"Private Equity is Ruining American Healthcare"

[RangerBob]

I'm not a business or economics major, so I don't know what is actually best for US healthcare. But I can say with 100% honesty I'd rather be employed directly by the government or working in a single-payer system than in a system that gets completely absorbed by for-profit interests like in the article.

Personally, I'd like to see us return to a system where we're all solo docs/partners/groups, and not working for for-profit corporations (a relative term, as many groups and even private docs are structured as corporations). There were still sleezy docs back "then." But we had ultimate autonomy and as a profession, we handled that autonomy and responsibility better than almost any other profession. Most of us take our oath and responsibility to our patients seriously. But with the erosion of our autonomy comes an erosion in our ability to effect change and ultimately, provide patients the care/services they deserve.

I don't know how good of investigative reporting Bloomberg reporters usually do (it's not my normal news source), and I don't know how common this setup truly is, but I can still say I don't like what I'm reading in this article.

How Private Equity Is Ruining American Health Care

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[TwistedTea]

Not defending the premise of the article but are most of the problems discussed and examples used exclusive to for profit clinics? Upcharging, quality (lack of) vertical mergers etc. Big hospital systems that are not or non profit seem to do the same thing (minus having investors of course).

I would also rather have it go back to more small practice-ish type deals but so much regulation and overhead makes it hard.

 

[deleted927028]

Not defending the premise of the article but are most of the problems discussed and examples used exclusive to for profit clinics? Upcharging, quality (lack of) vertical mergers etc. Big hospital systems that are not or non profit seem to do the same thing (minus having investors of course).

I would also rather have it go back to more small practice-ish type deals but so much regulation and overhead makes it hard.

Which regulation you are blaming? I am sure you are as clueless as all the conservatives and libertarians. Even if there is any such regulation, I am 200% sure that it was enacted by the corrupt politicians on behalf of the health insurance companies, hospitals, drug companies etc for bribe. So, you have to start blaming them instead of some imaginary evil government. You are just repeating after Fox News and the corrupt pointless.

See, to solve a problem, first of all you have to identify the problem with honesty and no bias. Otherwise, you will be going in circles. The number one issue here in USA is that people have been brainwashed for generations into believe that the government that they elect every two years is some alien evil, it is inefficient, it cannot do anything well, government is the problem, small government means lower tax (fools don’t realize they will pay many folds in fees for the SAME benefit/service), paying tax means paying for OTHERS’ services (fools don’t realize that it also means OTHERS are paying for THEM), regulations for corporations mean less freedom for THEM, any government involvement is violation of their freedom (I don’t really understand what the F it means), government provided services means that the government is controlling all aspects of their life (if private companies provide the same service for ten times cost, it is FREEDOM) etc...

Because of this, the money hungry vultures encroached into all areas where it is better for the people if the Government handles those. In other words, the essential services and goods. Even a fool would understand that wherever the demand is inelastic even when the prices raise,the free market will not work in favor of the consumers or the common man. So it is imperative that the government provides those goods and services for minimum possible cost. Any stupid around the world would know that all the natural resources belong to the nation or all Citizens rather than a few private companies, so the government has to harvest them and use the proceeds for common causes. Also, any idiot would understand that if the government spends money funds something and invent something, the benefit should go to the nation, not a few private companies.

Since all the Americans are brainwashed, we do not understand any of these and we let a few private companies to loot the nation and all the citizens. To keep the looting going, the private companies bribe all the politicians, fund their election and force them to sign whatever these scumbags write into laws and regulations.

So, what is the solution? LEARN FROM OTHER NATIONS. They don’t hate their government or consider it as an alien evil. They force the politicians to provide them all the above mentioned services to them for everyone’s benefit.

We have to demand the government to take over healthcare, energy, natural resources, education, banking, research done using government money etc, and provide all those in an effective and efficient way with minimum cost to all of us no matter what is the color of the skin of a person.

In which stupid country the government would provide FDIC insurance for deposits made in PRIVATE banks? Where the government would pay private banks to distribute its money to its own citizens? Where the government would give away the patent for the inventions found using its money to private companies and to rob its own citizens? ONLY IN THE STUPIDEST COUNTRY CALLED USA !!!

 

[deleted927028]

If you are brainwashed to believe that the police is evil, whom will you support and defend? The criminals!!! That’s how we have come to defend the private corporations vehemently no matter what they do and how much they freeze the people, AGAINST OUR OWN INTEREST. Because, otherwise we will be branded as the supporters of the evil useless government that we elect every two years !!!!

