Take back our hospitals: Physicians call to repeal ACA section 6001

Section 6001 of the 2010 Affordable Care Act (ACA) effectively banned physician-owned hospitals (POH) in the United States. This legislation was nominally motivated by concerns over conflict-of-interest when physicians are stakeholders in the business of medicine, but in reality, was the result of political horse-trading to secure enough votes to pass the ACA. Section 6001 sacrificed physicians’ interests, in effect benefiting the American Hospital Association and large insurance companies who collectively must have celebrated the elimination of a major source of market competition.

Now, physicians are fighting back.

The experiment has been run, and the 15 years of data are clear: POH provide some of the highest quality, lowest cost care in this country. A CMS analysis of 250 POHs grandfathered in after ACA passage found that out of the top ten hospitals in the nation for quality, access, and cost, nine were physician-owned. They further concluded that of the top 100 hospitals in the nation, 48 of these were physician-owned. A 2021 literature review by the Mercatus Institute identified 21 independent studies on POH cost and safety, and concluded that specialty-specific POHs provide superior quality care at lower cost, and there is equivalent care provided at general acute-care POHs.

So, what has Section 6001 accomplished? Increased market consolidation into sprawling health systems, with physicians across all specialties fleeing private practice and turning to hospital employment by these same large systems, all of which compounds the growing rates of physician burnout and attrition. In short, Section 6001 provides a poison to a properly functioning market: lack of competition. Even worse, Section 6001 has deepened our national physician shortage.

If the ACA was intended to increase access and decrease cost for American patients, Section 6001 is antithetical to that goal in both theory and practice. Physicians face a Sisyphean task: we are forced to argue for the repeal of legislation which eliminated a right that never should have been taken from us. After all, every other industry is allowed professional ownership and independence. So how can any legislation isolate and ban a single professional group from ownership? The repeal of Section 6001 places healthcare back in the hands of people who truly understand medicine, can achieve the highest quality of care while spending the least, and who continue to care for our patients despite marginalization in our own industry: physicians.

It’s time to take back our hospitals. Our national experiment with a physician ban on hospital ownership is over. To improve healthcare and decrease costs in the United States, we must allow physician ownership of hospitals. We must repeal Section 6001.

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