Excellent Med Econ Article on Employed vs Independent MD/DO's

[drusso]

Employed vs independent doctors: Numbers don't tell the whole story

Why independence is not a thing of the past. Rather, it is the future of medicine.

www.medicaleconomics.com

"Yet hospitals continue to roll up practices for one reason: Money. The more doctors that hospitals or private equity companies own, the more market share they capture, the more bargaining power they have with insurers, the more facility fees they can charge (added costs hospitals charge for outpatient services that independent doctors don’t), and the more referrals they can be sure get driven into their systems."

The take home for graduating fellows: Choose who you do business with care. Are you working for patients or working for the mob?

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[DOctorJay]

You can join with a hospital, meet all the admin, find that it's a great fit.

And then they bring in new admin (especially in places laser focused on growth) and all of a sudden your contract/comp package changes, your patient population changes, your schedule changes, your bosses change, and you feel like Dorothy, swept away in a tornado to some unknown land run by some mysterious force behind a curtain.

 

[Ducttape]

while there is a take home message to your statement, the bias is obvious.

better to state: "are you working for an individual patient practice or a hospital based practice". yes, your decisions are subservient to the "greater good" of the hospital in the latter situation.

 

[drusso]

while there is a take home message to your statement, the bias is obvious.

better to state: "are you working for an individual patient practice or a hospital based practice". yes, your decisions are subservient to the "greater good" of the hospital in the latter situation.

...Stockholm Syndrome...

Are Some Physicians Stockholm Syndrome Victims?

A hostage sides with her captors in a bank hold-up Years ago, when the Population Health Blog was the staff physician supervising an ov...

diseasemanagementcareblog.blogspot.com

"As so elegantly described by Paul Levy in his blog, the Stockholm Syndrome occurs when hostages misinterpret the near-term lack of abuse by their captors to the point of emotionally bonding with them. While he was writing about the relationship of healthcare institutions to electronic record vendors, the PHB wonders if the same could be said about the relationship of physicians to their administrators, policymakers, elected representatives, regulators, and the other clerisy.

Their reward for any role they've played in marginalizing physicians is greater authority, and some docs may not only going along with it, but embracing it."

 

[nvrsumr]

The only issue is this consolidation drives up the cost of care while benefiting no one but the MBAs.

If hospitals were more efficient and charged less for better outcomes then none of Drusso's societal arguments would matter.

But hospitals cost more for less when it comes to outpatient services.

 

[Ducttape]

or just get rid of 75% of administrators and the system would be much more efficient.

 

[drusso]

or just get rid of 75% of administrators and the system would be much more efficient.

Hospitals are threatened by office-based independent practices. They see them as “revenue leak”

88% of hospital execs feel threatened by Optum, CVS Health, Amazon: 4 notes. UnitedHealth Group's Optum poses the biggest perceived threat to hospital and health system executives worried about non-hospital competitors that offer consumer-friendly health services, according to Kaufman Hall's 2019 State of Consumerism in Healthcare report.

UnitedHealth Group's Optum poses the biggest perceived threat to hospital and health system executives worried about non-hospital competitors that offer consumer-friendly health services, according to Kaufman Hall's 2019 State of Consumerism in Healthcare report.

www.beckershospitalreview.com

 

[DOctorJay]

Hospitals are threatened by office-based independent practices. They see them as “revenue leak”

88% of hospital execs feel threatened by Optum, CVS Health, Amazon: 4 notes. UnitedHealth Group's Optum poses the biggest perceived threat to hospital and health system executives worried about non-hospital competitors that offer consumer-friendly health services, according to Kaufman Hall's 2019 State of Consumerism in Healthcare report.

UnitedHealth Group's Optum poses the biggest perceived threat to hospital and health system executives worried about non-hospital competitors that offer consumer-friendly health services, according to Kaufman Hall's 2019 State of Consumerism in Healthcare report.

www.beckershospitalreview.com

They label physicians “leaking” as “bad citizens”

 

[geauxg8rs]

They label physicians “leaking” as “bad citizens”

my local "not for profit" hospital calls them integrated and non integrated physicians. I used to work at the hospital for a "non integrated" group who did all of their procedures at the hospital. the hospital was making a killing off our facility fees.
Around the time that I was starting, The hospital sell out medical director arranged a meet and greet party for the docs at a country club. I didn't find out about the meet and greet until after the party. I told the clinic office manager that I would like to know about such events going forward as I wanted to meet other doctors in the community. The office manager (worked for the hospital) asked the med director to let me know of such events going forward. The med director's ****ing response was "he is non integrated and is not welcome at these parties."
they are beyond petty.

