In Part 1, we posited several data points, and began our interview with "Dr Bill." Let's now wrap up that interview, and draw some conclusions:
IB: Okay, then in what way are hospitals becoming "predatory?"
Bill: Here's the catch for the hospitals: they want access to certain kinds of ancillary services, and want control those services in the community. So they look at, say, cardiologists that have EKG machines and cardiac imaging or the like, and say "well, we can lease up Dr So-and-so's practice, and make his practice a hospital outpatient department (HOPD) and increase Dr XYZ's earnings because now the hospital is billing services at hospital higher rates," part of which the hospital shares with Dr XYZ. The Hospital buys and owns the practices ancillary equipment which gets us the staff and the equipment." And then, of course, they don't really need all that staff...
IB: Okay, we get that. But how would that work from the physician's perspective?
Bill: Think of it as leasing the practice, with an option to buy. The hospital can then bill Medicare at its own, usually higher rates, and reimburse the doc at somewhat lower rates, pocketing the difference. But it's really a one-way street: the hospital gets paid more, but doesn't necessarily pay the doctor more, and the doctor has no idea what that differential is. As part of the agreement, the doctor has to disclose all his reimbursement info to the hospital, but the hospital doesn't have to reciprocate.
IB: A kind of "reverse transparency." Can you tell us a little more about the equipment issue?
Bill: The hospital leases the practice, but owns the equipment and the ancillaries. So it could be things like MRI machines, but it could also be the Durable Medical Equipment experts, the Physical Therapists, and the like. They can then pick and choose who and what they want to "keep."
IB: So it's a kind of "shell game?" How does that fit in with the Economic Credentialing?
Bill: Well, now they own (or at least control) the "structure," so they can micro-manage all they want. "Why did you keep Mrs Jones in an extra day?" or "Why did you use the expensive hip replacement unit on Mr Smith when the less expensive one would work just as well?" That last is especially onerous: yes, the cheaper unit might "work," but it's more likely to cause Mr Smith years of pain and, perhaps, a limp. But he survived and the follow-up is manageable, just prescribe some pills.
IB: So what you're saying is that the promise that "if you like your doctor" (which implies that you like the way your doctor practices) "you can keep your doctor" is under the bus?
Bill: Oh, absolutely! You may be able to see him, but maybe not. If you're on Medicare, and you need emergency surgery, for example, you're going to get the hospital-owned doc, who may or may not be your own, and you get no say in it. And the numbers are huge: your resident Medical Office Manager said Medicare patients make up 20% of her practice? Well, it's over 30% for us. So we can sell out to the hospital, or we can try to make do with a 30% cut in patients.
IB: Okay, that's a legitimate point, but yours is sort of an exception, isn't it? Most towns have multiple hospitals, so they're competing against each other. The doc's would be in the driver's seat, right?
Bill: You believe that? Tell me, how many hospitals in Dayton? Six or seven, right? But how many are owned by the same companies? They're all owned by two hospital groups. How much competition is there really?
Thanks, Bill!
So let's bring this full circle: remember those Data Points?
DP 1: Few doc's believe that ObamaCare© will improve health care, and
DP 2: There will be fewer physician-owned and/or specialty hospitals available, and
DP 3: ACO's will further consolidate available providers...
All of which, when put together, give us this:
"If Obamacare is completely implemented, doctors will no longer be practicing medicine. They will instead become the drones tasked with deciding who gets the meager healthcare crumbs doled out by the bureaucrats who have the ultimate power over patient life and death ... It spends 1.1 billion dollars to create ... the Coordinating Council on Comparative Effectiveness Research ... The council consists of 15 people appointed by the President ... A second board created by the stimulus bill called The National Coordinator for Health Information Technology “will determine treatment at the time and place of care."
Says whom? Some right-wing pundit with an axe to grind?
Nope, that would be Dr. Elaina George, a Board-certified Otolaryngologist (aka ENT doc)
That's the framework; here's the result:
"[These councils] are all isolated from day to day patient care; and therefore, are insulated from the real practice of the art of medicine."
But that, ultimately, is the goal: by removing the "human factor" from the equation, it's that much easier to commoditize the availability and delivery of health care. That is, they're there to ration care based not on the value of life but on the cost of the care. Dots connected.
