A few years back, when the notion of a government health insurance challenger to the dysfunctional status quo was being discussed, all sorts of horror stories came out of the woodwork. The special interest bogeyman was working overtime to scare us all. During that period of tempest, I spoke with people I knew in Canada – specifically at the University of Manitoba Centre for Health Policy. The question they asked was “do Americans know that there is a noose tightening around their neck, and the out-of-control healthcare sector is the hangman?”
I don’t know how you evaluate your odds of enduring in our current healthcare system – both financially and physically and I sure as heck don’t know how the deep pockets people (employers) are reading the tea leaves. Overall, it just feels like the vise grip of the healthcare industry is tightening down to the point where there will be no room to squirm at all.
Health care systems are eating up almost every doctor practice in sight – even to the point that the Justice Department has to step in and say “no”, to a looming monopoly (i.e., Boise St Lukes). The dead aim of all of this is for doctors to be under the thumb of “employer” systems who can then pull the strings and plow patients into the hospital mother ships.
Does it hurt? How about the Mass General and Brigham & Womens’ Hospital debacle – the end result will hurt the market (payers and consumers) in the greater Boston area for years because these two behemoths decided they can crush any opposition at will.
I won’t go at length into my history written on all of the abuses – they are legion: hospitals charging outrageous sums for simple stuff like appendectomies, hospitals bribing doctors, doctors cutting healthy people up or prescribing chemo for healthy patients, hospitals disciplining ER docs for failing to admit (quotas) enough patients from the ER, docs getting paid huge amounts by drug companies to push products, doctors with their fingers in equipment manufacturing interests (PODs). The list never ends and so many roadmaps lead us to the conclusions that hospitals are at the center of profligate abuses.
Take today’s press, for example. Infirmary Health System in Mobile, Ala, one of Alabama’s largest health systems is paying $25 million to resolve a federal whistle-blower lawsuit that claimed its clinics routinely overpaid doctors to refer their radiology patients to hospitals, despite clear bans against paying for such referrals. Infirmary has just settled the allegations that since 2008, two of its clinics paid radiologists bonuses that were calculated based on how many patients were referred for services.
And the laugh line is always “XYZ has settled without admitting any wrongdoing.”
There is a lot of angst among physicians about their lot in the system, and rightfully so if we look at the practice of medicine. The practice of medicine is being dictated by guys in suits who think more bottom line than patients. And physicians are being shoved to the back of the bus – they are just cogs in the big grist mill grinding on us all.
Right now, my attention is focused on the work being done by Dr Vikas Saini and Shannon Brownlee at the Lown Institute. The Right Care Alliance mission statement is as follows:
“The Right Care Alliance is a network of clinicians, patients, and community leaders who work together to reduce overuse, underuse, and misuse of medical tests and treatments in the health care delivery system, and to restore the clinician-patient relationship.”
Let me make a point clear. While many, many physicians are getting sand kicked in their faces way too much, a lot of medical integrity is being bought and sold out there. Physician accountability has become suspect far too often. Too many hands are greasing palms, and too many palms are getting willingly greased.
What’s needed is this. First, employers have to get off their duffs and start demanding their due – honesty in pricing, ethical providers with their eyes on quality patient care (and not the profitability of the hospital systems), and a massed market force driving the elimination of waste, excesses, growing costs and medical harms being done at the hands of systemic institutional greed.
Second, doctors need to stop complaining and forcefully assert certain realities to the whole system, i.e., “we are the doctors, we are in charge of our patients’ care, we are in the critical relationships with our patients and we won’t continue to take orders from guys in suits with profit-first motives, when those conflict with or threaten patients’ well-being.
That’s what the Right Care Alliance aims to do, and it is going on the road. Dallas Fort Worth, just like everywhere else, needs a good dose of Right Care thinking.