…but only during the hours of 8:00 am to 5:00 pm, and not on weekends, holidays or golfing Wednesdays. Paying patients only, Medicaid not accepted. Admittance conditional upon positive wallet biopsy. And not if you actually need emergency care or anything unprofitable. Not valid in some states. Enter at your own risk. Some patients may check in, but they don’t check out.
Give it a few years, and signs like the one above will be replaced with signs like this one:
A physician-owned specialty hospital called 911 for a critical patient who developed breathing problems after spinal surgery. I’ve run more than a few calls like this. An excerpt from the article:
The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.
Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals.
Now I may be shooting myself in the foot here because I make a fair bit of money teaching certification courses at small specialty hospitals like these, but the article shines a spotlight on the ugly issue of money and health care. In my opinion, specialty hospitals are not good for our health care system.
Emergency Departments are colossal money losers just about everywhere you look. Lack of access to primary care, coupled with the paltry reimbursement from Medicaid that in many cases is far less than the actual cost of the care provided, forces a disproportionate number of the poor and uninsured to use hospital Emergency Departments as their primary health care portal. I don’t have statistics, but my experience tells me that the vast majority of these ED visits are clinic-type ailments that could and should be handled by the patient’s primary care physician, if they had one. But EMTALA places the financial burden of care for these people squarely on the shoulders of the hospital Emergency Department and by extension, the poor underpaid sap with “MD” following his name who is unlucky enough to be working there.
Most full service hospitals subsidize their Emergency Department losses with revenue streams from profitable areas like outpatient surgery, endoscopy and the like. Teaching hospitals can do it on the cheap because they have a steady supply of slave labor in the form of medical residents still learning their profession.
But these specialty hospitals siphon away the profits from the larger hospitals without being required to provide expensive emergency care services. In some cases, like the one cited here, there isn’t even a doctor on-site 24/7. Wood paneled rooms and the newest gee-whiz medical technology don’t do you a lot of good when your surgeon is sleeping at home in your moment of dire need. Give me an on-site doctor over a mint on the pillow every time.
Even Podunk General Hospital, Tire Repair, Nail Salon and Crawfish Hut has a doctor on-site 24/7, and we’re constantly wondering where the money for our next box of gauze is coming from.
What to do about the situation, I don’t know. The marketplace drove doctors to these specialty hospitals. You spend upwards of twelve years of your life in school learning the healing arts, sacrificing your sanity, time with your family and half a million bucks in tuition, you deserve the right to seek the highest compensation for the service you provide. In many cases, short-sightedness and lack of respect from the hospital administration were the culprit responsible for driving the physicians away. In other cases it was pure economics.
But the fact remains that our hospital system is starting to resemble a shriveled husk of buildings and infrastructure, while the people who keep the system propped up are starting to leave for greener pastures. The few dedicated ones who remain (Docs, nurses, mid-level practitioners and your humble scribe) are feeling the added burden. It’s only a matter of time before this whole house of cards collapses.
Congresscritters, either overhaul EMTALA and find a way to make primary care more accessible for patients and profitable for providers, or pass legislation requiring specialty hospitals to operate an Emergency Department.
Take your pick, but something has to be done.
And while you’re at it, it would be nice if the Medicare reimbursement for ambulance transport actually came close to covering the cost of ambulance transport. Otherwise, within a few years we’ll have nice, shiny, well-staffed hospitals and lots of very sick patients with no way to get there.
