The same low-risk procedure can cost five to 12 times more in a hospital outpatient department than in a physician's office. That gap is giving hospitals the money to recruit physicians out of independent practice, and in growing parts of the country there is no independent practice left to choose. Medical Economics Senior Editor Richard Payerchin sat down with three advocates working with the U.S. Women's Health Alliance: Jack Feltz, M.D., the Alliance's president and a founding member; Rebecca Herrero, M.D., MBA, FACOG, president and CEO of Women's Health Associates of Southern Nevada; and Daniel B. Frier, Esq., co-founder and co-managing partner of Frier Levitt. They walk through the Independent Medical Practice Sustainability and Patient Access Act, the Stark and Anti-Kickback definitions the bill would tighten, and the counterintuitive core of their proposal: pay physicians more for office-based procedures and total cost of care goes down. Feltz and Herrero also make the case for why they're on Capitol Hill instead of in an exam room, when going hospital-employed would almost certainly pay them better. Music Credits:Elegant Jazz by Nadezhda Pilitskaia - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:14 | Cold open Feltz on why the Alliance is fighting: private practice is the cornerstone of health care in the country, and it should be reinforced rather than left to disintegrate. 0:14 – 1:18 | Introduction Austin Littrell introduces the episode and the three guests. 1:18 – 2:07 | Meet the guests Richard Payerchin introduces Jack Feltz, M.D., Rebecca Herrero, M.D., MBA, FACOG, and attorney Daniel B. Frier, Esq. 2:07 – 2:52 | What the U.S. Women's Health Alliance is Feltz describes a membership organization of independent OB/GYN practices operating in 37 states and the District of Columbia, with roughly 5,000 members caring for more than 10 million women. 2:52 – 4:06 | The financial reality for independent OB/GYNs Herrero on the specialty's shortage, the office-all-day-plus-call-all-night lifestyle, and what younger physicians coming out of residency are asking for instead. The result is an access problem. 4:06 – 6:39 | Why they fight for it Feltz on opening his first office 40 years ago, with curtains his mother sewed and a reception desk his father built, and what corporatization and vertical integration have done to that relationship since. Herrero is now delivering the babies of babies she delivered. 6:39 – 8:17 | The bill and the trip to Capitol Hill Frier on building the Independent Medical Practice Sustainability and Patient Access Act with the Alliance's advocacy committee, and why physicians are left out of nearly every conversation about how physicians get paid. 8:17 – 10:27 | The five-to-12-times problem Frier on how the site-of-service gap gives hospitals the cash to recruit physicians out of private practice, why student loan forgiveness at not-for-profit hospitals is nearly impossible to compete against, and what happens to patient choice once the local independent practices evaporate. 10:27 – 11:35 | What patients actually pay Feltz on rising copays and deductibles, double-digit insurance inflation, health care debt as the leading cause of family bankruptcy in America, and the studies showing no difference in quality between hospital-based and independent physicians. 11:35 – 12:34 | Why office-based procedures win Herrero on why patients are more satisfied when low-risk procedures happen in a familiar office, often without an anesthesiologist, and at a fraction of the patient responsibility. 12:34 – 13:25 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to submit their own workflow ideas. 13:25 – 15:52 | "We could easily become hospital-employed physicians" Feltz on why he and Herrero would both rather be seeing patients than testifying, why leaving for a hospital would likely pay them more, and why they aren't. Herrero adds where she goes for her own care, and why. 15:52 – 18:56 | Inside the legislation: fair market value and the HOPD delta Frier on tightening what "commercially reasonable" and "fair market value" mean under Stark and the Anti-Kickback Statute, and the counterintuitive ask: narrow the office-versus-hospital gap by paying physicians a little more, not by cutting hospital rates. 18:56 – 19:57 | Where hospitals and practices should be spending their energy Feltz argues the current competitive landscape benefits no one, hospitals included, and that Congress cannot let health care inflation keep running. 19:57 – 21:33 | Physician-owned hospitals and the conflict-of-interest argument Frier says the bigger conflict already exists: employed physicians who are judged on patient leakage and risk their jobs if they refer outside the system. 21:33 – 22:41 | Nevada's OB/GYN hospital Herrero on a physician-owned obstetrics hospital and why the overutilization argument struggles when every pregnant patient eventually delivers. 22:41 – 25:15 | "I don't even call myself an OB/GYN anymore" Feltz on the shift to whole-woman care, the roughly 80% of health care dollars he says are spent on women's decisions for themselves and their families, and 40-year patient relationships. Herrero on why she refers to independent specialists whenever she can. 25:15 – 27:07 | Do physicians still want independence? Feltz says the desire is enormous and the economic model is stacked against it, pointing to the AMA House of Delegates speaker who couldn't afford to stay. Herrero is seeing pockets of physicians leave hospital systems and come back. 27:07 – 28:04 | An open invitation Feltz invites any hospital or health plan executive to come talk about a path where both sides prosper and patients get the best care. 28:04 – 29:05 | Outro Littrell thanks the guests and wraps the episode.
