Boston Globe: Hospital pressured employed MD's to not refer out of system

[drusso]

Steward Health Care exerted undue pressure to restrict referrals outside chain, suit says - The Boston Globe

"Dr. Stephen Zappala, a longtime Massachusetts urologist, said company representatives exerted immense personal and financial pressure on him and other physicians to refer patients only to Steward hospitals and specialists, putting profits first."

Many will deny it, but hospitals commonly exert this kind of pressure on their employees. They see it as part and parcel of the employer-employee relationship.

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[deleted480308]

Steward Health Care exerted undue pressure to restrict referrals outside chain, suit says - The Boston Globe

"Dr. Stephen Zappala, a longtime Massachusetts urologist, said company representatives exerted immense personal and financial pressure on him and other physicians to refer patients only to Steward hospitals and specialists, putting profits first."

Many will deny it, but hospitals commonly exert this kind of pressure on their employees. They see it as part and parcel of the employer-employee relationship.

That was openly happening in half the hospitals I rotated at as a student

 

[VA Hopeful Dr]

So obviously hospitals like the keep business in house, but making it part of a bonus structure or honestly doing anything other than just encouraging people to give referrals within a network is begging for this sort of thing to happen.

Most aggressive I've ever experienced is a hospital that sends out a quarterly email encouraging you to keep referrals within the system, as well as an Excel spreadsheet that shows what percentage of your referrals were in network. Anything more than that and there's a very good chance you're going to get sued. There was a hospital in the lower part of the state that just paid out 20 million dollars. They originally were going to fight the neurologist about where his MRIs went (they were stupid enough to threaten to fire him over the MRI referrals in an email), but then the federal government joined the suit and they decided to settle, surprise surprise.

 

[Gauss]

Many will deny it,

No, most won't.
Same internal referring pressures exist in most large multidisciplinary PP groups. Hospitals aren't the only culprits

 

[244913]

Steward Health Care exerted undue pressure to restrict referrals outside chain, suit says - The Boston Globe

"Dr. Stephen Zappala, a longtime Massachusetts urologist, said company representatives exerted immense personal and financial pressure on him and other physicians to refer patients only to Steward hospitals and specialists, putting profits first."

Many will deny it, but hospitals commonly exert this kind of pressure on their employees. They see it as part and parcel of the employer-employee relationship.

I know this really chafes your whites, but with your skillz/reputation/beard/PTA involvement and truly multidisciplinary approach surely you can bury any competition from hospital employed slugs. This is a problem for others I'd guess...

Don't wish it was easier; wish you were better

 

[painfree23]

whys this a story..

 

[hyperalgesia]

It would be news if a health system didn't do this.

 

[SSdoc33]

I know this really chafes your whites, but with your skillz/reputation/beard/PTA involvement and truly multidisciplinary approach surely you can bury any competition from hospital employed slugs. This is a problem for others I'd guess...

Don't wish it was easier; wish you were better

ahhh, if only. id love to believe that higher quality docs were more successful in terms of financial remuneration. if that were the case ductape would be a millionaire. it has been my experience that the shadiest docs with the worst technique and the worst morals are the ones who have full waiting rooms and drive bentleys. we dont get paid on quality.

 

[244913]

ahhh, if only. id love to believe that higher quality docs were more successful in terms of financial remuneration. if that were the case ductape would be a millionaire. it has been my experience that the shadiest docs with the worst technique and the worst morals are the ones who have full waiting rooms and drive bentleys. we dont get paid on quality.

Yes, in general there may be an inverse correlation between ethical standards and profit margins. For many patients a "good" doctor may = shiny new waiting room, attractive staff, bottled water in office, good Yelp reviews...

 

[drusso]

It would be news if a health system didn't do this.

This is why physicians need to Unionize. Employers are directing and controlling patient care.

 

[244913]

I'll tell you, Drusso, that in our health system patients who get referred out for pain management see one of two or three "interventional only" practices in the community where a midlevel starts them on narcotics, they work through series of three or facet injections until insurance exhausted and are then sent back to health system PCP, unimproved, except now on opioids.

No discussion of PT, no psych, no non narcotic med mgmt.

This idea of yours- obsession really- that PP does it right and hospital employed do it wrong doesn't always hold water. What do you think of that?

