The Employed Doctor Bill
I have mentioned this trend before but I wanted to point out this editorial from a doctor in Kentucky. All doctors, unless direct care models get more popular, will be working for hospitals. It used to be that hospitals hired doctors for market share. Now that bigger systems are swallowing up more and more hospitals, that isn’t the case anymore. So, why are hospitals employing doctors? As the author states, “according to a 2012 MedPAC Advisory Report, including hospital facility fees increases reimbursement for a 15-minute office visit by 80 percent.” It’s a good read but he really doesn’t give a solution. The key would be to create an incentive for doctors to be on their own again. To me, that marriage between and doctors has too many conflict of interests. Did I ever mention the email from my past hospital CEO complaining that there were not enough patients being admitted? True story.
This is bizarre! Why should anyone pay so much more for facility fees? There should just be one reimbursement price for the procedure, no matter where it is done, or by whom – as long as it is done appropriately and well. Other countries seem to cope very well by doing it this way, for example Canada or Australia. It forces clinics and hospitals to think through what procedures really cost, and find ways to do it efficiently, not necessarily with all the gold-plated accessories. .
The problem is that the hospitals have the money. What hospitals don’t realize is that in reality they are a cost center; not a revenue generator. They can’t do anything without a doctor’s order. Organized medicine requires doctors to put aside their petty differences and work together to improve the healthcare system as a whole.
Thank God for Texas and California, where it’s illegal for physicians to be employed by non-physicians. Yeah, there are ways around it–hospitalist contract with radiology & ER groups, etc and can get a doctor canned if they make enough trouble–but at least my performance review is done by somebody who is licensed to practice medicine and usually is doing so regularly.
I think that the underlying move is to have the business world/administraters be our boss. They have never liked the independance and power that physicians excercise. It’s control. They want to tell us how to practice medicine their way. It’s happing already. Pre auth, formalaries, tiers, radiology blessings to oredr tests. It’s “Mother may I” medicine. Fly fishing is looking better all the time.