WASHINGTON, D.C. [Brown University] — While the array of forces driving the demise of independent physicians in the United States is complex, Congress can take multiple key actions to support private health care providers and enable them to focus on patient care.

That’s according to Dr. Ashish K. Jha, dean of the Brown University School of Public health.

The top of his list? Ensure that Medicare pays private physicians the same amount that it pays health care systems for the same medical services.

“I think Congressional action on site-neutral payments is essential,” Jha told members of Congress on Thursday, May 23. “It just makes no sense to pay more for the same care, in the same location, just because the ownership of that practice has changed.”

Jha spoke as a witness in a Congressional hearing on how the federal government can address the decrease of small, independent physician practices nationally. He was one among a panel of experts who testified in a U.S. House of Representatives Committee on Ways and Means subcommittee hearing titled “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.”

In addition to serving at Brown as School of Public Health dean and a professor of health services, policy and practice, Jha is a practicing physician who has spent much of his clinical career caring for military veterans in the Veterans Affairs Health Care system. In those different capacities, Jha told Congress, he has witnessed the collapse of small physician practices and the resulting impacts on both patients and providers.

A major factor in the decline of private practice, Jha said, is a payment system through which Medicare pays more when a patient receives care at a hospital or a health care system than at an independent practice.

“This totally perverts the marketplace,” he said. “There is now this very large incentive for hospitals to buy up physician practices, and that doesn’t increase access, it doesn’t increase quality — all it does is allow Medicare to pay a lot more, and consumers to pay a lot more through private insurance.”

Another major burden facing independent physicians, Jha said, is the commercial takeover of Medicare via the Medicare Advantage program, which requires complicated documentation from physicians, increases the chances that recommended treatments will be denied and hampers doctors’ ability to provide care.

Jha also recommended vigorous federal enforcement of anti-trust laws to reduce the consolidation of physician practices by private equity firms; legislation focused on transparency around medical practice ownership; and adjustments to physician pay rates to keep up with inflation.

“My belief if that if we do all these things, we can have a dynamic health care system where independent practices can thrive and flourish, and patients can have more choices, lower costs and better care,” Jha concluded.