitz, CPA