Saturday, November 30, 2019

Watching Our Healthcare Hindenburg Burn

Just before Thanksgiving, 15 physicians were notified they will be replaced by less-experienced and cheaper nurse practitioners at the nearly $1 billion Edwards-Elmhurst healthcare system here in Chicago. Doctors, the article says, were "broadsided," perhaps because they were naive to events that occurred in Springfield, IL earlier this year. Thanks to aggressive lobbying, recent legislation was unanimously passed in both the House and Senate Illinois legislature allowing nurse practitioners to practice independently of physicians in any capacity except surgery. Working doctors likely missed this since they don't populate legislative halls - they populate clinics and hospitals caring for patients - or at least most did.

This trend of using more and more nurse practitioners in lieu of physicians appears to be accelerating nationwide as large hospital systems or consolidated primary care clinics with bloated numbers of midlevel administrators look to cut costs. Nurse practitioners are everywhere now: staffing ICUs, Emergency Rooms, and yes, primary care clinics. Some nurse practitioners are used to preferentially fill lucrative surgical pipelines armed with little other knowledge than what a routine case for surgery requires. And while advanced practice nurse practitioners do treat common ailments like earaches and sore throats, often quite well, how many can recognize the warning signs of a case of epiglottitis? What happens to patients then?

Is compromising years of physician training and care experience for cost efficiency really about patient care or cost savings or a facility's bottom line? Is the inevitable pitting of nurses against doctors in the patient's best interest or the institution's? Who sees the costs supposedly saved by hiring cheaper advanced practice nurses?  Will Edward-Elmhurst Healthsystem suddenly stop spending millions on collection agents who served as second-largest contractor for Edward-Elmhurst Healthsystem in Fiscal Year 2018?

Working physicians aren't without some blame either. Where were the physicians on the Medical Executive Committee of Edward-Elmhurst Healthsystem with this announcement? Did they approve  replacing 15 physician-colleagues for lesser-trained nurse practitioners or fearful of losing their jobs if they didn't "align" themselves with this administrative move? Who is advocating for patients at Edward-Elmhurst Healthsystem (or any other large non-physician run hospital system) now? Anyone?

Can Dr. Google and inexperienced physician posers safely replace the highly trained, experienced physician? No one really knows. This latest move is little more than a grand experiment promoted by healthcare consultants with patients' lives on the line.  Which leads us to ask: is touting a shortage of US physicians really a concern of the Association of American Medical Colleges or just a ploy by other member organizations of Accreditation Council for Graduate Medical Education (like the American Hospital Association) to justify these physician firings so hospitals can pad their bottom line?

Our Healthcare Hindenburg is burning: a bubble of excessive prices, high middleman salaries, a rapidly accelerating physician shortage, competition of healthsystems and patients increasingly unable to pay even basic co-pays for healthcare, medications, and procedures, as they are left to take the financial hit to maintain the health care industrial complex's status quo.

In healthcare, it's "Winner Takes All" with the likes of PriceWaterHouseCooper, McKinsey, and the Advisory Board at the helm.  The competition is fierce.

Patients (and their better-trained frontline physicians) be damned.



Paul Barbera MD said...

The solution is simple. And it has occurred in other health care systems around the world.
A physician strike. Physicians refusing to go to work unless issues like this one are resolved.
It probably would only have to last a day, as health care administrators would have no solution other than negotiate with physicians and meet their demands.

Alan Kogan, MD said...

How naive. If a corporation sells polished widgets, then the corporation polishing the most widgets with the least expensive polisher will always be the most profitable. By the way, how many widgets do you see in your clinic each day, and aren't they all the same. Don't they all have the same irregularities that require exactly the same polishing?
This corporate philosophy seems perfect to achieve its one and only goal...profits. What could possibly go wrong?


Elliott Robbins said...

Patient safety is always the lowest consideration in these types of corporate decisions. I have great respect for physician assistants, nurse practitioners and nurses, many of whom are well trained and experienced, and can treat lower acuity problems better than or at least as well as physicians. Such individuals play vital roles, working in tandem with physicians on higher acuity patients.

Whenever a non-physician usurps a position that the average patient might be expecting to be filled by a physician, I can guarantee that risk management and their defense attorneys will have drafted fine print addressing the fact that the patient might be seen only by a non-physician who has neither the education nor the training of a medical doctor, and said non-physician may or may not consult with a physician, and the patient assumes all the risks inherent thereto, or words to that effect. The consent documents are rarely read or understood by the patient, and are routinely signed, often electronically, in the presence of administrative staff members who are incapable of explaining such documents and/or are discouraged from doing so, even in the unlikely event the patient has questions. I also can guarantee that the non-physician will dress and appear like a physician with a small name tag which may contain the initials "PA" or "NP" after his/her name, but despite the name tag and perhaps the brief introduction where the non-physician introduces himself as nurse practitioner Bob Smith or physician assistant Bob Smith, most patients will still believe they are being seen and have been seen by a physician. Most patients will not be aware of the differences in education, training or qualifications between physicians and non-physicians even if they comprehend that they are being diagnosed and treated by a non-physician. When avoidable misdiagnoses and morbidity occur, the first thing I will hear as an attorney representing such patients and their families, is that my client or the decedent knew or should have known that he/she was being diagnosed and treated by a non-physician, and if he/she wanted to be seen by a physician they should have gone elsewhere.

