Here’s a good one:
A local not-for-profit hospital has been in a physician hiring frenzy. They recently added some gastroenterologists to their stable. They had to pay them a lot of money to get them to come over to the dark side. The hospital had this money because they have been very aggressive cost shifters. Anyway, having paid all of this money to these GI doctors they were anxious to get it back….you know…return on investment. The hospital found that they could charge about $1000 if the patients undergoing colonoscopy and other GI procedures were anesthetized rather than sedated. Use of the old tried and true Demerol and Versed cocktail just wasn’t going to be allowed anymore. If the GI docs were forced to use Propofol (Michael Jackson’s sleeping potion) the sedation (which can’t be charged for) could now be called an anesthetic (which can be charged for by the hospital). Bingo! $1000/GI procedure! ”We’ll get a one year return on our investment in two months!” Oh, and this doesn’t include the bill you will now get from an anesthesiologist (remember that’s what I do). Think the patients will be given a choice of sedative or anesthetic?
There are so many places to go with this story. Let’s settle for one. The cost of a colonoscopy at this hospital just went up about $1500 (the $1000 plus the bill from the anesthesiologist). Because this approach is safer? Better? Seriously? That will be the excuse. Anesthetizing the patients will somehow be safer than sedating them.
I’ll know this is a better and safer way to have a colonoscopy when the doctors that don’t have a hospital administrator’s gun to their head embrace this approach. This hospital is going to need to invent a lot more red ink to maintain the fiction of their not-for-profit status if they keep this stuff up.
G. Keith Smith, M.D.