IB: Okay, then in what way are hospitals becoming "predatory?"
Bill: Here's the catch for the hospitals: they want access to certain kinds of ancillary services, and want control those services in the community. So they look at, say, cardiologists that have EKG machines and cardiac imaging or the like, and say "well, we can lease up Dr So-and-so's practice, and make his practice a hospital outpatient department (HOPD) and increase Dr XYZ's earnings because now the hospital is billing services at hospital higher rates," part of which the hospital shares with Dr XYZ. The Hospital buys and owns the practices ancillary equipment which gets us the staff and the equipment." And then, of course, they don't really need all that staff...
IB: Okay, we get that. But how would that work from the physician's perspective?
Bill: Think of it as leasing the practice, with an option to buy. The hospital can then bill Medicare at its own, usually higher rates, and reimburse the doc at somewhat lower rates, pocketing the difference. But it's really a one-way street: the hospital gets paid more, but doesn't necessarily pay the doctor more, and the doctor has no idea what that differential is. As part of the agreement, the doctor has to disclose all his reimbursement info to the hospital, but the hospital doesn't have to reciprocate.
IB: A kind of "reverse transparency." Can you tell us a little more about the equipment issue?
Bill: The hospital leases the practice, but owns the equipment and the ancillaries. So it could be things like MRI machines, but it could also be the Durable Medical Equipment experts, the Physical Therapists, and the like. They can then pick and choose who and what they want to "keep."
IB: So it's a kind of "shell game?" How does that fit in with the Economic Credentialing?
Bill: Well, now they own (or at least control) the "structure," so they can micro-manage all they want. "Why did you keep Mrs Jones in an extra day?" or "Why did you use the expensive hip replacement unit on Mr Smith when the less expensive one would work just as well?" That last is especially onerous: yes, the cheaper unit might "work," but it's more likely to cause Mr Smith years of pain and, perhaps, a limp. But he survived and the follow-up is manageable, just prescribe some pills.
IB: So what you're saying is that the promise that "if you like your doctor" (which implies that you like the way your doctor practices) "you can keep your doctor" is under the bus?
Bill: Oh, absolutely! You may be able to see him, but maybe not. If you're on Medicare, and you need emergency surgery, for example, you're going to get the hospital-owned doc, who may or may not be your own, and you get no say in it. And the numbers are huge: your resident Medical Office Manager said Medicare patients make up 20% of her practice? Well, it's over 30% for us. So we can sell out to the hospital, or we can try to make do with a 30% cut in patients.
IB: Okay, that's a legitimate point, but yours is sort of an exception, isn't it? Most towns have multiple hospitals, so they're competing against each other. The doc's would be in the driver's seat, right?
Bill: You believe that? Tell me, how many hospitals in Dayton? Six or seven, right? But how many are owned by the same companies? They're all owned by two hospital groups. How much competition is there really?
Thanks, Bill!
So let's bring this full circle: remember those Data Points?
DP 1: Few doc's believe that ObamaCare© will improve health care, and
DP 2: There will be fewer physician-owned and/or specialty hospitals available, and
DP 3: ACO's will further consolidate available providers...
All of which, when put together, give us this:
"If Obamacare is completely implemented, doctors will no longer be practicing medicine. They will instead become the drones tasked with deciding who gets the meager healthcare crumbs doled out by the bureaucrats who have the ultimate power over patient life and death ... It spends 1.1 billion dollars to create ... the Coordinating Council on Comparative Effectiveness Research ... The council consists of 15 people appointed by the President ... A second board created by the stimulus bill called The National Coordinator for Health Information Technology “will determine treatment at the time and place of care."
Says whom? Some right-wing pundit with an axe to grind?
Nope, that would be Dr. Elaina George, a Board-certified Otolaryngologist (aka ENT doc)
That's the framework; here's the result:
"[These councils] are all isolated from day to day patient care; and therefore, are insulated from the real practice of the art of medicine."
But that, ultimately, is the goal: by removing the "human factor" from the equation, it's that much easier to commoditize the availability and delivery of health care. That is, they're there to ration care based not on the value of life but on the cost of the care. Dots connected.
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