If we are going to start substituting non-physicians into roles formerly occupied by physicians, a movement which is arguably counter to patient safety, then for starters, there will need to be full, open, repetitive disclosure and patient education, including a careful, detailed and understandable recitation of the differences in education, training and qualifications between the schools of medicine.

Those in the medical profession who are dealing with these rapidly evolving changes understand the differences between physicians and non-physicians and the various limitations, advantages and disadvantages of being triaged or treated by the various disciplines. I can assure you that the average patient has no clue about this bait and switch underway, and the medical profession takes this lack of knowledge for granted.

Elliott Robbins, Trial Lawyer

COI R US - More ABMS Obfuscation and Evidence of "Industry Insider Infiltration" said...

ABIM's Trust Meter is Busted - more "industry insiders" at the ABMS than you can count

Why does Dr. Baron suppress the alarming unattractive fact that his "Chief Medical Officer", Richard G. Battaglia worked for PwC (for untold years) before "coming over to the ABIM"?

Is this ominous omission due to the fact that ABIM's "Mr. PwC MAN" Battaglia (PwC director, manager hired in 2015) chooses to live closer to his "former boss" in Buffalo, New York?

Yes, it appears that ABIM has hired another one of those "guys" who prefers to not live in Philadelphia. But instead chooses to lobby/consult in DC or wherever for big additional money on top of their obscene "do-nothing for physicians or patients" salary from ABIM. Just like Christine Cassel, Battaglia lives out of state, a rarely came to the office. Hired for political and financial connections.

ABMS tax returns reveal a clear financial relationship with PwC. ABIM hides theirs - covers it up. (We don't have current information on financial relationships due to the lag in tax returns and ABMS' failure to include all contractors of significance. ABIM still does not list Pearson Vue, their largest contractor, who they signed a 10-year multi-million dollar conatract with.)

How about a press conference on ABMS/ABIM financial ties to the industry!

ABIM's "trust meter" is busted.

London-Based PwC, Pearson, and Dutch Media Giants said...

Is MOC a result of foreign intervention in our government? Nowhere else in the world are physicians treated like crap forced to participate in MOC. Only in the US! Are we dumping grounds for bad products and services that don't sell elsewhere?

Isn't it interesting that longitudinal testing theory originated among the Anglo-Dutch entrepreneurs, but MOC would not be tolerated by the physicians in Europe, Africa, Canada, South America or Asia. Not even in the offshore banking islands in the Carribean where the ABMS and medical societies appear to be hiding a lot of investment cash. Nobody knows how many shell companies have been created by these global testing giants and their many partners.

Pearson Vue, PwC, Elsevier, and Wolters Kluwer - all foreign corporations muscling in on our lucrative healthcare industry,and shaping it to their financial advantage.

This includes their market domination in publishing, education, testing, certification, and accreditation, helping to create and maintain the ABMS certification monopolies through millions of $$$,$$$,$$$ quietly spent on lobbying our legislators/industry leaders/accreditation/certification trade associations/medical societies for concessions/boons to enhance their bottom lines.

Wolters Kluwer acquires UpToDate in 2008

Now a foreign company sits as a partner at the table with non-physician/financial/revolver executives at the ABMS/ABIM!

And nobody is getting excited about this in Congress! They should be very concerned, especially the current WH administration. There is a huge trade imbalance.

ABMS and PwC said...

ABMS Dark Corporate Money and Relationships?

ABMS payment of nearly $1 million to PwC in 2015, the same year the ABIM hired their "Chief Medical Officer" Richard Battaglia is more than concerning.

ABMS payment of $922,479 to PwC for "consulting".

Proper disclosure (the ABIM ommits Battaglia's PwC employment history because they fully understand the conflicts of interest and wish to conduct "business as usual" outside the margins of what is proper and focused on their core role as public servant. Instead of focus the ABMS/ABMS commits public fraud by working for corporate profits and political agendas and not public safety.

The American Hospital Association and PwC

"Workforce 2015 (featuring input by Richard Battaglia and other PwC managers/directors/reserachers.
Strategy Trumps Shortages"

This report was developed by the American Hospital Association’s 2009 Long-Range Policy Committee. It was subsequently
approved by the AHA Board of Trustees for distribution.

"• Reginald Butler, Richard Battaglia, MD, and Reatha
Clarke from PricewaterhouseCoopers who have been
working on PwC’s “Millennials at Work: Perspectives
from a New Generation,” and who generously shared
their findings and insights.
The committee appreciates greatly their willingness to
share insights and experiences.
The report is presented in four sections:
• The developing workforce challenges,
• Redesigning work,
• Retaining existing workers, and
• Attracting the new generation of workers.
In addition, the AHA is publishing a workforce data book
on its website, with some
of the statistical information used in this report to develop
findings and recommendations."