 

[drusso]

I'll tell you, Drusso, that in our health system patients who get referred out for pain management see one of two or three "interventional only" practices in the community where a midlevel starts them on narcotics, they work through series of three or facet injections until insurance exhausted and are then sent back to health system PCP, unimproved, except now on opioids.

No discussion of PT, no psych, no non narcotic med mgmt.

This idea of yours- obsession really- that PP does it right and hospital employed do it wrong doesn't always hold water. What do you think of that?

Well, that's ****ty too.

But, I think that this is a clear case of hospital collusion, RICO, and possible Stark violations. Why would any doctor let non-medically admins tell them what to do? The cake is a lie: Large health systems/physician employers are saving no one money...and, I couldn't live with myself if I knew my employer was exploiting loopholes to jack health care costs.

Healthcare Reform Creates Provider Monopolies | The Lund Report

Continuing problem of health-care consolidation is leading to higher costs for patients

Monopolized healthcare market reduces quality, increases costs

P.S. Longitudinal Beard Care is not all that it is cracked up to be...

 

[Ducttape]

I personally think there is a great deal of separation from calling admins thieves and crooks with no interest in patients themselves and saying that the doctors are personally responsible/at fault.

I like to believe that most of us are taking care of patients because we want them to get better, not solely for financial remuneration but apparently I’m too naive. Or stupid.

 

[ziggyziggy]

Just thinking aloud, Do physicians as part of group practice/hospital/healthcare system has fiduciary duty towards the employer/practice?
All of the healthcare is a business whether its single physician practice, group or large healthcare or not for profit. I don't know why we pretend its not. So, if you stop pretending and think of it as a business, tell me one such entity which will let their employees do above. And, I am not saying this at the cost of patient harm.

 

[drusso]

Ever

Just thinking aloud, Do physicians as part of group practice/hospital/healthcare system has fiduciary duty towards the employer/practice?
All of the healthcare is a business whether its single physician practice, group or large healthcare or not for profit. I don't know why we pretend its not. So, if you stop pretending and think of it as a business, tell me one such entity which will let their employees do above. And, I am not saying this at the cost of patient harm.

Every year our employees review, sign and attest to a "certificate of health care compliance." This states that they are not aware of any instances of health care fraud. It also states that if they did see or suspect any fraud that they would follow the appropriate policies and procedures--namely bringing the areas of concern to the attention of the business manager and owners immediately.

This procedure was instituted upon the advice of our malpractice and business insurance brokers. I doubt the plaintiffs in case above felt supported by their Admin in efforts to identify and reduce fraud (directing care for profit, etc).

 

[DODOCSS]

rehash

Mayo: Doctor gets vindication - and $12 million

 

[drusso]

rehash

Mayo: Doctor gets vindication - and $12 million

"He was even more outraged that a public hospital district tasked with treating the poor was giving outsized contracts to specialists that discouraged or excused them from treating the poor. All while the district collected $1.7 billion in property tax over past 10 years."

"Reilly said he doesn't feel guilty about the windfall. He said there should be future savings at Broward Health from a strict new corporate integrity agreement that's part of the settlement. And he hopes the case will serve as a warning to other hospital chains, public and private. "This money should never have been [Broward Health's] to begin with," Reilly said. "My goal was to reform a broken system."

This is even more disgusting and highlights the "swamp" that is public supported health care. This is a mis-use of the public treasury and physicians taxes into the system. No MD/DO should be subjected to pressure on who or where to refer their patients.

 

[VA Hopeful Dr]

rehash

Mayo: Doctor gets vindication - and $12 million

Lucky bastard

 

[SSdoc33]

Just thinking aloud, Do physicians as part of group practice/hospital/healthcare system has fiduciary duty towards the employer/practice?
All of the healthcare is a business whether its single physician practice, group or large healthcare or not for profit. I don't know why we pretend its not. So, if you stop pretending and think of it as a business, tell me one such entity which will let their employees do above. And, I am not saying this at the cost of patient harm.

yes and no.

you cant do an AMAZING job and spend 2 hours with every patient. that is a money-loser for the hospital just as it would be in private practice. OTOH, blowing thru 10 patients and hour probably isnt the wisest either.

drusso, although overstated as usual, does have a point here. healthcare decisions should be made by the physicians, not the administrators. but is doing a SCS on every patient that walks in the door a reasonable healthcare decision. there is some gray area here....

