I was invited to a health policy roundtable in Austin, Texas several weeks ago, primarily to discuss pricing transparency and some legislation to mandate price transparency in health care in the state of Texas.  No fan of central planning of any kind, my parting remarks to the panel reflected my belief that price transparency is coming to health care whether legislators mandate it or not.  The government skeptic in me leads me to believe that mandating transparent pricing will simply afford an opportunity for those who wish to buy an exemption from transparency from the “state,” to do so. 

“How do we accelerate a free market health model in the state of Texas,” the panel was asked. 

“Allow the physicians to own part or all of the hospitals,” I said.  Silence.  Looks of confusion.  Many thoughts going through the legislator’s heads, none of which were revealed.  My thoughts are that this would also completely solve the issue of physician shortages in rural parts of this country, Texas and Oklahoma included.  Physician ownership of hospitals was the rule all over this country not too many years ago prior to the Hill Burton Act.  

But the panel members from Texas had one thing on their mind.  A physician-owned hospital in Texas that was completely abusive in their billing practices:  an example (one example) of a bad apple.  I’ve thought about this now for several weeks and now find it interesting that while this one “bad apple” is sufficient to cast a permanent stain on the idea of physician hospital/facility ownership, countless examples of institutionalized abuse in large hospital systems escape the same harsh judgement.  

It’s as if they were thinking, “since this one hospital did this, physician ownership must be a bad idea.  Promoting physician ownership as you suggest is unthinkable!”  

Meanwhile, corporate healthcare in the state of Texas does the same or worse on a daily basis as a matter of routine!  Somehow it is ok for hospitals to commit fraud and own doctors who “self-refer” to their employer, but not ok for doctors to own hospitals.

I think the time has come for rural hospital ownership by the physicians working in these facilities.  Physicians all over the country (even the big city ones) would flock to these facilities to participate in this opportunity.  Patients would go see their physician and feel comfortable in the facility over which their physician had ownership and control, much more so than the old “county” model.  Patients in rural areas wouldn’t be shuttled to the mother ship in the big city by their doctors whose practices have fallen prey to the hostile takeovers of the big city hospital wolves.

I think it is time for rural towns to take their hospitals back from the corporate vultures.  It is time for small communities to wake up to the fact that corporate hospitals, after first invading rural doctor practices, subsequently starve the small hospitals of their revenue by pushing their new small town doctor employees to funnel patients to their mother ship.  Watch for all the physician-owned facilities to jump on the price transparency wagon.  Watch for the corporate players to fight it desperately.  The “bad apples” should be obvious by now.

G. Keith Smith, M.D.