(NY Times) A Hospital War Reflects a Bind for Doctors in the U.S.

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground….

Read it all.


Posted in * Culture-Watch, * Economics, Politics, --The 2009 American Health Care Reform Debate, Consumer/consumer spending, Corporations/Corporate Life, Economy, Health & Medicine, Personal Finance

5 comments on “(NY Times) A Hospital War Reflects a Bind for Doctors in the U.S.

  1. Teatime2 says:

    Interesting. That’s similar to what’s going on here and our city is a lot smaller than Boise. Add in the fact, too, that one of the hospitals (a non-profit) operates its own health insurance company and I’m sure the hospital is making money hand over fist. It has its doctor employees, who are both providers and members of the health plan, seeing patients, many of whom are also part of the health plan, and sending them to the hospital for tests and treatment. That’s a lot of money circulating in-house PLUS the hospital-owned health plan offers Medicare Advantage HMOs, too.

    I’ve got their HMO and, overall, I’m fairly pleased with it. As long as I follow the rules, my copays are tiny. But it can be problematic as the doctors shuffle around and change allegiances between the two hospitals. My long-standing GI doc decided to quit taking the hospital insurance and quit practicing there. I’ve had a monthlong wait for an appointment with a new one in the plan, and had to go to the ER in the meantime for treatment.

    Also, I have noticed that my internist is ordering more and more tests and I’m wondering if there’s the pressure cited by this article. The hospital called me a couple of days ago to say a sleep study had been ordered. I told them I had one just about a month ago. She said my internist wants another one to compare the two. In a very polite and loving way, I declined and said the Christian equivalent of “bite me.” And at the risk of being labeled “non-compliant,” I will tell my doctor that we need to concentrate on the really bad stuff because, Lord knows, I have enough of that to keep a whole team busy. She likely doesn’t know that the sleep tech. told me my test came back good, with just a few minor episodes of apnea.

  2. Capn Jack Sparrow says:

    I read the article. It’s actually fairly balanced. I’m a FP doc with experience in several types of systems, including state, Federal, small private group, big private group and even solo practice for 4 years. I did get occasional pressure to order tests or practice in a way that seemed to be more about making money for the system than what the patient really needed. I don’t work at those places anymore! I recently moved partially into the specialty of sleep medicine (you really might not need that second study, teatime, if the first one was done right and you had a representative night of sleep. Have the first report sent to the doc that wants the second study done, or ask for a sitdown consult with a sleep specialist.)

    Medicine is moving rapidly, even more so with Obamacare, into a two track model.

    One track is Wal Mart model; High volume, low profit margin, generally adequate quality (but not always very personal), sometimes pretty bad quality. There is a fair chance your “provider” will not be a MD or speak good English. It’s called “Pay for Performance” or “Patient Centered Medical Home” (the ultimate irony!)

    The other track is low volume, low overhead, higher margin per patient visit. Your doc has more time for you and will definately speak English, or maybe another language if you want! You might pay $50/visit cash, maybe $300/yr to get your doc’s cell number. Doc will have several hundred patients instead of several thousand in the other model. He does not participate with any insurance, but you might get some money back from insurance.

    Consider that what the gov’t and insurance define as “quality” and “performance” is not generally what the doc and patient think of as quality. Gov’t says, submit this code that you gave the patient this form. Submit that code to say that you talked about avoiding ventilators at death. Submit another code to show that a certain number of your patients have BP’s below a certain number, etc.

    Those might all be good things, but my patients just want to sit down and talk to me and have a real human interaction and get an honest medical opinion.

    Unfortunately, as will all Marxist utopian plans, the poor and ignorant suffer the most. Their care will become vastly less personal in the future. We will call it “Quality”, I’m sure, because all the right boxes were checked in the shiny, expensive EMR (Electronic Medical Record, used primarily for monitoring of your “data” by people other than your doc and you). Oh, and the docs will be OK in Obamacare. They probably won’t make as much money as before, but they will see alot fewer patients (nurses see the rest) and sign alot of forms. The window closes at 4:30 just like the Post Office.