 

[244913]

Why does an OS need a 12M dollar payout? Was he working for free all those years? Sounds like a bunch of horse**** to me.

 

[nvrsumr]

Govt got almost 700 million.... By settlement with another agency supported by the tax payor. Govt knows best.

 

[VA Hopeful Dr]

Why does an OS need a 12M dollar payout? Was he working for free all those years? Sounds like a bunch of horse**** to me.

It's to encourage people to sue if they know of FCA violations - the person who brings the suit gets a percentage of the total if the government joins the suit.

 

[drusso]

yes and no.

you cant do an AMAZING job and spend 2 hours with every patient. that is a money-loser for the hospital just as it would be in private practice. OTOH, blowing thru 10 patients and hour probably isnt the wisest either.

drusso, although overstated as usual, does have a point here. healthcare decisions should be made by the physicians, not the administrators. but is doing a SCS on every patient that walks in the door a reasonable healthcare decision. there is some gray area here....

Ah, c'mon..."appropriately stated..."

 

[drusso]

yes and no.

you cant do an AMAZING job and spend 2 hours with every patient. that is a money-loser for the hospital just as it would be in private practice. OTOH, blowing thru 10 patients and hour probably isnt the wisest either.

drusso, although overstated as usual, does have a point here. healthcare decisions should be made by the physicians, not the administrators. but is doing a SCS on every patient that walks in the door a reasonable healthcare decision. there is some gray area here....

Still overstated?

U.S. Supreme Court case could limit physician referral power

"If the nation’s highest court upholds a ruling by the 2nd U.S. Circuit Court of Appeals, it would mean dominant health insurers or dominant hospital systems could create contracts that include anti-referral rules that prohibit physicians from referring patients to out-of-network specialists for innovative or medically-necessary tests that would provide the patient with the best care."

 

[hyperalgesia]

Still overstated?

U.S. Supreme Court case could limit physician referral power

"If the nation’s highest court upholds a ruling by the 2nd U.S. Circuit Court of Appeals, it would mean dominant health insurers or dominant hospital systems could create contracts that include anti-referral rules that prohibit physicians from referring patients to out-of-network specialists for innovative or medically-necessary tests that would provide the patient with the best care."

It doesn't seem that different from an HMO or even PPO. Someone please sue CMS for SoS discrimination.

 

[drpainfree]

Ever


Every year our employees review, sign and attest to a "certificate of health care compliance." This states that they are not aware of any instances of health care fraud. It also states that if they did see or suspect any fraud that they would follow the appropriate policies and procedures--namely bringing the areas of concern to the attention of the business manager and owners immediately.

This procedure was instituted upon the advice of our malpractice and business insurance brokers. I doubt the plaintiffs in case above felt supported by their Admin in efforts to identify and reduce fraud (directing care for profit, etc).

drusso, can you share a copy of "certificate of health care compliance"? I'd love to have my employees sign this periodically.

will pm you now.

 

[drusso]

drusso, although overstated as usual, does have a point here. healthcare decisions should be made by the physicians, not the administrators. but is doing a SCS on every patient that walks in the door a reasonable healthcare decision. there is some gray area here....

If you don't like the influence hospital admins have over employed MD/DO's, then maybe try working for the insurance company...

Some Health Insurers Are Acquiring Practices As An Ongoing Battle With Hospitals Continues.
Modern Healthcare (6/2, Livingston, Subscription Publication) reported, “In the turf war between hospitals and health insurers over physician practices, hospitals are winning by a long shot,” however, “they’d be ill advised to get too comfortable.” That is because insurers such as UnitedHealth Group, Centene Corp., Humana, and Anthem are acquiring medical practices. Some companies consider “owning physician practices as a way to control spending,” while others believe they “are defending their influence and revenue stream from rampant hospital-physician practice consolidation.” To date, however, few physicians work for insurance companies. Data from the American Medical Association show “about 2% of all physicians in 2016 were employed directly by a health insurer or worked in a practice that was owned by one.”