Surgery Center of Oklahoma Blog

Are there shortages of physicians in rural parts of Oklahoma?  Of course there are.  A recent article from the Tulsa World, reprinted in the Daily Oklahoman tells the story about a typical, overworked physician, Dr. Michael Woods.  The writer misses the point entirely, as is typical for this topic and in articles like this.  This one is easy.  Ready?  Whenever a shortage of anything exists, it is due to price controls. 

Where did the price controls come from and in what form?  The federal government.  Medicare and Medicaid payments.  The elderly that were perfectly willing to pay for their medical care for decades, have been placed in a program we all know as “Medicare” that underpays physicians and punishes them severely for any mistakes or mis-steps in the billing process.  The paperwork and hassles associated with this program are not even remotely describable.  This is not rocket science.  If  you pay poorly and create alot of problems you are not going to be the client restaurants want in their establishment.  If the majority of clients in a town are covered by an incredibly bureaucratic restaurant food stamp program that doesn’t pay their bills, the restaurant will relocate.  Why would anyone think that medicine is different?  As the demographics of rural America have definitely aged, the likelihood of a high cost, high hassle, low pay job for physicians can’t possibly compete with one that is otherwise. 

So, should Medicare pay physicians more money?  Certainly not.  Medicare should be abolished, albeit gradually, as most seniors have not prepared for their medical expenses and no market alternative to this horrible Ponzi scheme exists yet. 

Hassles gone.  Pay goes up.  Doctors establish practices in rural America.  Seems obvious to me.

G. Keith Smith, M.D.

I was in downtown Oklahoma City the day of the Murrah Bombing, anesthesitizing a patient for a knee arthroscopy.  I was working at a local hospital and treated/anesthetized several of the injured.  This event revealed some of the best in people I have ever seen.  The spirit of volunteerism and the lack of looting distinguished the Oklahoma City disaster from violent events elsewhere in the country.   Medical personnel responded to this disaster just as you would have expected them to.  They did their job.  There was no heroism in it.  People did what they were trained to do.  Local, retired physicians without their medical licenses or insurance made themselves available to treat and many did treat the wounded. 

 Then there were those who sought notoriety due to their connection with this disaster.   This desire for fame in the midst of this carnage revealed to me perhaps the worst I have ever seen in people.  Press conferences by hospital administrators seeking their moment of “glory” actually physically impeded the movement of injured patients from the emergency rooms to the operating rooms.  This desire for national television exposure was quite a thing to behold.  Some physicians rather than actually help the injured sought to identify themselves as “the person in charge” to capture as much of the limelight as possible.  One hospital in town actually complained that they didn’t get their “fair share of vicitms.”  Local, state and federal politicians used this disaster to brazenly advance their own careers and agendas.  Some business owners far from the blast claimed total damage to their structures and made off with insurance checks that insurance carriers didn’t dare deny them.  Gordon Liddy’s show was taken off of the radio for accusing then president Bill Clinton of “dancing in the blood of the Murrah bombing victims,” as this crisis undoubtedly rescued him from impeachment for a time.   Liddy was probably right, in hindsight, having watched the political class feed on this as some sort of gift to them and their careers.

I am reminded of the Oklahoma City disaster when I look at photos of the tornado damage in Joplin, Mo.  I have recently seen articles about medical personnel that are self-aggrandizing attempts to cast themselves as heros and garner all of the press they possibly can.  This is a disgusting sight to me, having seen what I have seen as described above.  There is no heroism in doing your job.  In all fairness to those seeking fame, I think that our culture has a hard time finding true heros and tends nowadays to celebrate victims.  

My heart goes out to all of those affected in Joplin and also to those battling a new cynicism resulting from watching the limelight seekers and opportunists feed on the crisis.

