Surgery Center of Oklahoma Blog

It is one thing for a physician to surrender to a hospital administration bent on destroying private practice for as far as the eye can see.  Physicians typically have mortgages and bills to pay, kids in private school, etc.  Physicians are not great with money, typically being short-sighted with finances.  Fear takes over, and the next thing they know they are a hospital employee, a decision they will regret for the rest of their career in the vast majority of instances.

It is quite another thing for a physician to seek the job of the hatchet man.  These physicians have such fear that they don’t want to just participate as employees, they want to get on the inside and be decision makers over those with whom they previously could not compete.  They want power because they are consumed with fear….fear of what the free market would do to them if they were practicing on their own.  These individuals are universally hated by the medical community and are perceived as evil doers by many.  I think they are the wimp doctors…the sell-outs….the Vichy doctors, as I have called them for years…the collaborators.  They use strong-arm tactics to bully private practice physicians and legitimize the scheming of their bosses the wonderful hospital administrators that are, of course, not wanting to make a profit.

In the mid ’90′s these jerks led the way for hospital physician organizations (HPO’s, or PHO’s).  These organizations were  a disaster and didn’t last.  These fear-mongers along with the hospital administrators tried to capitalize on the fear that the Clinton health care plan if passed (and that was a certainty we were told) would destroy our private practices….. so why not surrender now while the getting is good?  Every one of the physicians I know that became Vichy doctors were vilified and their reputations destroyed as sell-outs when none of this came about.

Now we face Obamacare.  Once again, the fear mongers are at work.  Once again there are physicians out there all too willing to participate in wielding the hatchet at the private practice physician hold-outs.  Some of the Vichy doctors are small mousy men that kids used to beat up on the playground.  Some of them are poster children for narcissistic personality disorder.  They have abandoned their oath as physicians and have the morals and ethics of most congressmen.  They are all collaborators and will, like their predecessors,  find their reputations in the toilet, I predict, once the insanity of government medicine for all is outed as the denier and killer it is.

G. Keith Smith, M.D.

Someone sent me this article. The gist of the article is that surgery centers are lax on infection control procedures.  A whole host of folks are quoted in the article saying that surgery centers need to be held to the same high standards that hospitals are.  If you have been following this blog you are laughing right now.

You should be asking yourself “why are state health departments cracking down on surgery centers with these infection control procedure violations now?”  If this has been an issue why the crackdown now?  Well it just so happens that our wonderful federal government that has more money that it knows how to spend gave state health departments funds to conduct this very activity in the last “stimulus package.”  I know this because when the Oklahoma State Department of Health came to our surgery center I asked them about this.

Why would the gangsters in Washington want to give money (that they don’t have) to state health departments to attempt to discredit surgery centers?  Notice two things:  hospitals were not included in this crackdown and they are reporting on departures from procedures, not infection rates.  Could politics be involved?  Think any money changed hands from the hospitals to our wonderful leaders in D.C.?  Or maybe there is a promise of future bribes like the American Hospital Association’s million dollar contract with former Oklahoma Senator Don Nickels who shortly after leaving the senate set up a lobbying company.  The AHA was his first customer and this contract was on the heels of his offering extremely anti-competitive surgery center crushing legislation.  Ahh…business the D.C. way!

What you will not see is a comparison of infection rates between surgery centers and hospitals.  This would be devastating information for the hospitals.  This type of press release just shows how desperate the hospitals are to avoid having to compete with surgery centers.

We have published our infection rates online.  I would encourage our hospital friends to be transparent not only about their pricing but also about their infection rates.  Focusing on breaches of procedure is a smoke screen meant to prevent folks from looking at results.

G. Keith Smith, M.D.

Check out the Foundation for Economic Education. This outfit was founded by the great libertarian Leonard Read.  There is absolutely no way to better acquaint oneself with the great political philosophy of non-aggression than familiarizing yourself with his works.  My favorites are “Anything That’s Peaceful,” “Elements of Libertarian Leadership,” and “I Pencil.” …you can read “I Pencil” here.

I thought of him this weekend while visiting with a friend who is going through the angry phase of the wake up to reality that I believe many libertarians go through on their philosophical journey.  This anger finds its way into the politics of medicine.  Forcing people to undergo drug tests.  Forcing sterilization or abortion.  These are the methods of the aggressive, non-peaceful men that are tired of being robbed.  The right approach was, according to Read, always a non-aggressive, loving approach.  He was an intensely Christian man and his political views were as consistent with his faith as any man that has written about political economy or political philosophy, in my humble opinion.  His writings had an intense impact on me, not only his philosophy but his faith.

His answer, by the way to the above scenario would be to characterize the event that led to the creation of the welfare check as an aggressive, violent act of robbery.  Why discuss how to dispense with the money?  What about the original crime and victim?  His writings always seem to bring peace in troubled times.

G. Keith Smith, M.D.

The old joke is, “Mr. Williams, I think you have a problem with your gallbladder.”  ”Doc, could I get a second opinion?”  ”Why, yes,” says the doctor.  ”It might be your kidney.”

The son of a friend of mine suffered a broken bone recently.  I asked who was taking care of him and the answer was one of the truly outstanding orthopedists that works at our facility.  This very experienced and ethical doctor knew that surgery was not indicated and that this young man would heal without any surgical intervention.

