The document discusses concerns about the trend of hospitals acquiring physician practices, arguing that this consolidation drives up healthcare costs. It notes that hospitals are reimbursed at higher rates than physicians' offices for the same services. This differential encourages the acquisition of practices and results in Medicare paying over $1 billion more annually. The document advocates for equalizing reimbursement rates between hospitals and physicians' offices to help control costs while preserving patient access and care quality regardless of location. It also supports integrated physician groups as a lower-cost alternative to hospital consolidation that can counterbalance growing hospital monopolies.

1. Medicare Part D is a wonderful
program that protects the health of
our deserving seniors in Florida
and throughout the nation. Recent
proposed changes would be
detrimental to seniors who rely on
Part D for the medications they
desperately need. We need to preserve
it for current enrollees and those it
will help in the future.
Since enacted, the program has
exceeded cost-saving expectations
and is widely loved by seniors.
This outstanding program delivers
needed treatments at a far lower cost
than projected by the Congressional
Budget Office. Part D costs are 45
percent lower than projected for the
initial 2004-2013 forecast period,
and CBO has continued reducing its
cost projection. Spending estimates
have been reduced by more than
$100 billion each of the past three
years, proving that seniors are getting
tremendous value in a program that is
consistently affordable.
Additionally, average premiums
for enrollees this year are far below
original projections at about $30
monthly, which is less than the
original estimates of $61. Most
Medicare enrollees cannot afford
an extra $50 or $100 in additional
monthly expenses, so it is fortunate
that the premiums for Part D remain
low, ensuring their medicines are
affordable.
Not only is the program costing
less than expected, but studies
have shown that Part D decreases
medical spending in Medicare. CBO
estimates that a 1 percent increase
in the number of prescriptions
filled by enrollees would cause
Medicare’s spending on services to
fall by about one-fifth of 1 percent.
Additionally, a study in the Journal
of the American Medical Association
found that the Medicare prescription
drug program was followed by a
$1,200 annual decrease in non-drug
medical spending among those who
previously had limited drug coverage.
This reduction saved taxpayers $13.4
billion overall during the first full
year of Part D.
Some have suggested this extremely
successful and important program be
changed to lower costs. However, any
modifications to this program would
not lower costs for seniors; instead,
it would inhibit the program. When
Part D was enacted, it included a non-
interference clause that allows for
the free market to negotiate the price
of medications. It is for this reason
that costs remain low. According to
the nonpartisan CBO, if we allow
the secretary of Health and Human
Services to interfere in the private
price negotiations between Medicare
Part D plans and drug manufacturers
and pharmacies in the program, we
will not see cost savings. CBO also
says that striking the non-interference
clause will not yield significant
savings unless the government also
restricts access or fixes prices.
Some also argue that the benefit
should be changed to work like
Veterans Affairs’ prescription
drug benefit. However, many VA
beneficiaries prefer to use other
coverage for their medicines rather
than rely on VA coverage because
of its restrictive formulary. A recent
study on the subject, conducted by
the Lewin Group, found that of the
most routinely prescribed drugs for
seniors, 93 percent were covered by
both of the two most popular Part D
plans — compared to only 67 percent
covered by the VA formulary.
Additionally, the proposed
Independent Payment Advisory
Board would be detrimental to the
program, dictating arbitrary budget
cuts. The proposed board is not
accountable to anyone, and it would
function independently of any control
by elected officials in violation of the
principle of the democratic process.
Any change to the Part D program
that could result in cost increases
for enrollees would be detrimental.
If seniors are unable to pay for the
critical medications they need, many
will suffer. We need to protect the
critically important program that
saves the lives of so many here in our
Sunshine State.
Austin R. Curry is the executive
director of Elder Care Advocacy of
Florida.
Medicare Part D needs to
be preserved for seniors
By AUSTIN R. CURRY | Special To The Tampa Tribune
Published: March 26, 2013

