I like to fish. I don’t get to go very often but have noticed over the years that some fish are more discriminating than others. Some fish aren’t discriminating at all. In the spring, Sand Bass in Oklahoma will strike anything that’s shiny. Trout seem like they are always hard to catch…very discriminating creatures. I am going to give Mr. Todd Hixon, the author of the article linked to above, the benefit of the doubt and declare him indiscriminate…like a carp or catfish that’s happy to feast on the detritus on the bottom of the pond.
He has taken the bait. The points he makes in his article are the old, worn out talking points of the perfectly coiffed hospital administrator from 10 years ago. Here they are: physicians are paid too much, 2-5 times their European counterparts; that physician- owned facilities to which they refer, results in unnecessary tests and adds to the cost of care; paid poorly by Medicare (wait…didn’t he just say physicians are paid too much??!!), physicians increase the volume of work they do; physician owership results in cherry picking patients, leaving the hospitals with more seriously ill patients.
Think I’m too hard on him? His source of data? The Columbia School of Public Health (full of conservative readers of Forbes magazine, I’m sure!) and some government goon at the Dept. of Health and Human Services. You see, I mean it when I say I’m giving him the benefit of the doubt as indiscriminate or ignorant. The alternative, that he is a shill for the big hospitals, would indict him as an evil liar. I don’t know this guy. But what he has written (actually what he has not written) functions as the distraction that so many hospital-types long for. Look who’s spending money like there is no tomorrow. Hospitals. Where did they get this money? Think there is a link between these multi-billion dollar hospital corporations and the high cost of care in the U.S.? Duh. He doesn’t even mention them.
At one point in the article he praises CMS (Center for Medicare and Medicaid Services). He says,”I’m glad to know that CMS is chipping away at the cost difference.” He is talking about the difference between what physicians are paid in the U.S. versus their counterparts across the pond. How about this: hospitals are paid 5-10 times more for the same surgical procedures than what we list on our website. And our facility is physician-owned. Greedy doctors, Mr. Hixon! Canadians come to our facility for surgery, not the big hospitals in Oklahoma City. Why is that?
His final point, what many call “cherry picking,” is that physicians who own their own facilities send their healthier, better insured patients to the facilities they own, leaving the hospitals with the sicker, poorer folks. This is the part of his article that pissed me off. This argument against physician ownership has been largely abandoned because the facts have ripped this trite trash to shreds long ago. You see, the American Hospital Association lobbied long and hard (successfully, I might add) for Medicare and Medicaid payments to non-hospital affiliated outpatient centers to be so low that most of the time, dealing with Medicare is a money-losing proposition unless you are a big hospital, where the payments are many times higher. To then complain that very few of these patients are seen in these non-hospital centers subsequent to these profit-killing price controls seems just a bit disingenuous, don’t you think? Furthermore, the hospitals get paid even when the patients and insurance don’t pay them. What?! The scam of “uncompensated care” results in payment from Uncle Sam (that’s you and me) to the hospitals a percentage of the difference between what they bill and what they collect. These shell games insure that every patient entering the “not for profit” hospital labyrinth respresents a “cherry.” Add to this the aggressive employment by hospitals of physicians and their forced utilization of ancillary services like lab/X-ray/MRI, etc. and you don’t have to be Sherlock Holmes to figure out where the money is going in health care.
Incredibly, at the end of the article he promises a future post on the desirability of price tranparency, greater buyer choice and empowering the free market in medicine. To finish his article like this, having made the prior and inaccurate points the big hospitals pay lobbyists to make, leads me think that, after all, he is duplicitous. You simply cannot be a free market cheerleader in medicine and not simultaneously bash the billing and business practices of large hospitals. Can’t do it. Period. I hope that Mr. Hixon is simply indiscriminate. What an embarrassing article for Forbes magazine.
G. Keith Smith, M.D.