its all about the benjamins

It used to be that the docs in my ER worked for the hospital. Several years ago they decided to form their own private group and contract with the hospital. I know for a fact that they had a big jump in salary. They have incentives that pay more, the more patients they see. The higher the level of care, the more the doctor charge.

There has been a big change in patient care, in many ways for the better. The doctors want the patients to be happy, they don't want them to wait. They want them to come back for their care. We have had a big reduction in wait times. They don't want any patient complaints. Patient complaints = no renewal of contract for docs.

The cons: Because they don't want complaints and want people to come back, they do whatever they have to do to make people happy. They do what the patient expects, not necessary what the patient needs. There is a tendency to order more tests and things like MRIs and CT angios. A lot of people could live without them or do them outpatient. The more money that is spent, higher level of care, more money for doc.

Narcs are given freely for stuff that don't need narcs. Unnecessary scripts for narcs are written. Don't want the patient to be unhappy and complain. Doc complaints = no renewal of contract.

Why do I bring this up? To show the conflict that will arise with health care reform and budget constraints. In an effort to decrease costs, emergency room care will become a focus. Millions and millions of dollars are spent on unnecessary ER visits that could be handled in a doctors office. As part of a new budget in my state, hospitals will be offered incentives to decrease ER visits. I envision a time when unnecessary ER visits will have financial penalties for patients. The question is how will these coming changes fit with ER docs wanting all these patients to come back? The more patients the more money for the docs.