2. Written by:
Deepak A. Kapoor, M.D.
Recently, investigative reports have
shed light on a serious yet underreported
problem: hospitals’ role in perpetuating
spiraling health-care costs. Differential
reimbursement policies have enabled
hospitals to acquire thousands of physi-
cian practices nationwide, consolidating
their market control in many communi-
ties. For example, the American College
of Cardiology reports that since 2007, the
number of hospital employed cardiolo-
gists has more than tripled, while the
number in private practice has fallen 23
percent. This trend extends to physician
recruitment: recent surveys indicate that
hospital employment is now preferred
by new graduates over traditional private
practice.
Historically, hospitals are the least ef-
ficient, most expensive site of service for
medical care. Unfortunately, hospitals are
rewarded for this inefficiency by being
reimbursed at higher rates than physi-
cians’ offices for providing exactly the
same service. These increased costs are
passed to patients and employers through
higher insurance premiums; these costs
also strain the solvency of state and fed-
eral health-care programs.
It has been reported that Medicare is pay-
ing more than a billion dollars annually
for the same services because hospitals
can charge more when doctors work for
them. Whether for diagnostic imaging,
surgical services, chemotherapy or thera-
peutic radiation, hospital reimbursement
for outpatient services are often multiple
times that for physician offices or ambu-
latory surgery centers. In fact, the Deficit
Reduction Act capped reimbursement for
medical imaging procedures in the physi-
cian office at the outpatient hospital rate
— thus, all such procedures cost the same
or less at physicians’ offices than hospi-
tals. Unfortunately, no such constraints
exist on bloated hospital charges.
Those advocating hospital takeover of
community practitioners argue that this
improves efficiency and outcomes, but
such unrestrained acquisition can result in
dangerous hospital monopolies. Reports
indicate that some physicians working
for Health Management Associates were
pressured to increase revenues both by di-
recting patient referrals to doctors work-
ing for the same hospital and by meeting
emergency room admittance quotas.
HMA, the fourth largest for-profit hospi-
tal chain in the U.S., with nearly half of
its revenues coming from Medicare and
Medicaid programs, was accused of set-
ting arbitrary benchmarks for physicians
admitting patients in order to increase
profits, regardless of medical need. This
unethical behavior puts ill patients at
direct risk for hospital acquired infections
and other complications, further reducing
access and increasing costs.
Technological advances have enabled
community-based physicians to of-
fer integrated care in the independent
practice setting — which allows patients
to be diagnosed and treated by different
specialists under one roof or organized
electronically into virtual groups — pro-
viding patients with efficient, accessible,
high-quality services. These integrated
physician groups are able to improve ac-
cess and control costs while maintaining
traditional doctor-patient relationships.
These groups serve the added benefit of
effectively counterbalancing hospital
healthcare monopolies, providing patients
with an important community alternative
to monolithic healthcare conglomerates.
If the disproportionate payment sys-
tem presently in effect continues, such
groups will have no choice other than to
close their doors or sell their practices to
hospitals; ultimately forcing patients into
more expensive, less convenient sites of
service.
Fundamental to the American ideal of fair
play is the notion of equal pay for equal
work. Indeed, the Medicare Payment Ad-
visory Commission has embraced this by
recommending fee parity for outpatient
evaluation and management visits in both
hospitals and physicians’ offices. The
future of healthcare depends on control-
ling costs while preserving access and
improving outcomes regardless of site
of service; leveling the reimbursement
playing field is an important first step in
this direction.
Deepak A. Kapoor,
M.D. is president of the
Large Urology Group
Practice Association,
Schaumburg, IL., as
well as chairman and
CEO of Integrated
Medical Professionals,
PLLC, the largest independent urology
group practice in the United States.
Patients deserve high-quality care
without excessive costs
Tallahassee DemocratTallahassee com A GANNETT COMPANY
Promoting democracy since 1905
Published on January 29, 2013

3. New study confirms PSA screening saves lives
By Deepak A. Kapoor, M.D., president, Large Urology Group Practice Association
03/20/12 11:34 AM ET
For the past two decades (the PSA screening era), we have seen a nearly 40 percent decrease in deaths from prostate
cancer although there has been no increase in incidence during this interval. This month, a follow-up of the European
Randomized Study of Screening for Prostate Cancer (ERSPC) was published in the New England Journal of Medicine. It
confirmed what urologists and other health care providers have known for years: PSA screening is a valuable life-saving
tool. The study, “Prostate-Cancer Mortality at 11 Years of Follow-up,” showed that the statistical significance of prostate
screening for all age groups has improved, with an overall survival advantage of 21 percent. More importantly, for
patients followed for more than 10 years, this advantage increased to 38 percent.
Nearly six months ago, U.S. Preventive Services Task Force (USPSTF) recommended healthy men no longer receive PSA
tests as part of routine cancer screening. Ironically, this decision against routine PSA screening was made by a panel that
does not include urologists or oncologists. The same task force tried unsuccessfully to eliminate mammograms for women
ages 40-49 and recommended against teaching women to do breast self-exams. The panel made the PSA recommendation
based on contradictory information from studies with serious design flaws. Based on USPSTF recommendations, the
Government Accountability Office (GAO) singled out PSA tests as a screening that would require patient co-pays,
potentially discouraging men to have testing that could identify cancer in its earliest, most curable stage.
What is particularly disturbing about all this discussion is that PSA screening itself is not treatment, but is merely a simple
blood test. There are essentially no risks to screening, and with screening results, patients have the information they need
to make better informed decisions about their health. Particularly in need of this information are those at greatest risk for
prostate cancer: African-American men and those with a family history of prostate cancer. Opponents to prostate cancer
screening are not concerned about the risks or costs of screening (both of which are negligible) but rather that patients, in
consultation with their own doctor, may not make the “right” treatment decision. This paternalistic interference by the
government with the one of the most private decisions in any man’s life is inconsistent with the values we hold most dear.
It is simply indefensible.
The revised ERSPC data highlights the problems with the USPSTF process. Under the Affordable Care Act, this taxpayer-
funded agency has been given great power to determine what screening tests must be provided. Despite this authority, the
USPSTF does complies with neither the Federal Advisory Committee Act, (FACA) nor the Administrative Procedures
Act (APA) which were enacted to ensure that those that ultimately work for American citizens conduct their business in
an objective, transparent fashion. We as a country deserve to know who is making health policy decisions by what
criteria, as well as if there is an inherent bias or potential conflict of interest that those with that decision-making power
may have.
Ultimately, the decision on how to screen and treat prostate cancer should stay where it has always been: between patients
and their doctors. This landmark research on the benefits of PSA screening is critical not only for men’s health, but also
serves to illustrate the severe flaws in our existing process. Enactment of the USPSTF recommendations will cause the
needless deaths of thousands of men, and not only must this recommendation be modified, but the entire process revised
to ensure such missteps do not occur in the future.
Deepak A. Kapoor, M.D. is president of the Large Urology Group Practice Association, representing more than 1,800
urologists nationwide, as well as chairman and CEO of Integrated Medical Professionals, PLLC, the largest independent
urology group practice in the United States.