Dr. David Eagle: The Hospital Squeeze

David Eagle (0:00)

You know, her co-payment went from like $50 to $70 a visit to over $300 for a visit. And they would just, you know, like send us messages saying, look, I want to keep seeing you, but I can't afford to do this. And they had to find other doctors. And a lot of times, the question for me was, what other doctors in the community would you recommend? You know, same office, same doctors, same patients, coming to get the same service. And the only thing that really changed was the cost. The efficiency went down, too. I think that's just an example of what the health care system doesn't need anymore. But yet I think that's played out in hundreds of clinics across the country.

SPEAKER_2 (0:30)

This is Dc Ekg, exploring the intersection of politics and health care by diagnosing Washington and prescribing solutions. We take a deep dive into the legislation, regulation and innovation impacting policy makers, providers and patients.

Now America's health policy expert, Joe Grogan.

Joe Grogan (0:54)

Welcome back to Dc Ekg. I'm your host, Joe Grogan. Joined today by Dr. David Eagle from New York Cancer and Blood Specialists. He's also the vice president of the American Independent Medical Practice Association, past president of Community Oncology Alliance, and your board certified hematologist, oncologist, and you've got over 20 years of experience. I had to read all that because it's a lot of stuff here, doctor. Thanks so much for joining the show.

David Eagle (1:21)

Joe, thanks for having me. Appreciate it.

Joe Grogan (1:23)

You have a tremendous, a broad area of expertise and a lot of experience in the medical community. I want to start by asking you why independent medical practice, especially in oncology, is so important in your view for the practice of medicine, for patients, and for our health care system.

David Eagle (1:44)

Yeah, I think independent practice is both important for community oncology. I think it's also important in general medicine. I think it just means a lot when doctors actually have more say in control over how patients are managed. I've been on both sides of this over my career. A lot of my career has really tracked some of the policy and reimbursement changes have come out of Washington, DC.

Doctors that control the practice, every time I've been in a private oncology practice, we've always had a policy to have new cancer referrals. We offered an appointment in the office within two working days. When I worked for a hospital system, which I did for three years, I had no control over that.

When I work as an independent office, I had to bill under the physician fee schedule, there were no facility fees. When I worked for a hospital system, they pivoted to hospital-based billing, and patients paid massively higher co-pays to come see the same doctor, get the same service in the same building, but just paid more. Nothing changed other than the payment that the patients made. So I lost a lot of patients that way. I think independent medicine preserves competition, which we really need in our healthcare system today. And also, one thing I really, really notice is that independent doctors really grow roots in the community. Hospital administrators, they tend to move on to different positions after a few years. There's nothing wrong with that. That's just kind of part of their career track. But I've seen more of my physician colleagues migrate into the hospital systems. In fact, they kind of parallel that. They don't tend to grow roots in the community. They don't really tend to put down roots and really are in the community for the long haul. When I first started my private practice in Charlotte, almost 26 years ago, there was no idea that we would ever leave. I was a second partner in the practice, a senior partner and I were there, and none of us ever thought we would ever leave the practice or move on to any other things. I think there's lots of advantages, but I think lower cost care, high quality care, focusing on the patient the way the doctors really know to give them care and preserving competition. I think those are just critical things, particularly as our healthcare system gets more and more consolidated.

Joe Grogan (3:38)

What's the state of current independent oncology practices now?

David Eagle (3:42)

When I started in 2000, community independent medical practices were 85 percent of cancer care. Depends on how you define the number, but that's probably somewhere between 40 and 50 percent since that time.

There's just been a steady migration from the community practice setting into hospital-based employment. It really started in 2003 with the Medicare Modernization Act when the old AWP system transitioned to the ASP system. That was the start of it. But then more things followed. They applied the sequester to the ASP system, so the add-on payment of six percent became 4.3 percent. Meanwhile, hospitals were getting the benefits of 340B, increasing consolidation in the hospital systems, increasing compliance issues for private practices like macro MIPS and meaningful use requirements.