One of the reasons that our prices are so low (a sixth to a tenth of what the so-called “not for profit” hospitals charge) is that our facility is completely owned and controlled by the physicians working here. This ownership arrangement allows us to limit the facility charge (traditionally that portion of the surgical/hospital charge that makes up the majority of the total bill) to one that includes a small, forecasted marginal profit. Stated another way, our ownership structure eliminates the most greedy and inefficient profit seeker from the equation: the “not for profit hospital.” Ironically, we are acting more like a not for profit institution than these hospitals who beg everyone to notice how charitable they are while simultaneously accounting for over 60% of personal bankruptcies in this country.
The hospitals don’t like the fact that doctors own their own facilities. They rather prefer that facilities own doctors. Here are some of the hospital talking points, followed by what they don’t want talked about.
1)Greedy doctors can’t be trusted with the conflict of interest that arises from facility ownership. They will do unnecessary surgery. The truth is that surgeons doing unnecessary surgery are found predominately in hospitals where they are employed. No physician wants to be partners/co-owners in a business laden with the liability of some unscrupulous surgeon/physician. Because of this, these folks are rarely found in facilities where physicians share liability with one another. The true conflict of interest resides with hospital employed physicians, who are not only told many times to upcode or up-charge for their care, but who are forced to refer their patients not to necessarily the best specialists or surgeons, but rather to the other physician employees in the hospital “network.” The outrageousness of this conflict, one which places the interests of the patient dead last, cannot be overlooked or overstated, in my opinion.
2)Greedy doctors will skimp on quality, as they first, can’t be trusted to police themselves and second, won’t use the latest technology because this expense comes right out of their pocket. The truth is that the lack of administrative layers allows for the purchase of new technology almost immediately once it is proven and available. We have had new surgical devices and technology delivered the same day as requested at our surgery center! This is one of the primary reasons that surgeons want to own and operate their own facilities: so that they will have what they need to perform surgeries in a state-of-the-art manner, without having to make their case to someone making more money than them with no clinical knowledge, whatsoever. Low quality surgeons tend to be removed or kicked out of facilities because, once again, no one wants to share their liability. So much for a lack of policing ourselves.
3)Greedy doctors will not see uninsured, Medicare or Medicaid patients in their facilities. This ”cherry picking” will leave all of the folks the payment for whose care is below cost, to be seen at the “not for profit” hospitals. We started quoting prices in 1997, the year we opened. Almost all of the patients were the uninsured, patients left in the street by the outrageous pricing of the big hospitals. What the giant hospitals don’t want you to know is that they have very successfully lobbied for much larger reimbursement from Medicare and Medicaid for their facilities, while simultaneously having incredible success lobbying for lower reimbursement for their physician-owned competitors! For the hospitals to subsequently claim that the physician-owned facilities are “cherry picking” neglects the fact that any patient that walks through the hospital doors is a cherry. Various rules and regulations apply to physician owned facilities that accept federal money, rules and regulations that don’t apply to the big hospitals. In spite of these facts, almost all physician-owned facilities deal with federal health programs. We have never taken a dime of federal money at our facility. I still see Medicare patients, but they leave their Medicare card in their car and we work out a fee that seems fair to both of us.
4)Patients will die unnecessarily in physician-owned facilities because a cardiologist or a neurosurgeon, while immediately available at a large hospital, would be completely unavailable in a specialty hospital or outpatient surgery center. This is ludicrous for two reasons. First, if I need a cardiologist at my surgery center, I pick up my cell phone and call one. They show up in minutes. In fact, I’ve been told that in hospitals that employee pulmonary doctors and cardiologists, getting them to show up quickly or even at all, is very unlikely! Private practice physicians, particularly specialists and surgeons, live and die by the quality of care they deliver to patients and the service they provide as consultants to the referring physicians. I was actually talking to a cardiologist on the phone about a patient in our recovery room years ago, when he walked into my recovery room unannounced to see the patient (and to see me talking to him on the phone!).
5)Left to their own devices, greedy doctors will order unnecessary lab tests on their patients to create more revenue for themselves. I have had relatives and friends have surgery at big hospitals in the past, only to have unnecessary EKG’s, lab and xrays done prior to the surgery. The surgeon didn’t want this. The anesthesiologist didn’t need this done. It was hospital policy. If you guessed that this is the hospital policy because it is a huge revenue generator, you get a gold star. Hospital-employee doctors are under constant pressure to order more MRI’s and xrays in order to “pump up their production numbers.” The hospitals having paid top dollar to buy out many of these physician practices routinely lean on them to churn patients for revenue in order to realize a return on their “investment.”
6)Physician owners are just in it for the money. Oops! Check out our prices online, compare them to the hospital prices and try saying this out loud with a straight face!
G. Keith Smith, M.D.