My Dire Prediction For Employed Doctors
Researchers are saying that the Affordable Care Act will eventually cause a massive rise in hospital mergers. They are using Massachusetts as a guideline where “one-third of the state’s 70 acute care hospitals have merged, acquired or partnered with another system in the first six years since Massachusetts implemented its universal health care program in 2007, and an additional 20% are in discussions to do so”. Monopolies are NOT good for medicine. Without competition these hospitals and their dictators…er, CEOs….go unchecked. The administrators multiply like tribbles (hence the term I created called Administribbles) and gouge patients with huge bills. They also raise their own salaries because we all know how important they are. What is funny is that this American Medical News article falls right into their trap and spins their story for them. According to the piece they kind of buy into the fact that the “bigger size” is seen as beneficial:
- Consolidation is the first step toward providing coordinated care that the state hopes to achieve, said Ronald Dunlap, MD, president of the Massachusetts Medical Society.
- Consolidation allows for the formation of patient care networks that provide the infrastructure that ultimately leads to patient-centered medical homes and accountable care organizations, he said.
- In a separate report issued in June, the American Hospital Assn. said mergers aren’t necessarily a bad thing, because in many cases the acquired hospital is a small or community facility that otherwise would be at risk of shutting down because of financial issues.
- The PwC report said what’s going to drive the formation of more coordinated care models in Massachusetts is the state’s purchasing power to provide health care to government employees, which probably will shift physician practices and hospitals in the direction of more efficient delivery models, which is expected to reduce costs.
Are you under the spell of Adminstralian bullshit yet? Well, the article went on to say that “not as much money was saved as predicted.” Boy, I didn’t see that coming.
Here is the big thing that the article says NOTHING about. Unfortunately, most doctors (if not all) will eventually be employed by hospitals in the future. Hell, that is happening already today. When competition declines due to hospital consolidation then the salaries that offered to employed doctors will decrease! Step one was for hospitals to buy the practices to impose a ridiculously high facility fee. Done. Step two is to buy the docs. Done. Step three is to buy the future docs for less and less. This is in process. Step four is to make the doctors the CEO’s bitches. You tell me where we are on that one? I have my own idea.
The other piece of the employed physician puzzle is this: CMS will begin to decrease what it pays hospitals to admit patients, in their effort to cut healthcare costs from the federal budget. Hell they have cut about as much as they can from the doctors, a 0.23% increase in payment over the last ten years is disgraceful. But I digress, as the CMS payments to the hospital decrease where will the hospital cut back on its expenditures? Not on what it pays the administrators. No again we the physicians will be the scapegoats of cut backs. Being employed is not income or practice security it is a means of controlling the physicians. WE ARE NOT SHEEP or are we?
And the worrisome part of mergers and partnerships is the Catholic Church doing it all across the nation already, with predictable results for women’s health care. The Church imposes its rules on what practices a hospital or doctor can follow (no abortions, no birth control, no surgeries for ectopic pregnancies that result in a putative abortion, no vasectomies, you get the picture).
The alleged upshot of this is that said partners of Catholic hospitals can share research information with the large Catholic health care system, but the last time I checked, Catholic research consists of validating what the Holy See hands down, not advancing science.
This is worthy of an article in its own right (some in various local news media outlets are noting what happens when the Catholic Church comes to town and partners with the only community hospital in an area already).
YES. That’s the next step. Docs get bought out, all employed, then the monopoly-having admins will start paying them less. Then they all quit and go Direct Access. That’s why I’m going to do it now, and skip many years of crap and headache.
Massachusetts at least forbids noncompetes, so that employed doc in Big Silo Number One, can go to Big Silo Number Two.
One thing that might change the conditions on the ground, is if facility fees are banned. If that happens, actually all the employed docs will get spun off rapidly.
True dat!
However the escape clause is primary care that goes direct pay!
Get rid of the middlemen and go back to the days past.