Ideas meant to help Washington patients will put independent docs out of business | Opinion

As an independent physician working in Tacoma, I know that practices like mine are struggling to keep their doors open. Bills currently before the state legislature would only add to our woes.

SB 5387 and its companion, HB 1675, aim to ensure that clinical decisions remain in the hands of doctors and the patients they serve — a critical priority.

Unfortunately, as currently drafted, these bills would make it much more difficult for independent doctors to partner with outside companies that provide business, operational and technological support. That would put many practices in the South Sound at risk of closing and jeopardize access to care across the state.

Independent physician practices are cost-effective, community-based access points for high-quality care. And they serve thousands of patients in rural and urban areas who might otherwise struggle to find providers.

Many independent practices offer specialized services that are unavailable or disallowed in other systems. For example, reproductive health specialists who care for high-risk obstetrical patients or provide fertility services must remain independent of large, religiously affiliated hospital systems to provide a full range of services. The complexity of these specialties often requires partnering with outside companies to provide the best possible care while remaining independent.

If these bills pass as written, women’s access to reproductive health services could be severely impacted in Washington State.

Physicians should always have the final say in clinical decision-making, and key provisions in the two bills would help enshrine this value into law. But other sections of the legislation would undermine physicians’ ability to operate independently.

Many independent physician practices like the one I lead are already in dire financial straits, thanks largely to Medicare and Medicaid’s flawed payment structures.

For years, Medicare has paid doctor’s offices considerably less for each service and procedure than it pays hospitals for delivering the exact same care. Since 2001, Medicare reimbursement for doctors has increased less than 10%. Inflation is up 60% in that time. Hospital reimbursement is up more than 70%.

After adjusting for inflation, Medicare reimbursement for physicians in independent practices has actually declined 33% in the past 25 years.

Medicaid payments in Washington have remained stagnant for a decade and a half — and lagged far behind most other states.

Meanwhile, the costs of providing care have soared. For small practices, particularly those in rural and underserved areas, this financial squeeze makes it increasingly difficult to stay afloat.

To survive, many independent physician practices have partnered with specialized companies that provide operational support while leaving doctors in full control of clinical decision-making. These partnerships have helped practices stay open, expand and deliver innovative, high-quality care — and have been found to result in lower expenditures, fewer inpatient days and less emergency department visits.

One independent dermatology practice in Everett has been able to launch the largest dermatology clinical research department in the state, offering free, cutting-edge treatments — including for patients with orphan diseases that are often life-threatening and have few, if any, FDA-approved therapies.

Another independent practice has implemented new screening and telehealth services, providing same-day clinic appointments for urgent gastrointestinal issues. Nearly half of the patients who used this service said they would have otherwise gone to an emergency room or urgent care clinic -- much costlier settings.

It’s improvements like these that SB 5387 and HB 1675 would jeopardize by making it harder for physicians to remain independent.

Washington lawmakers are right to insist that physicians and other licensed healthcare professionals maintain full autonomy over clinical decision-making. But as written, these bills won’t accomplish that goal.

Independent physician practices are important pieces of Washington’s healthcare infrastructure. Legislators must ensure that independent practices can keep doing the crucial work their patients count on them for.

This story was originally published March 5, 2025 at 3:00 AM with the headline "Ideas meant to help Washington patients will put independent docs out of business | Opinion."