In the business section of the 12/9/11 edition of the Daily Oklahoman, Karen Rieger, head of a large law firm’s health care practice group is interviewed. She makes some observations that could not be more mistaken. . She states for instance that “consumers should see benefits from closer collaboration between physicians and hospitals in the delivery of health care services. In the past, independent physicians billed on a fee-for-service basis and did not have incentives to provide efficient, high quality care.” I wonder how Ms. Regier’s law practice would change if she were paid a salary by her law firm regardless of the quantity or quality of work she did? Or maybe she thinks that billing a fee for a service is only a bad idea for doctors. It’s the end of a long hard day and a patient calls and is very sick and wants to be seen. The salaried doctor tells them that the office is closed for the day. I’ll see you in two weeks. The greedy “fee for service” doctor tells them to “come on in.” I could go on and on, but her statement is so idiotic I’m boring myself countering it.
Next she discusses the new Shared Savings Program, a part of the wonderful Obamacare fiasco. “Under the program, Medicare will share the savings it realizes from the provision of health care services by groups of physicians, hospitals and providers, called Accountable Care Organizations, to groups of Medicare beneficiaries.” Translation? If doctors and hospitals (probably the doctors’ employer) get together and figure out a way to cheat patients out of their benefits and take the cheapest path on everything, they will make more money. Denying care or only providing the cheapest care will become the order of the day and everyone makes more money and Medicare saves money and WOW isn’t this fabulous! Yeah, unless you are the person called a patient.
Finally, Ms. Rieger, saves the ultimate blunder for last. “Direct employment (of physicians) is beneficial because it provides greater collaboration in the delivery of care, minimizes antitrust and other legal risks, reduces the administrative burden on physicians and simplifies the development of integrated electronic medical records systems.” Readers of this blog are familiar with the “great collaboration” between an Oklahoma City hospital and the gastroenterologists they employ. Having found that the age old and tried and true sedation provided by Versed and Demerol not nearly lucrative enough for colonoscopies and other endoscopic procedures, the hospital simply required their employed gastroenterologists to use Propofol sedation. You see, if Propofol is used, an anesthetic is said to have happened. If an anesthetic happens, the hospital can bill an extra $1000. There is also an expense for the anesthesiologist, but let’s not muddy the waters with an extra $400. Let’s just call it an extra $1000. This extra $1000 will help the “return on investment” that the hospital has ”invested” in these doctors they have hired. And since the doctors are employees they must do what they are told. No longer the advocates of the patient or the patient’s pocketbook, these physicians are compromised by this employee arrangement that Ms. Regier calls “beneficial.” Notice also what has happened to the price of a colonoscopy at this hospital by virtue of this “beneficial” arrangement. It is certainly beneficial….to the hospital, working ever so hard each and every day to “not make a profit.”
A county hospital recently installed an electronic medical records system. The physicians they employ were “integrated” in to this system, by which I mean that the system in the hospital was the same system in the doctors’ offices. After the system went “live,” one surgeon told me that while he could have previously seen about 45 patients in a day, he would now be lucky to see 15 in a day due to the additional workload created by data entry into the electronic medical record. The funny part is that he doesn’t care. He is an employee and is paid the same whether he sees 45 or 15 patients in a day. What does this say about the future of access to care? What does this say about efficiencies in medical practice? What could this possibly mean for the future of the cost of care? Who is John Galt?
My guess is that Ms. Regier’s law practice consists primarily of creating contracts between hospitals and their employed physicians. Maybe this all sounds wonderful to talk about in fancy board rooms. Out here in the real world, this simply doesn’t work.
G. Keith Smith, M.D.
