The front page story in last Sunday’s edition of the Dallas Morning News used red ink headline terms - “Sociopath” … “Clear and Present Danger” … “Serial Killer” to describe a Dallas physician.
These descriptions were not employed by lawyers, but by Dallas area neurosurgeons to describe a fellow neurosurgeon who was crippling and killing patients at local hospitals. From the first hospital where he had privileges, he was paid a $600,000 annual base salary, plus whopping incentives to bring patient revenues in. He was hired as a rainmaker and proclaimed an aggressive surgeon could easily command a $3 million personal income. When serious problems surfaced and his privileges were suspended, he was given a clean bill of health by the first hospital, affording him additional time to gain operating privileges at other area facilities to inflict further harm. A troublesome question arose – was he operating in a substance impaired state, and why were no steps taken to stop him? When the horror stories from other physicians finally got bad enough, his Texas medical license was revoked and he left the state. FYI, Texas medical oversight is notoriously slow to act on such cases.
Troubling tales about a rampantly profit-infused American health care system abound. Hospitals paying physician obscene amounts to boost patient revenues, oncologists administering chemotherapy to patients without cancer, cardiologists placing stents in healthy hearts, heart surgeons operating on healthy hearts, hospitals with poor track records for post-operative complications, spinal surgeons doing multiple fusions on the same patients. There are legions of such instances of these abuses, all fueled by revenues. And hospitals/systems keep buying up physician(s) practices to control revenue flows.
There are effective, proactive filters out there which employers can easily incorporate into their health benefit plans to identify and head off problems, e.g., classifying hospitals by quality quartiles. Once identified, it becomes possible to steer patients to quality facilities, either best available locally or to outlying centers of excellence. The positive effects can be massive in terms of both quality and cost.
Yet in discussions with colleagues around the country, when employers or employer coalitions are approached with propositions to emplace these filters into their benefit plans, the response has been “we’re not ready for that”. When high(est) quality hospitals are identified out of the immediate areas, requiring travel, the response from employer benefits and HR personnel is “employees won’t travel”.
What is wrong with employer individuals who are charged with and ought to be held accountable for ignoring such proven, effective means to control cost and quality?
Exactly what are employers waiting for, when delaying opportunities to steer employees and dependents to quality (either best locally or to centers of excellence) provider facilities, avoidance of unnecessary surgeries and reducing the cost of care for both employers and their employees?
The delays in the implementation of control/quality measures by employers in the face of the clear and present dangers that exist everywhere begs questions about awareness and commitment on the part of employer personnel charged with managing healthcare benefit plans, and the influences exerted by special interests, e.g., consultants. Metropolitan health coalitions are typically heavily infused by non-employer interests, e.g., hospitals/systems, insurance companies, wellness vendors and consultants who are satisfied to attract business from individual employers. These coalitions are happy hunting grounds for special interests, and collaborative employer action is to be avoided.
Here’s the bottom line. Employers do have tools at their disposal to make healthcare better, safer and less costly to both themselves and their employees. It requires a mindset change that largely hasn’t evolved yet. That is why employers remain islands in the stream for the most part, too reliant on advice lacking in innovative thinking and subject to ongoing high costs.