Shots fired and bomb planted at family medicine clinic - over opioids?

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I had a guy complain to my hospital admin - "He strongly recommended against me getting surgery". That was borderline malpractice to him.
Wow. You’re trying to help this guy and he complains about you to the administration.

just nuts

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It doesnt help anyone to tell a patient they shouldn't have had a surgery. Just pisses off the patient and surgeon even more. But, definitely advocate for them to avoid future surgeries if not indicated. Flat out tell them 'i dont think you should have surgery'

The employed doctors are muzzled in this regard. Admin views it has stealing facility fees to tell patients that they don't need surgery. In the integrated health system model, everyone's fingers are picking meat off the same bone. It's a zero sum game. "Revenue leakage = less bonus."
 
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The employed doctors are muzzled in this regard. Admin views it has stealing facility fees to tell patients that they don't need surgery. In the integrated health system model, everyone's fingers are picking meat off the same bone. It's a zero sum game. "Revenue leakage = less bonus."
Not true.
 
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Not true.


Hospitals do not have to overtly direct their PCPs, according Dr. Lester, the Orlando-area radiation oncologist. Even if it is not stated in the physician’s contract — and it usually is not — “it’s understood that you’ll refer in-house,” he said. If employed physicians allow too much “leakage” of referrals, the hospitals might not renew their contract, which usually lasts only 1-3 years, he added.

In addition, hospitals use “physician liaisons” to check employed physicians’ referral patterns and have a word with the “splitters,” those who refer too many patients outside. “Part of the physician liaison’s job is to maintain complete loyalty to the system,” she said. Electronic health record (EHR) systems make it easy to profile physicians and track their referrals.

I've been on the ass-end of this. I've had former hospital employed MD's contact me after they've left the health system and say, "I'm sorry. We were being watched and were told that there was a "cap" on how many outside system referrals we could make." Even thought they all felt guilty and used, it doesn't stop it from happening all over again at the next place.
 
I can do you one better. I had a fairly big hospital system 40m away that was sending me patients. I sent some of those patients for surgery in the “city”. The physician liaison came to my office to request that I refer the patients back to one of their surgeons going forward.
 
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I can do you one better. I had a fairly big hospital system 40m away that was sending me patients. I sent some of those patients for surgery in the “city”. The physician liaison came to my office to request that I refer the patients back to one of their surgeons going forward.

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I advise against surgery ALL THE TIME. It is really surprising how much surgery gets done for inappropriate indications.

It really used to piss me off a lot more when I was doing a lot of medical management, trying to compensate for inappropriate post-op pain, but now with my new job it's much more of a "you know my opinion, but your body, your choice".
 

Hospitals do not have to overtly direct their PCPs, according Dr. Lester, the Orlando-area radiation oncologist. Even if it is not stated in the physician’s contract — and it usually is not — “it’s understood that you’ll refer in-house,” he said. If employed physicians allow too much “leakage” of referrals, the hospitals might not renew their contract, which usually lasts only 1-3 years, he added.

In addition, hospitals use “physician liaisons” to check employed physicians’ referral patterns and have a word with the “splitters,” those who refer too many patients outside. “Part of the physician liaison’s job is to maintain complete loyalty to the system,” she said. Electronic health record (EHR) systems make it easy to profile physicians and track their referrals.


I've been on the ass-end of this. I've had former hospital employed MD's contact me after they've left the health system and say, "I'm sorry. We were being watched and were told that there was a "cap" on how many outside system referrals we could make." Even thought they all felt guilty and used, it doesn't stop it from happening all over again at the next place.
I know a PCP who would use the EMR for all in-house referrals, but use a script pad for all out-of-house referrals to avoid being seen as a "bad apple".
 
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I know a PCP who would use the EMR for all in-house referrals, but use a script pad for all out-of-house referrals to avoid being seen as a "bad apple".

That's a common work around. Also, some PCP's just text me on the side and I have my office call the patient. It looks like a self-referral. The fear of retribution is real.
 
I know a PCP who would use the EMR for all in-house referrals, but use a script pad for all out-of-house referrals to avoid being seen as a "bad apple".
Same for me. I would give this hospital pCP pamphlets and he would hand them to patients and they are told to call
Me. Spineless
 
There’s more to this story than meets the eye. The shooter rented a room in his mobile home to the doctor he later despised for 2 years

“Meanwhile, Ulrich continued to nurse a grudge against his former doctor. Raymond Zandstra, who rented a room in Ulrich’s trailer for about two years until moving out last July, recalled how Ulrich had erected a sign excoriating the former doctor by name on the side of his shed in the trailer park where they lived. Ulrich was angry the doctor had “cut him off” from his pain medication, Zandstra said.”

 
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