 

[drusso]

my local "not for profit" hospital calls them integrated and non integrated physicians. I used to work at the hospital for a "non integrated" group who did all of their procedures at the hospital. the hospital was making a killing off our facility fees.
Around the time that I was starting, The hospital sell out medical director arranged a meet and greet party for the docs at a country club. I didn't find out about the meet and greet until after the party. I told the clinic office manager that I would like to know about such events going forward as I wanted to meet other doctors in the community. The office manager (worked for the hospital) asked the med director to let me know of such events going forward. The med director's ****ing response was "he is non integrated and is not welcome at these parties."
they are beyond petty.

More of these stories need to be cataloged and spread around--especially to new-Grad MD/DO's & Fellows. #notacog

 

[drusso]

They label physicians “leaking” as “bad citizens”

Yep. Heard them described as "the enemy" too.

 

[geauxg8rs]

More of these stories need to be cataloged and spread around--especially to new-Grad MD/DO's & Fellows. #notacog

Now that I am a total enemy in their eyes since I have my own clinic, and they get no facility fees on my procedures, some of the “integrated” docs have resorted to some bad faith practices. One hospital employed pcp who regularly referred to me now tells his patients (when they ask for a referral to me by name) tells them that they are mistaken and that I moved out of the area. Another tells patients that he won’t put the referral in the “computer” but will give them one of my pamphlets and they should just call me directly.

These lemmings must have had so
Much fear beat into them to refer in house or no contract renewal. So nice for a Christian “not for profit” hospital system.

I had to resort to putting a billboard literally a stones throw from the hospital clinic where I was. Yet some docs still tell patients I am out of the area.

 

[Ducttape]

but it never goes both ways.

you never have a private doctor adamantly refuse to refer to a hospital based physician. never ever.

unless somehow that patient has Medicaid, and then its "this HOPD doc is the best ever! he'll take over your pills!"

/sarcasm off.

(but I do agree with the admin part tho)

 

[drusso]

Now that I am a total enemy in their eyes since I have my own clinic, and they get no facility fees on my procedures, some of the “integrated” docs have resorted to some bad faith practices. One hospital employed pcp who regularly referred to me now tells his patients (when they ask for a referral to me by name) tells them that they are mistaken and that I moved out of the area. Another tells patients that he won’t put the referral in the “computer” but will give them one of my pamphlets and they should just call me directly.

These lemmings must have had so
Much fear beat into them to refer in house or no contract renewal. So nice for a Christian “not for profit” hospital system.

I had to resort to putting a billboard literally a stones throw from the hospital clinic where I was. Yet some docs still tell patients I am out of the area.

Commentary: We need to reaffirm the role independent docs play in the push for value in healthcare

The conversation around healthcare costs has become central in political and social debates. Employer spending on healthcare services increased by 44% per enrollee from 2007 to 2016, translating to billions in additional costs for business and employees.

www.modernhealthcare.com

"Independent physicians and physician groups—relieved of some of the administrative burdens they face in the corporate environment—are empowered to deliver more personalized care experiences for patients and are a linchpin in the search for the quadruple aim: improved population health, better patient experience, better provider experience and reduced costs."

 

[geauxg8rs]

but it never goes both ways.

you never have a private doctor adamantly refuse to refer to a hospital based physician. never ever.

unless somehow that patient has Medicaid, and then its "this HOPD doc is the best ever! he'll take over your

True. As much as I despise this hospital, I still refer patients there. To whichever specialists I think do the best job, refer for labs and imaging, etc. One of the best parts of being independent is being able to refer to whomever I think will do best job for my patient. How refreshing

 

[Ligament]

They label physicians “leaking” as “bad citizens”

I actually got a lecture once from a system CEO about being a good corporate citizen. He said that term verbatim. "good corporate citizen."

 

[drusso]

I actually got a lecture once from a system CEO about being a good corporate citizen.

Insulting and demeaning.

Hospitals don't want to be transparent and explain how much they are making off doctors and gouging insurance companies...