 

[deleted927028]

Typo. Fleece not freeze. Thank you

 

[TwistedTea]

Which regulation you are blaming? I am sure you are as clueless as all the conservatives and libertarians. Even if there is any such regulation, I am 200% sure that it was enacted by the corrupt politicians on behalf of the health insurance companies, hospitals, drug companies etc for bribe. So, you have to start blaming them instead of some imaginary evil government. You are just repeating after Fox News and the corrupt pointless.

See, to solve a problem, first of all you have to identify the problem with honesty and no bias. Otherwise, you will be going in circles. The number one issue here in USA is that people have been brainwashed for generations into believe that the government that they elect every two years is some alien evil, it is inefficient, it cannot do anything well, government is the problem, small government means lower tax (fools don’t realize they will pay many folds in fees for the SAME benefit/service), paying tax means paying for OTHERS’ services (fools don’t realize that it also means OTHERS are paying for THEM), regulations for corporations mean less freedom for THEM, any government involvement is violation of their freedom (I don’t really understand what the F it means), government provided services means that the government is controlling all aspects of their life (if private companies provide the same service for ten times cost, it is FREEDOM) etc...

Because of this, the money hungry vultures encroached into all areas where it is better for the people if the Government handles those. In other words, the essential services and goods. Even a fool would understand that wherever the demand is inelastic even when the prices raise,the free market will not work in favor of the consumers or the common man. So it is imperative that the government provides those goods and services for minimum possible cost. Any stupid around the world would know that all the natural resources belong to the nation or all Citizens rather than a few private companies, so the government has to harvest them and use the proceeds for common causes. Also, any idiot would understand that if the government spends money funds something and invent something, the benefit should go to the nation, not a few private companies.

Since all the Americans are brainwashed, we do not understand any of these and we let a few private companies to loot the nation and all the citizens. To keep the looting going, the private companies bribe all the politicians, fund their election and force them to sign whatever these scumbags write into laws and regulations.

So, what is the solution? LEARN FROM OTHER NATIONS. They don’t hate their government or consider it as an alien evil. They force the politicians to provide them all the above mentioned services to them for everyone’s benefit.

We have to demand the government to take over healthcare, energy, natural resources, education, banking, research done using government money etc, and provide all those in an effective and efficient way with minimum cost to all of us no matter what is the color of the skin of a person.

In which stupid country the government would provide FDIC insurance for deposits made in PRIVATE banks? Where the government would pay private banks to distribute its money to its own citizens? Where the government would give away the patent for the inventions found using its money to private companies and to rob its own citizens? ONLY IN THE STUPIDEST COUNTRY CALLED USA !!!

Well I was hoping to have a decent discussion but doesn’t look like that’s going to happen.

 

[RangerBob]

Not defending the premise of the article but are most of the problems discussed and examples used exclusive to for profit clinics? Upcharging, quality (lack of) vertical mergers etc. Big hospital systems that are not or non profit seem to do the same thing (minus having investors of course).

I would also rather have it go back to more small practice-ish type deals but so much regulation and overhead makes it hard.

Yes, these issues are seen and being accelerated elsewhere, especially as those other systems are trying to compete with the for profit systems.

 

[TwistedTea]

Yes, these issues are seen and being accelerated elsewhere, especially as those other systems are trying to compete with the for profit systems.

I’m not sure either of which would be better (single payer vs pure for profit system. Maybe a mix of he two) I suppose devils in the details. We wouldn’t think that the docs working even for the for profit places would be able to deviate too strongly from EBM, with insurance companies monitoring all the claims (talking about the chart showing how the clinics and up charge and rationalize the more expensive treatment). I think the breaking point would be if and when management started intervening when docs weren’t billing for the most expensive option. I’d probably have left by then pending what the contract says. Of course the “vanity” part is probably why private equity wanted in in the first place obviously lol. Past that I don’t know. Hopefully more peeps besides Loveall will chime in.

 

[RangerBob]

I’m not sure either of which would be better (single payer vs pure for profit system. Maybe a mix of he two) I suppose devils in the details. We wouldn’t think that the docs working even for the for profit places would be able to deviate too strongly from EBM, with insurance companies monitoring all the claims (talking about the chart showing how the clinics and up charge and rationalize the more expensive treatment). I think the breaking point would be if and when management started intervening when docs weren’t billing for the most expensive option. I’d probably have left by then pending what the contract says. Of course the “vanity” part is probably why private equity wanted in in the first place obviously lol.

