Congress banned new physician-owned hospitals from Medicare in 2010. The same physicians can freely own ambulatory surgery centers and refer patients there all day. The asymmetry is not policy. It is a lobbying snapshot.
The Stark Law whole hospital exception let doctors own hospitals as full enterprises and refer freely. Section 6001 of the ACA killed that in 2010, freezing roughly 250 facilities at their 2010 bed and OR counts.
The FTC and DOJ said in 2004: entry is good, fix payment distortions instead of blocking competitors. Nobody fixed the distortions. Hospital market concentration doubled anyway.
The 2015 BMJ study comparing 200-plus physician-owned hospitals to nearly 2,000 others found no systematic quality or cost difference. But the grandfathered hospitals are survivors. The sample was never random.
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