Surgery Center of Oklahoma Blog

This article is from the same writer that inspired my piece called “How much should I spend on booze?”  Writing in Forbes magazine, she is upset that a federal standard for what insurance policies should cover never materialized.  Not exactly a fan of state’s rights, huh?  Keep in mind this is in Forbes magazine.

On the other side of the aisle, an apologist for big government health care writes that it is precisely the state of Oregon’s ability to decide for itself what works best for Oregon, that will bring the best socialist health care to the folks who live there.  I’m guessing that this writer hasn’t, until recently, been a fan of state’s rights.

Funny how folks’ agendas can change in monumental ways how they think about government.  One, usually on the right wing side wants to use power to force whatever they think is a good idea down others’ throats and the other, usually on the left, wants the feds to leave her and her state alone….well…just on this issue!

I recommend Leonard Read’s “Anything That’s Peaceful,” to both of them, as they seem to be suffering from a malady of inconsistency on how to run other people’s lives.  ”Freedom is a good idea…well unless it conflicts with what I think is best for you!”  ”State’s rights never make sense and the tenth amendment is stupid and racist…well unless the tyrants in my state come up with better ideas than the tyrants in D.C.”  Thoughts like these must be running through their heads, potentially causing much cognitive dissonance.  Hope their health care plans include provisions for mental health down the road.

G. Keith Smith, M.D.

Lori Montgomery writing for the Washington Post proclaims that the rate of growth of Medicare spending has dropped.  At first she acts perplexed.   Then she figures it out!  Osamacare is working!    Medicare, thanks to Osamacare’s new regulations,  is not out of control, after all!    Government health care works!   But where is the true explanation for this drop in the growth of this program?  How about this:  Medicare patients are having more and more difficulty getting care as physicians in increasing numbers are either refusing to see Medicare patients or are drastically limiting their exposure to Medicare patients.  That this rationing is not even considered as an explanation in her long article for this “drop in the rate of growth of spending,” is indicative of how out of touch the big media folks are with the real medical world.  The only other explanation is that Lori Montgomery, like many others, is part of a huge propaganda machine.  Wonder which it is?

G. Keith Smith, M.D.

Check out this video from Washington, D.C. with Rep. James Lankford.  During a recent visit he asked me to sit down and visit with him about the high price of health care and what we are doing about it at our facility. He is rightly concerned about a price control bureaucracy over health care and the rationing that would inevitably result.

G. Keith Smith, M.D.

Check out this article I wrote that the local media just posted on the site, OKCBIZ.  Thanks to the folks at VI Brand for getting this message out there.

G. Keith Smith, M.D.

Merry Christmas to 200 hospital employees and 60 patients in 2 Hawaii hospitals. The employees were fired and the patients basically evicted.  Don’t hear much about the disaster of universal health coverage in Hawaii these days.  United States Congresswoman Marsha Blackburn has made her career detailing the horrors of “TennCare,” the nightmarish experiment with universal coverage in Tennessee.  Romulan Romney’s (one day he will have his own planet) experiment in Massachusetts has resulted in the highest health care costs in the country.  Washington state’s experiment didn’t last very long either.  Hawaii was different, though.  They had done things right where others had gone wrong.  That’s why it has done so well.  Right?  Check this out.  This is the future of Osamacare.

There are no successful examples of government- run anything, much less health care.  To the extent that the government is involved, the market is excluded and precluded from using its wrecking ball on incompetence and fraud.    When governments run health care, rationing is the only tool they have for continued solvency.  With these examples and Canada’s and Great Britain’s experience, only the naive believe that universal health coverage results in universal health care.

Hawaii’s  health care failure is yet another example of the free market’s power.  Osamacare will fail, as well, but only after completely bankrupting the country once and for all, and denying care to millions of citizens in order to keep its prideful chin up.  Let us celebrate another victim of the free market:  Hawaii’s health care system.

G. Keith Smith, M.D.

The Oklahoma state attorney general has declared that “Black Friday” sales are illegal as goods are sold below their cost.  I guess every day is “Black Friday” for Medicare patients in physician offices.