G. Keith Smith, M.D.

An attempt was made to justify electronic medical records in our local paper today.  The writer said,”..some doctors are wary of electronic medical records at all, arguing that they take extra time and can actually decrease efficiency.”  This is true, but only partly true.  Physicians have multiple objections to electronic medical records, not the least of which is the breach of confidentiality these records, once digitized, represent.    Computerized medical records in the operating room arena are a disaster, distracting the operating room nurse from the surgery and the recovery room nurses from the patient.  Several surgeons have told me that the introduction of computerized medical records in the operating room has added one hour to time between cases.  Rooms and rooms of paper medical records can be stored now on a small disk.  Health records, like any others, once digitized are much easier for bureaucrats to grab.

Here is the creepy part, though.  The federal government is paying physicians and facilities to install these systems.  Have companies that peddle these systems contributed to certain political campaigns?  Why exactly do the folks in D.C. care whether our records are on paper or on a disk?  Is it because they care about you and me and want what is best for us?  Don’t make me laugh.  If electronic medical records made sense in the marketplace, physicians and facilities would have done this long ago on their own without the bribes and extortion of the feds.

Knowledge is power.  The health care zealots in D.C. want to know what is wrong with you.  Not because they want to feel your pain.  Remember that one man’s disease or illness or injury becomes every man’s problem once health care is socialized.  ”Those in charge” will eventually ration care and they know it.  This digitalization of medical records is a precursor to the national illness statistics, that once compiled will undoubtedly be reviewed so that “appropriate care” can be determined by some brilliant bureaucrat far from your reach.  More than likely, certain illnesses will fit into a bracket of “untreatable” due to the history of costs associated with this or that disease.

I believe that you are better off if no one, particularly government bureaucrats, knows what ails you.  If you have a chronic illness and are covered by national health insurance, the bureaucrats want you dead.  Your death will help their balance sheet when they show how efficiently health care dollars have been managed by them once in control.  Any excuse to make this health information available to the government will do:  helping rural doctors stay connected, everyone knowing your medications and allergies, emergency rooms made aware of your health history before you get there….I’m sure there are others.

Electronic medical record keeping in certain practice settings might make sense.  I know ophthalmologists who love them because they can take digital pictures and include them in the record.  I know orthopedists who love them because they have eliminated carrying x-rays around.  Making this information shareable online is a slippery slope, though.  That our government is paying physicians and facilities (and actually punishing them for not converting by promising lower Medicare payments) is reason enough to question if not resist this effort.  Our records are made of paper and we intend to keep it that way.

G. Keith Smith, M.D.

Let’s close the loop on this PPO repricing mess then leave this topic for awhile.  This is an important part of understanding why health care is so expensive and is therefore important to go over.  Up to this point the concept of why health insurance companies are motivated to seek out the highest priced care has been discussed.  If the insurance company’s agreement with the insured group or employer provides the insurance company a commission-like incentive to ratchet down the bill from the original billed amount (the commission paid as a percentage of the extent to which the bill is reduced), it is not hard to see how the insurance company benefits from an extremely large initial bill from the hospital.

Connect the dots now.  Why would the big hospitals play this game?  Two reasons.  First, in return for this “gift” to the insurance companies, many insurance companies will shut out competitors to these big hospitals, in effect, protecting them from lower priced, higher quality competitors (..if you are thinking Surgery Center of Oklahoma go to the head of the class!).  Second, the hospitals actually make money to the extent that the insurance company underpays them.  WHAT?!  Remember that if a hospital is paid $5 for an aspirin for which they charged $100, they claim to have lost $95.  It doesn’t matter that they paid 1 cent for the aspirin.  This $95 loss is necessary for the hospitals to maintain the fiction of their not-for-profit status.  But there’s more.  This $95 is uncompensated care.  This number is plugged into a complicated formula and the next year’s Medicare/Medicaid payments (your money) are bumped up through a program called “disproportionate share.”  Get it?  YOU pay them part of the $95 which they claim to have lost, which, of course, they didn’t lose at all.

None of this is possible without incredibly effective and well-funded lobbyists in D.C., one of which is our own former Senator, Don Nickels.  Wait until some brave legislator proposes a bill that requires posting of prices by hospitals and medical facilities.  Money will flow into D.C. to crush this like no one has maybe ever seen before.

G. Keith Smith, M.D.