Tuesday, June 9, 2015

Illness: The New Commodity

Hot! Hot! Hot!

De-regulation, choice and competition.

Are we talking about Enron or the NHS?

We all know about Enron. But what has it got to do with the NHS.

The columnist Paul Krugman, writing in The New York Times, asserted that Enron was an illustration of the consequences that occur from the deregulation and commodification of things such as energy.

We may never know the real reason for de-regulating such an important matter as energy but at least when Enron tried to move into water as well, it was halted.

Enron was about free market and market forces but the reality is quite different according to Paul Krugman.
©Am Ang Zhang 2013 

Lets face it, as our NHS is parceling off bits to private providers (aka AQPs) it was to bank on people's illness or worse, fear of illness. Once you have the Big Boys from the City involved, money or more precisely, money making is the only game.

I was working in a drugs service in the Home Counties. Some agencies, such as those providing drugs and alcohol support services, were opened up for competition by Labour years ago. This particular service was taken over by a non-NHS organisation last year which made a bid considerably lower than what it was then costing the NHS to run it. They did this by reducing the medical input and replacing the majority of nurses with “drugs workers”, many of whom were dedicated and thoughtful, but were not medically trained.

This organisation is only paid for addicts whom they successfully wean off heroin. It receives £3,000 per patient if they abstain for three months, then a further £5,000 if they are still drugs-free a year later. So each patient is worth about £8,000 to the organisation – but only if they stay off heroin. And this is at the root of the problem. I saw a homeless patient who had had several failed attempts at detoxing. He was injecting five bags of heroin a day (about £50 worth). He was incredibly frail and I knew that if he continued, he would soon be dead. To make matters worse, he was injecting into his groin because he had no usable veins left in his arm, running the risk of an infection that can result in amputation of the leg.

He was being kind.

Remember Serco?

 In July, Serco and fellow outsourcing giant G4S were accused of over-charging the Ministry of Justice for electronic prisoner tagging. According to the Ministry they had continued charged the government for prisoners who had died or come off the programme.

Now as your Medical Data are being sold off to these privateers what is to stop them from faking drug addicts and alcoholics.

But wait for this: why not pick well people as their urine and blood results are going to be good and, £8,000 per patient is a good earner.

And who may well be running the labs.....

The following is from an earlier post:

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 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).

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

By JULIE CRESWELL and REED ABELSON  Published: November 30, 2012
The Old Way
For decades, doctors in picturesque BoiseIdaho, 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 southernPennsylvania, 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.

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