Hospitals are sacrosanct pillars of a community with alabaster halls and sterile rooms where saving lives and curing disease emanates. But fifteen years ago some floundered in bankruptcy, and that’s when a business strategy began.
Today, medical decision-making is made by businesspeople, not your doctor. Physicians are a commodity used as a tool while administrators conveniently have their personal hospital ATM machine for salaries, bonuses, and retirement.
Who makes healthcare decisions? Insurance companies, Medicare, Medicaid, and Big Pharma. This applies to hospitals where patient stories get louder every day condemning poor care while doctors are hapless pawns on the hospital chessboard.
Chapter 1 was revealed in a 2004 article written by a medical attorney contending the hospital industry legal team “is out to decimate the independence of medical staffs and take away physicians’ rights” by placing “unfettered power and economic control over doctors in the hands of hospital administrators.”(a)
This initial assault was to target physicians who were “advocating quality of care for their patient” and removing them from Medical Staff. These tactics were templated and packaged “in smooth language to make them sound fair and reasonable.”
Five years ago, just prior to my first year on our physician Medical Executive Committee (MEC), I spoke with the author of the article wondering what other templated plans we would be facing. He didn’t know.
Subsequently, I learned some of their strategy through experience from our local hospital administrators so present it to you here in Chapter 2.
Strategy 1: Control votes. Make sure the Board of Directors vote in your favor. Use financial conflict of interest of seated bankers, construction contractors, real estate agents, and contracted doctors to sway their vote.
Strategy 2: Gain doctor votes by dangling contracts of anesthesiologists, radiologists, pathologists, and emergency physicians. Use this to affect election of MEC members who then punish targeted “whistleblowers” through sham Peer Review, Code of Conduct, Corrective Action, and credential reappointment. Eliminate votes by demoting dissenting doctors using false accusations when they reapply for hospital privileges.
Strategy 3: Dominate the media. Use advertisement monies to leverage print newspapers, websites, and blogs to publish non-critical stories. Send out slick hospital mailers aggrandizing patient care despite surrounding controversy and criticism.
Strategy 4: Manage hospital statistics, and not allow physicians nor the public to know about deaths, malpractice, public complaints, or lawsuits. Use statistics to blame doctors for alleged poor care not revealing hospital cutbacks and limited resources have effected quality.
Strategy 5: Settle all lawsuits avoiding legal meddling in hospital medical records and courtroom testimony of malfeasance.
Strategy 6: Takeover the duties of physician committees like those evaluating nurse practitioners and oversight of palliative care. This way the hospital can funnel in subordinate care, and push out elder seniors into Hospice, saving money.
Strategy 7: Hire cheap labor like new graduates, and rid yourself of the more costly experienced professionals. This applies to frontline caregivers including RNs, CNAs, ward clerks, monitor techs, and therapists.
Strategy 8: Change hospital policies and procedures and don’t inform the physician Medical Staff. For instance, the Sentinel Event Policy corrects medical errors so they don’t happen again. Minimize doctor involvement and input avoiding improvement and safety.
Strategy 9: Falsely enhance national Medicare survey results by illegally approaching ailing hospital patients with test questions.
Strategy 10: Know hospital oversight agencies such as The Joint Commission, Department of Public Health, State Attorney General, and Medicare are ineffective and tend to ignore complaints, even when patients die.
Strategy 11: Outrightly challenge the physician Medical Staff as their leadership is weak and disorganized (“like herding cats”), and legal advice is poor. Tell them “we must work as a team”, and not tell them you are calling all the shots. Keep them pawns, but use their medical licenses to make your money and fill the ATM.
Strategy 12: Use the “fear” and “for the community good” cards when asked questions to avoid scrutiny by the media or the public. No one wants to lose their hospital, nor put it in financial jeopardy like bankruptcy. Sprinkle in some guilt so you have a perfect shield to deflect criticism.
The public is only vaguely aware of this hospital strategy, but on the horizon are dark clouds of higher premiums and deductibles with out-of-pocket costs; less professional face-to-face care; more computer paperwork; smaller fine print; increased drug costs; and insensitive “drive-thru” care.
Chapter 3 is in the future, as hospital templated plans have not yet fully unfolded. But should doctors remain pawns on this hospital chessboard, healthcare will be in jeopardy. Checkmate.
Gene Uzawa Dorio, M.D.