When Business Meets Medicine

... business gets squeezed. From the front page story of the Chicago Tribune today entitled "Are Hospitals Passing Off Their Low-Profit Patients?"

Officials at non-profit hospitals contacted by the Tribune vigorously deny that they steer patients to Stroger's ER and say that they treat everyone who shows up at their hospitals.

They defend policies that move some patients out of emergency rooms—known as "triage out"—as reasonable measures to ensure proper care without overburdening ERs.

"Is it unreasonable for hospitals to ask if there are better ways to care for people more efficiently?" asks Howard Peters, senior vice president of governmental affairs for the Illinois Hospital Association.

But some ER doctors are concerned about these policies and what they mean for quality of care for poor patients.

"This is basically legalized patient dumping," said Dr. Jesse Pines, an assistant professor of emergency medicine at the University of Pennsylvania School of Medicine.

Pines also is a member of the American College of Emergency Room Physicians, which recently criticized the University of Chicago Medical Center for plans to send non-urgent patients to other facilities while cutting the number of inpatient beds available to the ER.

The group's members argue that because ERs are staffed and equipped 24 hours a day—regardless of who shows up—the added costs of caring for patients with non-urgent ailments is comparable to a doctor's office visit.

"We have a responsibility to rule out an emergency medical condition," said Dr. Catherine Marco, an ER professor at the University of Toledo and a member of the American College of Emergency Room Physicians' ethics committee. "If we're going that far, why not close the loop? At that point, it's not a labor intensive issue."

Critics of the U. of C. plan questioned whether it was a way for the hospital to avoid caring for indigent and Medicaid patients. Parts of the plan were later put on hold after two national ER physician groups and doctors inside the medical center spoke out against it.

These are not simple issues. Hospitals, often the largest community employer, struggle to manage staying fiscally sound at a time when the economy has tanked. Liability and regulatory requirements demand a bloated staff of quality assurance, information technology consultants, billing and collection agents, and the like. Competition from surrounding facilities is keen, with every other hospital purchasing the latest robots and technology to stay ahead of their competitors, lest they lose the patients and doctors, the lifeblood of their cash flow, to their rivals. Add to this, the potential to lose their cherished tax exempt status, and one can see the challenges that confront today's hospital administrators.

Increasingly, doctors find themselves at the crossroads of medicine and business because they are no longer independent, but employed by hospitals run by business people. This business relationship threatens the very fiber of the doctor-patient relationship central to the practice of medicine. Unfortunately, what we're seeing now are the strains created when third party interests and market forces have sufficiently disrupted that relationship.

-Wes