Monday, April 19, 2010

The Loss of Physician-Owned Hospitals Solves Nothing

With the new health care reform bill signed in to law, the fate of physician-owned hospitals was sealed:
The bill Congress passed in March includes a ban on new physician-owned hospitals and freezes those already in business at their present size. Doctors hold a one-third interest in Avera Heart, which opened in 2001, so the bill President Obama signed would prevent that facility from ever growing.

The law change, in effect, leaves expansion of treatment of cardiovascular disease open for Sanford to dominate locally in coming years - if in fact that field of medicine grows. Avera Heart says such growth is not a given, because people are living healthier and have less need for emergency care.
While it is easy to point to the potential conflict of interest inherent to physician-owned medical facilities, it is not so easy to demonstrate that non-physician-owned hospitals don't have similar conflicts with generating profits. After all, continuing to build large $78 million-dollar expansions requires hospitals of any kind to achieve a return on their investment in order to continue operations.

So with the downturn in heart attacks that we are now seeing thanks to public health initiatives like anti-smoking campaigns, how is Sanford going to fund their shiny new facility?

Why prevention, of course!
O'Brien acknowledges the down trend in heart attacks but said other needs are increasing. Sanford performed 20,000 heart screenings the past two years, and about 1,000 led to follow-up such as a stent procedure to clear a passageway for blood flow. In the past, many such problems would show up later as a heart attack.

"We see fewer heart attacks than we did in previous years, but more can be done without resorting to surgery," he said. "Across the country surgery numbers are down, and angioplasty and stent numbers are up." (Editor's note: So much for having the COURAGE to say "no," eh? Let's not forget the conflicts inherent to physicians being employees of hospitals who increasingly tie physician compensation to their productivity)
On the surface, prevention sounds sexy as a cure-all for our current health care cost conundrum. What's not to like with preventing disease before it happens? But to think the hospital administrators have patients best interests at heart by using prevention as their excuse to "screen" for more heart disease, we should ask ourselves if the non-physician hospitals are any more altruistic than partially physician-owned facilities:
"You don't build cath labs and surgical suites if you're going to do preventive medicine."

But then, our Congressmen understood all this, right?



Anonymous said...

I never understood how the rationale behind the Stark regulations wouldn't also apply to hospital ownership of medical groups and outpatient practices. Conflicts of interest work both ways.

Given the PPACA's various sweetheart deals for non-physician-owned hospitals, I imagine that our Congressmen understood very well whose bread they were choosing to butter (to the extent that they understood anything in the bill they passed).

Andrew_M_Garland said...

According to the Socialist mindset:

Evil: A surgeon makes a profit when he operates at a center that he partly owns.

Bad: A surgeon earns a fee each time he operates.

Good: A surgeon is paid a flat salary to be available for any operations that may be needed.

In the "Good" case, an altruistic, detached technician applies his skills at a rate that is optimal for good delivery of care. Not too fast or slow. Not motivated by profit to do too much without proper rest, relaxation, and vacation. Not doing too little according to a deep sense of responsibility to the public and his employing agency.

This pattern of work and reward has been thoroughly tested in Government, where it has been found to be the best. The best part is eliminating any profit, a completely useless and expensive charge that is the embodiment of "extra".

They Are Profiting From My Needs

Without profit, things would be so much cheaper. Or, maybe not. I once met a person who blamed a bakery for selling her a cake. You see, thay made a profit off of her.

- -
Via -->InsureBlog - The Myth of the Rich Doctor
At -->Daily Caller - Arizona doctor says Obamacare will force him to close shop

Quote [edited]
Democrats’ argue that much of the waste in health-care comes from the profit motive of physicians. Dr. Scherzer criticizes that argument.

Scherzer: The point of socialized medicine is for the government to limit the percentage of GDP spent on medical care. They won't admit they are rationing care. So, they accuse doctors of increasing their income by ordering too many tests. But, the vast majority of physicians are ethical and do not knowingly order unnecessary tests.

AMG: Eliminate the evils of profit, and the costs of medicine will come tumbling down, to match the obvious efficiency of government agencies. (smile)