I think either system is fine. We've been for profit, but in the past with physicians being their own bosses (and hospitals generally being solo or small systems and also being owned by local docs/RN managers), I think there was a better balance of our moral obligations while still earning profit. It wasn't profit for profit's sake.

If investors are getting involved in patient care decisions, that's clearly crossing a line. This article is describing a system that's essentially doing that. And that's also a big reason that many large institutions hire PA/NPs. They were created to increase access and decrease physician burden, but now they're usually hired because they can in many cases increase the bottom line more than an MD, dollar-for-dollar.

I can forsee a future where most PCP's aren't MDs. When I was at the VA, the midlevel primary care providers just referred for everything under the sun and ordered so many tests. That's certainly not cost effective for the VA. But if you're a for profit system and those midlevels are referring to your system's specialists, ordering imaging through your system's MRI machines, etc., then you make a ton of profit. Sure, with Stark laws sort of come into play, but patients usually like to keep things convenient and have all their care in one place (I certainly do-when my PCP ordered an MRI, I got it through his health systems imaging department).

 

[TwistedTea]

I think either system is fine. We've been for profit, but in the past with physicians being their own bosses (and hospitals generally being solo or small systems and also being owned by local docs/RN managers), I think there was a better balance of our moral obligations while still earning profit. It wasn't profit for profit's sake.

If investors are getting involved in patient care decisions, that's clearly crossing a line. This article is describing a system that's essentially doing that. And that's also a big reason that many large institutions hire PA/NPs. They were created to increase access and decrease physician burden, but now they're usually hired because they can in many cases increase the bottom line more than an MD, dollar-for-dollar.

I can forsee a future where most PCP's aren't MDs. When I was at the VA, the midlevel primary care providers just referred for everything under the sun and ordered so many tests. That's certainly not cost effective for the VA. But if you're a for profit system and those midlevels are referring to your system's specialists, ordering imaging through your system's MRI machines, etc., then you make a ton of profit. Sure, with Stark laws sort of come into play, but patients usually like to keep things convenient and have all their care in one place (I certainly do-when my PCP ordered an MRI, I got it through his health systems imaging department).

I can agree with that. I read about in a book once CEOs (obviously) aren’t bad people all the time like the media likes to portray. They are just often distant from those whom their decisions effect so sort of hardened to Ill effects. As with small physician owned group practices physicians (in addition to our fiduciary duty) are more likely to hold to better ethical standards since they know their patients personally.I’m sure a lot of people already know this but it’s sort of my own rationale for rather having small practices in contrast to giant for profit *medical syndications*.
Mislevels are a whole mother topic (yes mislevels). And yeah they do that at our VA also. One team is all midlevels and judt consults every fellow under the sun for everything

 

[RangerBob]

I can agree with that. I read about in a book once CEOs (obviously) aren’t bad people all the time like the media likes to portray. They are just often distant from those whom their decisions effect so sort of hardened to Ill effects. As with small physician owned group practices physicians (in addition to our fiduciary duty) are more likely to hold to better ethical standards since they know their patients personally.I’m sure a lot of people already know this but it’s sort of my own rationale for rather having small practices in contrast to giant for profit *medical syndications*.
Mislevels are a whole mother topic (yes mislevels). And yeah they do that at our VA also. One team is all midlevels and judt consults every fellow under the sun for everything

One thing I did like about all the midlevel referrals was we got more bread and butter/“easy” presentations. Sometimes it was nice to get a straightforward musculoskeletal strain back pain referral or lateral epicondylosis (stuff a PCP can handle unless refractory you treatment) instead of another fibromyalgia/3 prior lumbar lami/fusions/chronic pain patient.

On the other hand, if those PM&R clinics themselves used midlevels, they’d be seeing the former more straightforward (in theory) cases.

I didn’t mean to detail the thread to one about midlevels. They have their place and when used appropriately can certainly preserve quality of care and reduce healthcare expenses. I’ve been fortunate to work with some great ones. But they can be much more easily exploited for profit at the expense of our patients. Unfortunately, as we physicians get more absorbed into larger and larger organizations, the same is true for us as well.