OK…. Promise it’s my last response. I think it will be eye opening for many of you and expose the hypocrisy of the @FAHhospitals. Hold onto your hats. We need to dive into who the FAH is and who their members are. They represent the largest for-profit hospitals like HCA, Tenet/USPI, and Community Health Systems. HCA was formerly known as Columbia Healthcare. They paid $1.7B in a fraud settlement for systematically overbilling Medicare, upcoding diagnoses, and paying physicians kickbacks for referrals and then changed their name to HCA. Part of their argument against POHs is blocking self-referrals, which we already proved is still happening today and clearly HCA has utilized for a long time. But let’s look a little deeper. Let’s look at the hospital and ASC portfolio of these organizations. HCA’s Surgery Ventures division jointly owns ~150 surgery centers with over 3,400 physician partners across 16 states. Tenet’s USPI owns over 500 facilities including surgical hospitals and ASCs partnering with thousands more surgeons. They market these arrangements aggressively. HCA also owns Texas Orthopedic Hospital in Houston in partnership with surgeons and in particular with Fondren Orthopedic Group. In September 2024, a Houston Jury awarded Fondren $25.6M after finding that HCA brok its non-compete agreement by opening 10 competing hospitals while blocking its own physician partners from doing the same. The Anti-Kickback safe harbor protecting physician investment in ASCs was finalized in 1999. The original proposal in 1993 protected only surgeon-owned ASCs. After “many in the industry” pushed for it through the comment process, the final rule added a hospital/physician joint venture category. HCA and Tenet built massive ASC portfolios as a result. By 2010, over 5000 ASCs were operating across American, predominantly physician-owned and many through joint ventures. Then in 2010, the same hospital lobby used the ACA process to close the whole hospital exception for physician-owned inpatient hospitals. They pulled up the ladder behind them after locking in their own position. I’ve never seen HCA or Tenet or USPI argue that their ASC or hospital joint ventures are somehow cherry picking patients or damaging their hospital ventures. Why would they engage and create these new facilities at scale if that were the case? Today there are nearly 10,000 ASCs. Nobody has banned them. Insurers and the government are actively trying to move cases to these facilities. They are nearly universally owned in part or in whole by the physicians who work there. We have an embarrassingly large amount of data showing that physicians can own their own facilities and drive better outcomes at a lower cost. The most common procedures at these facilities? Orthopedic, cardiac, GI, and other “high value” cases argued by the AHA and FAH are being stolen by physician owned hospitals. So my last question to you @FAHhospitals …. If this is your position as you stated below, are you going to ask all of your members to divest from every one of your joint ventures (hospitals and ASCs) given your ethical responsibility to do so? I think we all know the answer to that question. I’m a partner with FAH members on some of these facilities as are many of my colleagues. We can all work together to help our healthcare system. None of this rhetoric is necessary or helpful. Let’s evaluate a repeal of Section 6001 on its merit, not what the for-profit hospital lobby has argued despite participating in the very model they claim to despise.