G. Keith Smith, M.D.

Let’s get something straight.  Hospitals provide no indigent care.  What?  You’re thinking I’ve gone off my rocker, aren’t you?   What about all of these emergency rooms where hospitals have to “take all comers?”  If this were true, why is there a building crane in front of every emergency room in the country?  Right here in Oklahoma City, one hospital is building free standing emergency rooms.  Would you expand a part of your business that was leading you to bankruptcy?

You see, hospitals get paid whether the patient pays them or not.  What?  My apologies to loyal followers of this blog as I am about to repeat myself.  Remember the DSH (disproportionate share) calculation in a prior blog.  To the extent that hospitals exhibit a difference between what they bill and what they collect, they are said to have provided indigent or “free” care equal to this number.  This “number” is then used in a bad debt calculation that modifies the hospital’s Medicare payments for the following year.  Translation?  Hospitals charge gigantic false amounts to make this “bad debt number” as high as they can.  Can you see that hospitals are actually motivated to make the charges even more gigantic for those who are least likely to afford it?  Hospitals also need this red ink to maintain the fiction of their not-for-profit status, as they are making giant profits.  This false “red ink” number increases their Medicare payments the next year.  That means the hospitals are being paid for all of these indigent patients that they claimed were hurting their balance sheets. That means that the notion that people are being denied care for lack of ability to pay is a lie.  That means that the entire justification for the criminal health care plan was a lie.  No wonder the American Hospital Association backed this bill.  Imagine the profits at the big hospitals when they can continue the prior game (poor mouthing it for the difference between what they bill and collect and cashing in on this scam) and getting paid for the folks that weren’t covered by some type of health plan in addition to the above.

Actually there are hospitals that have a legitimate gripe about their finances.  Rural hospitals.  The big city hospitals have stripped them of all of their “paying” business and have located satellite clinics in small towns to make darn sure that folks in rural America are funneled to the mother ship down the road, bypassing the local hospital.  For some reason the rural hospitals have not figured out that their interests and those of the big hospitals are not only not aligned, but are actually at odds.

The poor mouthing big hospitals have told their lie very effectively and so often that most believe it now.  I hope it is not too late to expose these mercenaries for the propagandists and opportunists they are.  Care in these big facilities becomes more awful and more expensive every year due to the effectiveness of the formation of cartels and the lack of competition and price transparency.  Aggressive media buys by these big hospitals have silenced most of the local media.  In fact, local media is saturated with pro-hospital stories every week.

Evidence is all around us vindicating my claim that these hospitals are loaded with cash.  Sports facilities, professional team sponsorships, new facilities, billion dollar building campaigns, full page newspaper ads and full length television commercials are a few examples, not to mention aggressive hiring of physicians and hostile takeovers of physician group practices.  I could go on.  People often times look at me like I’m crazy when I say these hospitals are getting rich “not making a profit.”  I think the responsibility for the high cost of health care rests primarily on the shoulders of these big “not for profit” hospitals.  Doesn’t it kind of piss you off to think that the hospitals have been sticking it to you with high bills (cost shifting) to cover their losses for the indigent, when they have been getting paid all along for this “indigent” care?

G. Keith Smith, M.D.

Imagine for a moment that you are a fly on the wall listening to the following exchange.  Pour yourself a nice glass of scotch or your favorite deep, dark, full bodied red (check out Vale do Bomfim…very reasonably priced and fabulous), take some deep breaths and try to take in the following conversation that actually happened last week. Before I reveal the conversation I further want you to imagine that you have just had surgery on your shoulder.  Your surgery didn’t go well.  You developed an infection.  Familiar with our website you are still confused about why your co-pay at the big hospital was more than the entire bill would have been at the Surgery Center of Oklahoma.  You still don’t understand why your family practice doctor sent you to the surgeon he did.  You told him you liked the surgeon you used before and sure liked the Surgery Center of Oklahoma.  Your family doctor didn’t seem phased by your comments.  Ok.  Here we go.

Setting:  a large hardware store    Actors:  A highly respected orthopedic surgeon practicing in Oklahoma City and a family medicine doctor who has been a hospital employee for about 2 years.

Surgeon:  Hey, how’s it going?  Haven’t seen you in a while.  Come to think of it, I haven’t seen any patients from you in a while either.  Are you doing ok?  Has my office staff been responsive when you have called?

