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.
Is the possible extension of a tax-credit for charity care relevant to this situation? Virginia has it: Google “Donations of Professional Services.”
Is practice in other English-speaking countries a consideration,
pending correction of this situation?
Keith Smith, Medical Director at the Surgery Center of Oklahoma, says their prices are anywhere from a sixth to a tenth of what a patient would typically pay at a so-called ‘not-for-profit’ hospital. Recently, employees of Oklahoma County were given the option of having their surgery at the Surgery Center of Oklahoma.
Gene –
You missed part of the strategy – make it more difficult for physician-owned hospitals to compete with established hospitals by restricting Medicare funding. The ACA includes a section which prevents new physician-owned hospitals from billing Medicare, and existing ones can not expand without losing their ability to bill Medicare. This is blatant cronyism pure and simple – and blocks physicians from taking their business elsewhere, even if it is to offer a higher quality, lower cost alternative.
To whomever is reading this blog and counting heads, this is just the beginning of a revolution to restore real quality to health care. The number of physicians and patients giving heed to this issue is increasing daily. You are being watched. Most of us, no matter what we do, have our own best interest at stake here. This is a problem that is not going to go away until we each discern right from wrong and then apply ourselves accordingly. History is repeating itself here. This is the land of the free and the home of the brave. Wisdom would have us choose to be members of a well principled team so that we may look back on our own history and say to ourselves, “l participated in the restoration of quality health care in The United States of America. I did what was right.”
“Those who move mountains begin by carrying away small stones”
Ancient Proverb
Judith L. Thompson MD FACS
Founding member and member of the board of directors
Letmydoctorpractice
Delegate Texas Medical Association
Too many others to list
Dr. Dorio make some very good points. Indeed physicians have been commoditized in the marketplace of healthcare. Lobbyists from the hospital association are abundant in Congress and have actively lobbied against physicians. The going trend is for doctors to sell their practices to hospitals. This liaison creates an inherent conflict of interest and increases the cost of care while adding to the bottom line of the hospital. None of this is in our patients’ interest and is a huge reason physicians have become so disillusioned with the practice of medicine.
Your editorial is a bulls eye and your advice that physicians must band together and turn up the volume and the heat is exactly what the doctor(s) ordered. As a former health reporter for a major newspaper group, I know first hand that Strategy 3 is true: “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.”
That’s why I left journalism after nearly 20 years. I am now executive director of the Association of Independent Doctors, a 3-year-old national nonprofit trade association dedicated to helping doctors stay independent by spreading the message about why we need to keep the government, insurance companies and hospitals from telling doctors how to practice. We are in 14 states, and growing fast. Please join our cause, like us on FaceBook and help us fight. We are stronger together
Marni Jameson Carey
Executive Director http://www.aid-us.org
Thank you for your tireless work to protect the patient-physician relationship, Dr. Dorio, from the untrained and unlicensed who would control medical care for financial or other personal gain, leaving patients and doctors to bear the risks of such interference with their lives and their licenses. I know you are correct in many or all of your assertions, from my own experience, and from the hundreds of doctors I have spoken with in the past two years, from around the country. One surgeon I worked with in WV was on the board of the main regional hospital in the northwest of that state. He told me, in 2011, that had seen, in WRITING, in the administration’s ‘playbook’, many of the same tactics you discuss. In particular, he related explicit direction on the part of administrators to isolate doctors from each other, by decreasing staff meetings, grand rounds and other opportunities for physicians to interact, and to isolate and attempt to falsely discredit professionally those clinicians who dared to raise patient safety problems caused by these amateurs’ money making schemes to interfere with highly trained professionals attempts to simply do their job. Such people should all face charges of practice without license, which is a felony, in my state. I for one have been working with national and state legislators to secure this legal remedy. See this link: http://www.oregonlive.com/portland/index.ssf/2015/09/jury_awards_3_million_to_legac.html for the story of a veteran nurse with a stellar patient care record, who raised patient safety concerns, and the attempt by administrators, taking home hundreds of thousands of dollars in bonuses (while laying off 400 clinical professionals, making under $100k/year total, in the name of ‘necessary cost savings’) to falsely attack her clinical record, and destroy her career as an R.N. She was vindicated by the jury, to the tune of $3 million. I heard examples at the AAPS (Assoc. of American Physicians and Surgeons) national conference of sham peer reviews – similar attempts to discredit conscientious doctors just trying to take good care of their patients.
I urge all concerned health professionals and patients to connect with one or more of the following groups, who are working to preserve quality patient care by trained experienced clinicians without this unconscionable impediment: Let My Doctor Practice, Docs4Patient Care Foundation, AAPS, Association of Independent Doctors, Physicians Working Together, Concerned Citizens for Healthcare Freedom, the National Physicians Council on Healthcare Policy, zdoggmd.com, and a growing number of others.
There will be a large DPC (direct patient care, or third party payer free) conference Dallas, Oct. 14-15, 2016, co-sponsored by D4PC Foundation, the Texas Medical Association, and The Physicians Foundation. Come, learn how to ‘Restore the practice of medicine to those who practice medicine’!
Michael Strickland, MD
One of the founders and member, board of directors
letmydoctorpractice.org
All doctors can be informed of conditions at various hospitals: See Ramius 10 on Twitter–the yellow graph says a lot: We spend too much on administration compared to advanced countries. See also the work of Senator Charles Grassley as cited on NPR, Google “charity profiting millions.”
When a patient enters the healthcare arena facing the fight of his life (literally) he needs in his corner a strong advocate. This optimally takes the form of a well seasoned physician who knows the art of medicine and how navigate the healthcare system. The patient’s best interest is not always served by his “team” (insurance provider, hospital), in fact there is an underlying suspicion those entities are opponents. As a physician my role is clear; I would never want my patients to perceive me as the opponent. Therefore we physicians must retain our independence. Contracts and administrators that remove our voice are contrary to our code of ethics and indeed the oath of Hippocrates.
Thank you for writing this warning. Doctors can learn to protect themselves by sharing such stories on Sermo.org and with http://www.aapsonline.org.
Senator Grassley is interested in this issue.
H.E.Butler III M.D., FACS
HButler@post.Harvard.edu
The derogatory comment made to Dr Dorio by a hospital board member, if made by any member of the medical staff to any hospital personnel, would lead to an investigation by the hospital with the possibility of severe sanctions against that physician. If you are a board member at Henry Mayo, such behavior will undoubtedly be tolerated and overlooked.Talk about a double standard!