Employers, hospitals and insurers butt heads over transparency proposals

One contentious provision of the Senate proposal is a requirement that hospitals and insurers give patients a cost estimate for any upcoming treatment within 48 hours of a request.

www.modernhealthcare.com

 

[DOctorJay]

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

 

[drpainfree]

stay away from hospitals, as far away as possible...

 

[drusso]

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

Need to get this kind of information out to medical students, residents, and fellows.

 

[SommeRiver]

I actually got a lecture once from a system CEO about being a good corporate citizen. He said that term verbatim. "good corporate citizen."

Disturbing IMO. Did no one raise their hand and ask for clarification of that term? I would have jumped at that chance...

 

[drusso]

Disturbing IMO. Did no one raise their hand and ask for clarification of that term? I would have jumped at that chance...

The self-inflicted death of the physician

We, as a profession, have handed over our authority to others, not all at once, but slowly, inexorably, over decades.

www.kevinmd.com

"We’ve allowed our noble profession to be taken over by both the anaplastic leveling shroud of the government and the neoplastic Scrooges of the insurance industry or perhaps both in cahoots with one another. We have been bureaucratized by the “left and commodified by the “right.” For the sake of our profession, and more importantly, for the sake of our patients (whom we will all eventually be one day). We need to wrest control of our calling back to those who earned the honor in the first place."

 

[deleted941485]

The self-inflicted death of the physician

We, as a profession, have handed over our authority to others, not all at once, but slowly, inexorably, over decades.

www.kevinmd.com

"We’ve allowed our noble profession to be taken over by both the anaplastic leveling shroud of the government and the neoplastic Scrooges of the insurance industry or perhaps both in cahoots with one another. We have been bureaucratized by the “left and commodified by the “right.” For the sake of our profession, and more importantly, for the sake of our patients (whom we will all eventually be one day). We need to wrest control of our calling back to those who earned the honor in the first place."

I think you hit on something important and it’s that physicians will find no refuge on either side of the political spectrum. You’ve got the Bernie’s on the left that want nothing more than for you to be just another government cog and the Right which basically wants you tucked away in some corporation or staffing profit machine. Both of these models are equally repulsive. But honestly they have no new ideas in this respect...zero. This is how they were indoctrinated either by a committed Marxists or full blooded supply side neoclassical economists.

These people cannot abide one bit a private practitioner. Out of their control. Making judgement based on training and evidence not algorithms and documentation. Charging for their services at prices the provider decided. This drives the left and the right bat**** crazy!! “Omg they aren’t working for us! Well we will see about that!” The public goes along with this because the vast majority of them are cogs in a wheel too. They cannot imagine (perhaps they can) having anyone else working any other way.

 

[VA Hopeful Dr]

Now that I am a total enemy in their eyes since I have my own clinic, and they get no facility fees on my procedures, some of the “integrated” docs have resorted to some bad faith practices. One hospital employed pcp who regularly referred to me now tells his patients (when they ask for a referral to me by name) tells them that they are mistaken and that I moved out of the area. Another tells patients that he won’t put the referral in the “computer” but will give them one of my pamphlets and they should just call me directly.

These lemmings must have had so
Much fear beat into them to refer in house or no contract renewal. So nice for a Christian “not for profit” hospital system.

I had to resort to putting a billboard literally a stones throw from the hospital clinic where I was. Yet some docs still tell patients I am out of the area.

That sounds fishy... perhaps illegal fishy. Not putting the referral in the computer means that PCP will get in trouble if he refers to you.

 

[jettavr6]

More of these stories need to be cataloged and spread around--especially to new-Grad MD/DO's & Fellows. #notacog

Cataloged for eventual presentation to the DOJ or OIG. These are anti-trust violations.

 

[MiddleOfNowherrr]

You can join with a hospital, meet all the admin, find that it's a great fit.

And then they bring in new admin (especially in places laser focused on growth) and all of a sudden your contract/comp package changes, your patient population changes, your schedule changes, your bosses change, and you feel like Dorothy, swept away in a tornado to some unknown land run by some mysterious force behind a curtain.

Experienced this very phenomena myself...

 

[drusso]

Experienced this very phenomena myself...

No one explains to residents and fellows what an “at-will” employee is and what it means. I’ve seen a lot of new grads fall for the bait & switch from hospitals.