Family Doc:  I’m doing ok.  You just don’t understand how things are and how they are going to be, that’s all.

Surgeon:  What are you talking about?

Family Doc:  You’ve refused to become a hospital employee and you’ve refused to play ball and now you’re going to see what that means.  I am not going to send you any more patients until you start doing surgeries at my employer’s new facility.

Surgeon:  Really?  Is the operating crew there experienced?  What do they have to offer the patients that the Surgery Center of Oklahoma isn’t providing?  Is their infection rate low?  Are the patients paying less out of pocket if they go there?

Family Doc:  That’s besides the point.  None of that matters.  If I send them to you, that’s where you have to go.  That’s just the way it is.

Surgeon:  Ok.  I understand.  You should expect to be the subject of a blog by my friend Dr. Smith.  Take care!

Now you are beginning to understand why, with your infected shoulder and having paid a fortune for your surgery, you wound up in the hands of a surgeon other than the one you already liked and  knew was good.  Your family doc was compromised.  What sort of leverage does the big hospital employer have?  How can they make him act this way, not in your best interest?  Your family doc has a performance graph.  The hospital employer has hired an army of accountants to make sure that he is earning his keep.  Your family doc gets “credit” for the charges he generates not only in his office but for the referrals he makes.  He also gets punished for the referrals he makes that don’t generate revenue for the hospital.  If, for instance, he sends a surgical referral to a surgeon who decides that the best place for the patient to have surgery is a facility other than the one employing your family doc, then it’s BIG POINTS OFF for your family doc.  Enough points off, not enough credits and his contract is subject to re-negotiation.  That means that the hospital is going to cut his pay.  A lot.  A 50% cut in pay is not unheard of.  Or, he could be let go entirely.  This wouldn’t be so bad if it weren’t for the fact that he is prohibited in the contract terms from seeing patients that are currently in his practice.  Or the clause that prohibits him from working within 50 miles of Oklahoma City.  Or the $50,000 “tail” provision on his malpractice insurance, payable upon termination of his contract.  Yes, I could go on.

In short, your family doc, if he is indeed an employee of a hospital, is incentivized to refer you to a surgeon that is not the best for you, but rather is the best for him.  Ouch.  Kind of pisses you off to read this when it’s put that way, huh?  Do I blame the family doc?  Yes, of course.  He is a collaborator.  Vichy.  He has sold out.  He has violated his oath.  Pathetic.  And you, the patient, are the victim.

Are there private practice physicians and surgeons who are abusive of patients and their wallets?  Sure. Referrals made to private practice abusers are usually made out of ignorance, though, and time and experience teaches primary care docs to avoid these guys.  But hospital employed family docs are forced to become mercenaries for their own self-preservation.  Nothing compares to the institutionalization of this mercenary approach to medicine.  Beware the physician working for a hospital.  He’s more than likely not working for you.

G. Keith Smith, M.D.

This article appeared in Forbes.  The author asks,”How much should we spend on health care?”  Here’s a question:  how much should we spend on milk?   How much should we spend on booze?  The reason that my questions seem odd to you is that you may not think you have a right to milk or booze and the definition of “we.”  How about this:  I’ll decide how much I spend on my health care and you decide how much you are going to spend and we’ll leave it at that.  How about this for a definition of “we.”  That’s my family and me.  What we can’t come up with we’ll take our chances on local help and charities.  “We’re all in this together” is a recipe for starvation and bankruptcy.  This mentality nearly starved the pilgrims (see my Thanksgiving blog) and has bankrupted communist regimes all over the planet.  Why are so many people determined to learn these awful lessons the hard way?

G. Keith Smith, M.D.

On the right side of this page near the bottom is a tab called “comments rss” under the heading “meta.”  Check out the post from Kanda Ramos, a recent patient here at our facility and an employee of the Kempton Group.  Recall that the Kempton Group has essentially made the Surgery Center of Oklahoma an exclusive provider due to our pricing and quality.  They have already referred many patients to us and the savings have been substantial already.  Imagine what the money not spent at our expensive competitor’s facilities will do.  Ah…Bastiat again and what is not seen!

G. Keith Smith, M.D.