Sunday, November 24, 2013

Hospital Medicine: Pride & World Class Trend!

?An imaginary scene:

 ©2012 Am Ang Zhang
CEO of a major hospital: We are going to be buying up GP practices, cardiologists and orthopaedic surgeons and other specialists. We then make sure that the GPs perform enough unnecessary tests and procedures or by admitting patients who do not need a hospital stay. There is no better time to make money as people are worried about their health.

Q: Why are you buying the specialists.
A: Because there is a shortage and these doctors are proud of what they can do. Just look at in flight magazine and they list all these top specialists around the US. Pride! Pride! Pride! This way we can control the fees for our own patients and charge the government or other insurers whatever fee we like.

Q: Some examples?
A: Colonoscopy is now three time what it used to be.
    Laser eye surgery, $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor.
    EKG: $319, versus $143

Q: What about hospital admissions?
A: For our own patients, doctor gets $5000 bonus if they are not admitted for more than 3 days and for the ones we charge other insurers or government, $5000 deducted if patient is not admitted.

Q:What about long term.
A: By having nearly all or most of the doctors, the others will eventually join us like with Kaiser Permenante. We then can control the total cost but still make money from the government. 

Q: What if nurses whistle-blow on us?
A: Sacked on the spot.

CEO: Doctors are now the hottest commodity. Our life is in their hands so to speak and the sooner we control them the better. They are now enjoying a good salary, some with performance bonuses and the administration headaches we take care of. The best money though is government money, be it Medicare or Medicaid.  By controlling hospitals and doctors, the government will have to go along with our price structure. We are money experts. We know what we do. We let the doctors treat (on our terms).
©2012 Am Ang Zhang

Well this unfortunately is not the future, it is happening now in Idaho, USA and a few other places and if we are not careful in your beloved NHS too.

Published: November 30, 2012
The Old Way
For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.
The New Way
But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little more than half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit. In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe increasing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay. 

Pumping Up Admissions: in reality!
According to two emergency room doctors who worked at Carlisle Regional Medical Center in southern Pennsylvania, the message could not have been clearer: more patients needed to be admitted.

The doctors were employed by EmCare, whose parent company was later acquired by the private equity firm Clayton, Dubilier & Rice in 2011 as part of a $3.2 billion deal. EmCare, in turn, was under contract to provide emergency room doctors for the hospital, which is owned by Health Management Associates. In interviews, doctors said that hospital administrators created targets for how many patients they should admit. More admissions translated into more dollars for the hospital.

Dr. Jean-Paul Romes, one of the physicians, recalled getting phone calls in the middle of the night questioning why he had not admitted an older patient whose hospitalization he could easily have justified. “The pressure to admit was so high,” he said. Dr. Romes left the hospital last year.

After another physician, Dr. Cloyd B. Gatrell, raised concerns that the hospital had too few nurses to keep patients safe, an EmCare executive warned him to “back off,” according to a lawsuit Dr. Gatrell filed last year. EmCare later fired him at Carlisle’s request, according to the suit. Dr. Gatrell’s wife, Kathryn, a nurse at Carlisle, had been fired earlier and also filed a lawsuit. Both Gatrells maintained they were fired for bringing up patient safety concerns, according to Dr. Gatrell’s lawsuit.
©2012 Am Ang Zhang
I have written a while back:

The side effect of the New NHS HSC Act with all the CCGs is that it would no longer matter if Foundation Trusts are private or not. Before long most specialists would only offer their expert services via private organisations. Why else are the Private Health Organisations hovering around!!! My reading is that the CCGs owned by Privateers will be doing what I suspected a long time ago: direct cases to their hospitals.

From one of their own advisers: Prof Chris Ham
Parliament debate: Public Bill Committee
Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."                             

“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”

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