  3. Capn Jack Sparrow says:

    We are seriously considering being bought out by our local hospital. It’s because OBAMACARE is designed to skyrocket the cost of health insurance and move our paying patients on to Medicaid, where we can’t keep the lights on or pay our staff.

    We loose staff all the time to hospitals who can pay them an adequate wage, unlike us, due to burdensome regulations. Alot of our staff are hard working single moms, minorities, etc. It really breaks my heart to see then struggling like they do and I wish we could pay them more. If we go with the hospital, they could get a raise and maybe buy us a few more years.

    Regarding the consolidation of practice issues under hospitals, this is the same issue in all businesses that are heavily regulated like banking, education, etc. Regulations drive up costs, which force consolidation into massive, faceless companies. That’s why big banks loved the “Occupy” protests, asking for more regulations. Those very regulations force small competitors out of business or into being bought by the big banks, resulting in no real accountability to the people who used to matter the most, CUSTOMERS!

    Same problem in Medicine. Our costs due to the need for “quality”, defined in my earlier post, are soaring. Hospitals have lawyers on staff, billing specialists, OSHA compliance officers, HIPPA compliance officers, Medicare compliance, etc, etc, etc. Lot’s and lot’s of middle and upper management to produce the “quality” that is required today. Small offices with docs who have time to talk to you (or maybe take a closer look at Teatime’s sleep study!) can’t afford that.

    Hospitals are allowed to charge alot more for the same service that we do in my office. That’s partially because the gov’t has to let the hospitals offset the cost of the “Universal Health Care” that they are required to give, often for free, in the emergency room due to the EMTALA law, passed in 1986.

    Everything is a tradeoff, it seems. I know some school teachers who are feeling the same way about the SOL tests, which also supposedly document “achievement”, I’m told. I’m working on paying off all my debts so I can go to the mission field if need be. At least there, I might actually get to see patients rather than fill out forms and punch buttons which document my “quality” and “performance”.

  4. robroy says:

    I cannot believe that people were so naive to re-elect Obama. Health care costs were spiraling out of control. The actuary of the CMS said that Obamacare would bend the cost care upwards. Of course, “consolidation” causes costs to go up even faster.

    Primary care physicians need a niche like Capn Jack has found. It will get very ugly. The good news for specialists that don’t have competition from mid-levels is that physicians are bailing out or scaling back at a dizzying rate. If the economy ever really sees a recovery, expect a mass exodus into retirement.

    If you have government insurance…get ready for wait times extending into months. If you have private insurance, get ready to be dumped or see you costs skyrocket. This will not end well.

    P.S. Capn, where are you thinking for missions?

  5. Capn Jack Sparrow says:

    Actually, Rob, I did a bit of medical missions in Jamaica. Up in the mountains folks have shelter, clean water, and generally enough food. They don’t have much else. It was wonderful and I can’t wait to get back there.

    Right now I’m thinking about “retirement”, to include mission work in the Carribean in a few years. All I need now is a cinder block house, a tin roof and warmth. I figure if I keep expenses low, I might be able to make enough working on the side in Grand Cayman or the Bahamas taking care of tourists (if any are left!).

    For now, we rent a tiny house and my car is 19 years old. My kids go to public school. Once I get the debts paid off from running a solo FP practice longer than I should have, I will be free to leave if Obamacare requires me to be unethical or tries to make me stop seeing patients.

    Thank God I have a career that is needed around the world. Hopefully my services will be sufficiently valued to cover the house and some food. I feel badly for folks who are trapped under mortgages and the ever rising expenses of what has become American life. They will have to pay for the coming collapse by working harder and harder, while others sit on their porches and collect “free stuff” in return for their votes. This situation will end very badly, I fear.