Sunday, April 29, 2012

that will be $500 up front maam

The public doesn't realize something about medicine, about hospitals. It has become a business, a corporate business. The days of the individual hospital fell by the wayside years ago. The vast majority of hospitals are now part of corporate conglomerates. Most hospitals are nonprofit. That gives the public the mistaken impression that they aren't in it for the money. Wrong.

The whole nonprofit thing is a misnomer. Nonprofit means there are no individuals who own stock who make money off the hospital. The profits go back into the organization. Here's the thing, INDIVIDUALS are making huge profits off these nonprofit hospitals: CEOs, administrators, doctors. CEOs or these hospitals often make millions in salary and bonuses. Doctors, especially specialists such as interventional cardiologist, neurologists, surgeons can make several hundred thousand a year easily. You don't think this leads to unnecessary procedures do you? Oh..of course not.

The nonprofit hospitals put the money where they make the money. Where do they make the money? Cardiology, neurology, orthopedics. In other words those profitable angioplasties and other cardiac procedures, strokes and interventional radiology, joint replacement surgery. This is where they put the money and this is where the specialists make the most money. Often times the rest of the hospital, that doesn't make as much money or loses money is left to deteriorate.

Now these nonprofitable hospitals are beginning to hire firms to aggressively seek payment up front of deductibles and co pays. Staff are trained via "scripts" to convince people in ERs, for example, that they have to cough up the money while they are still in triage. The fact that they are sometimes too agressive is front page news in my state after an attorney general investigation.

This is modern medicine folks. Do profits and money and health care mix? What do you think?


Anonymous said...

This is a thoughtful post that raises a complicated question.  I am not a medical practitioner.  My point of view is that of a patient who spent 18 weeks in one of those not-for-profit hospital conglomerates being treated for a neurologic condition.  I had a lot of expensive procedures — MRI, CT, numerous X-ray, ultrasound, IvIg, plasma exchange, electrodiagnostics, plus all of the usual procedures associated with hospitalization and, of course, lots of therapy.

I'm no expert, but I can think of only one instance when I thought a hospitalist was trying to pad the chart with unnecessary tests.  With that exception, I thought every doctor and nurse was devoted to providing the best medical care that my condition required.  Perhaps that was because I was such a good customer that they didn't feel any need to, but I prefer to think they were all dedicated professionals just trying to do their best for me.

Left out of your description is the role of the insurance companies.  I was fortunate to be well-insured (by another not-for-profit corporation).  The insurance company was following my case throughout, and on one occasion I was aware of a difference of opinion about the best course to take (which thankfully was resolved in my favor).  My hospital was very slow to put through the copay charges, and there were a few instances when the insurance refused a charge and the hospital absorbed it.

The bottom line for me was that I received the care and treatment I needed at a price I could afford.  Had I not been insured, it would have been devastating.  My view is that the inequity in insurance coverage for serious illness is a far greater problem for society as a whole, and especially for the uninsured, than the high cost of medical care.

Money must come into the hospital system in some way, so that it can upgrade equipment, hire and retain professionals who deserve to be well-paid, and expand the system to accommodate a growing population.  The hospital where I was treated is rebuilding, and they need it.  I don't object to their using some of my money to build a new state-of-the-art hospital.  I could relapse and find myself staying there someday.

There is definitely room for improvement where medical services and money to pay for them interact, but in my opinion it is almost entirely a political problem lying outside of the hospital system.  The internal politics of allocating money within the hospital seems the lesser problem to me.


Hospital Dream jobs said...

It's crazy folks, glad someone said it!

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