I had a few thoughts when I heard this.  My first thought was that when I heard who was taking care of this young man, I relaxed.  There was no doubt in my mind that the right diagnosis was made and that the right treatment will be forthcoming….no doubt….none.  No second opinion needed.  Get it?  One of those guys that always gets stuff like this right. Then I realized that the number of world class surgeons that Dr.’s Lantier and I are surrounded by at the Surgery Center of Oklahoma is impressive.  Our facility is loaded with guys like this.  Surgeons who get it right the first time.  Surgeons who fix other surgeons’ mistakes.  Surgeons who find and diagnose problems every day that many others would miss.  Surgeons who regularly make diagnoses that don’t involve surgery.  Surgeons who are really great people and have been kind and generous with the staff at our facility.

Then this thought:  many of these guys would like to be busier.  Yet, insurance plans prefer many times to send patients to hospitals where none of these great doctors will work.  So some less- able surgeon works on folks that would be better served by great surgeons who would actually like more business.  This cartelization of care has interfered with the discipline of the free market and channeled  patients where they were harmed and kept them from the best qualified physicians in many instances.

As a patient you should keep this in mind when your insurance plan financially punishes you for “going out of network.”

G. Keith Smith, M.D.

You need your knee fixed.  Your orthopedist wants you to go to a facility that’s out of your network.  You are miffed because this is going to cost you alot of money.  Or is it?

Your benefits are 80%/20% in network and 60%/40% out of network.  What does this gobbledegook mean?  It means that your out of pocket responsibility is 20% if you go to an in-network facility and it means that your out of pocket responsibility is 40% if you go out-of-network.  OK…SO?  If the charge or the allowable billed amount of the in-network facility is $12,000, your responsibility is 20% of that, or $2,400.  If the charge or allowable amount of the out-of-network facility is $3740 (our online price) your responsibility (40%) is $1496.  What?  You mean that your out-of-pocket expense for a surgical experience at the Surgery Center of Oklahoma is less than that at a big (not-for-profit) hospital?  How can this be?

Why are the insurance companies determined to direct you (scare you) to a facility where you will be out of pocket more money?  What could possibly motivate them to do this?

You live in Dallas.  You go to see your trusted family doctor.  You need your gallbladder out.  He goes online.  He has paid for a service called iRefer.  This gives him access to online ratings of facilities and their quality of care.  He can even search for price where it’s available.  He tells you that you can stay in Dallas and pay $28,000 for your gallbladder removal.  Or you can go to Oklahoma City and have a “5 diamond rated” surgeon at  a “5 diamond rated facility” remove your gallbladder  for $5655.”

What would you do?  What do you think the company you work for (if they are self-insured) wants you to do?  What if your company told you that your deductible would be waived and you would have no co-pay if you went to OKC?

Check out Medical Home Exchange. This may be the new paradigm of health care in the old USA.  Unless the government outlaws this innovation.

G. Keith Smith, M.D.

Why is health insurance tax deductible for businesses and not for individuals?  Could this possibly be a benefit to big insurance companies?

Put yourself in the shoes of the insurance company.  Wouldn’t you rather deal with a company’s human resources staff than to deal with each and every one of the employees of a 1000 employee company?  Wouldn’t you rather sell one policy that covers “1000 lives”  than to issue 1000 policies?

Now, consider Obamacare.  Five, maybe six regions of the country.  Each covered by one of the giant insurance companies.  Done.  No competition.  No need to provide customized insurance coverage to individuals.

Wonder why the insurance industry supported this fiasco?

G. Keith Smith, M.D.

Years ago I was at a dinner for some Oklahoma State legislators.  I was new to the political scene.  The fellow that set up the dinner was aware of my libertarian philosophy and sat me next to the most conservative legislator in the State senate.  He told the legislator, “ok…here is someone that makes you look liberal!”  The senator accepted the challenge.  He said, “where do you stand on ‘scope of practice?’”

Without hesitating, I said, “Let God sort them out.”

He turned to the dinner host that arranged the seating and said,”O.K.  You are right.  He is a libertarian.”

I have always marveled at the anesthesiologists and ophthalmologists that fight with nurse anesthetists and optometrists.  Nurse anesthetists want autonomy.  The anesthesiologists don’t want them to have it….they want to supervise the nurses.  Yet, in rural Oklahoma, nurse anesthetists are all that’s available when an emergency C-section is needed…or an emergency appendectomy.  Maybe they only need this “all-knowing” supervision when they are in the “big city.”

Optometrists want to do laser surgery.  Ophthalmologists don’t want them to do this.  Why?  Because patients are in jeopardy?  Or because they want protection from this group?

Money flows into the state capitol from both sides.  Statements are made.  Facts and figures are produced.  Statistics and studies are cited.  Year after year, the same result.  Nothing.  Why?  What kind of idiot would a legislator have to be to solve this?  Once it is solved, the game (money) is over.

Why not let the market work?  As anesthesiologists, our training should provide us with skills that place us in a position to compete with nurses that have not attended medical school and therefore lack the rigor of our training.  As ophthalmologists, the training necessary to complete this difficult path dwarfs the path taken by their optometry counterparts.  So why fear competition?  Why ask the legislator to get involved?  Why not embrace the discipline the free market provides for those unable to complete the task/service advertised on their shingle?

I know anesthesiologists that I would not let touch me.  I know nurse anesthetists that I would feel completely comfortable anesthetizing me.  Why not leave the government out of it.

I stand by my original statement:  ”..let God sort them out.”

G. Keith Smith, M.D.