A high-profile effort to curb corporate influence on how physicians provide care will resume in the upcoming Oregon legislative session.
An earlier version of the bill easily passed the state House last year with bipartisan support, but faced challenges in the Senate before leadership shut down the session early.
The first-of-its-kind effort seeks to go beyond what other states do to keep physicians in control of patient care as deep-pocketed corporations and investors rapidly purchase or affiliate with independent practices.
It drew national attention, with giant corporations like Amazon and UnitedHealth Group joining in the effort to sink it even as national advocacy and physician groups signed on in support.
The lawmakers spearheading the effort is state Rep. Ben Bowman, a Tigard Democrat who was chosen as House majority leader last year. He’s currently finalizing the details on a new version of the bill that would relax some of its more exacting restrictions, according to a summary of it issued by his office.
Bowman was unavailable for comment. Speaking on a panel of the Oregon Health Forum in October, Bowman said he was focused on crafting a bill that could pass. He acknowledged that there are “a lot of people who don’t like” his proposal and that they can “pay people to fight it.”
“Politics becomes challenging, right?” he said. “I have to be able to convince 31 of my colleagues in the House and 16 of my colleagues in the Senate to pass this bill. So the more we put in and the bigger the scope, the harder that conversation becomes.”
In the interim between legislative sessions, increasing consolidation and the corporate control of health care have continued to draw headlines in Oregon and elsewhere.
Eugene-area residents experienced a shortage of doctors that lawmakers and others blamed on the strong-arm approach of Optum, a subsidiary of health giant UnitedHealth. State regulators approved UnitedHealth’s purchase of the financially distressed Corvallis Clinic chain despite broad community opposition to the deal.
“I think the tension there is, how much involvement is too much involvement?”
In preparation for this year’s session, Bowman assembled a large workgroup to consider revisions based on feedback from independent clinics, insurers, hospitals, multinational corporations, academics, physician groups and others.
It’s not yet clear how successful that work will be given the strength of concerns raised by opponents.
Kyle Zebley, executive director of telehealth trade group ATA Action, told The Lund Report in an email that because the new bill not not been posted “it is unclear whether our concerns have been addressed.”
Zebley’s group had raised concerns that the previous bill would deter investment. He said that regardless of what happens, his association “genuinely appreciated the meaningful and collaborative approach taken by Representative Bowman and his staff, who have been open to continued dialogue.”
Other opponents of the previous bill did not respond to calls and emails from The Lund Report.
State Rep. Cyrus Javadi, a Tillamook Republican who backed the previous bill, said during an event hosted by the Oregon Health Forum last week that Bowman has heard concerns from independent clinics about their challenges securing resources they need to grow or finding someone who has the money to buy a practice when its owner is ready to retire.
“I think the tension there is, how much involvement is too much involvement?” he said. He added that the goal is to not “over-corporatize our private practitioners.”
What is in the new bill
As with the previous bill, the new one will attempt to close what Bowman has described as glaring loopholes in Oregon’s decades-old requirement that physicians and other medical providers have a controlling share of independent practices.
So the bill places curbs on how medical practices contract with what are known as management service organizations, companies that provide administrative and other support. Critics of these arrangements argue the companies can take over management of the practices, focusing on profits at the expense of physicians’ independence.
But doctors who rely on the outside firms told lawmakers during a legislative hearing last year that concerns are overblown, and the outside companies allow them to focus on patients instead of administrative work.
The new bill would allow for a bigger role for such management service organizations, according to Bowman’s office.
Another change would be to shift more of the liability for violations of the law to management service organizations rather than independent practices.
Under the previous bill, health regulators could identify companies that violate the state’s requirement that physicians control a medical practice and refer them to the Oregon Secretary of State’s Office, which would dissolve them.
The new version does not include that provision. Instead, the bill would allow a state program that reviews mergers and large transactions to stop pending transactions that would take too much control away from providers.
The bill would treat breaches of physician-control requirements as violations of Oregon’s Unlawful Trade Practices Act, a consumer protection law that is enforced by the state attorney general and civil lawsuits. Medical practices could also sue their management service organization.
The bill’s provisions would go into effect in three years for existing companies and take effect next year for new transactions, a shorter ramp-up period than the seven years in the old bill.
Bill would tackle ‘non-compete’ agreements
The use of non-compete agreements that prevent employees from working for competitors has been blamed for hurting patient access as well as provider compensation and health care costs.
Non-compete agreements used by Optum were blamed for causing a shortage of doctors in the Eugene area last year. Optum agreed to drop the agreements after pressure from lawmakers.
The revived Bowman bill would continue to tackle the issue. The new bill would void non-compete agreements between doctors and medical practices where they do not have an ownership stake. However, non-compete agreements would remain in place for physicians with ownership stakes in a practice.
State Rep. Nancy Nathanson, a Eugene Democrat who spearheaded efforts to get Optum to drop its non-competes that were blamed for hurting care in Lane County, is also sponsoring House Bill 3227, which would more broadly ban non-compete agreements in medical professions.
Bowman is joining Nathanson to consponsor another bill, House Bill 3325, which would require physicians who own a medical practice to live in Oregon for at least 275 days a year and be “actively involved in providing or managing patient care.”
I am curious if this only about physicians or takes into account dentists and others licensed by the state which can cause shortages as we now have with two major Dental Care Organizations owned by companies headquatered in Miami and Toronto. As I heard Rep. Nosse say when he talked about the OHSU/Legacy merger, he would rather go across town to talk about Oregon health care issues than get in the plane and fly, I believe he said New Orleans, but you get the point, to talk to the CEO of a company that does not care about Oregon and its problems. The only DCO headquartered in Oregon is Oregon Dental Service Community Dental. Mike Shirtcliff DMD