This is propaganda. This is from the cartel. Here is my analysis of their article.
Do some surgeons do unnecessary surgery? I used to think that surgeons who do unnecessary surgery do so whether they have an ownership interest in a facility, or not. I now know that those who are most likely to engage in this practice are not the facility owners. I know this because facilities like mine shun unethical surgeons, as the risk of this unethical practice is shared by all of the partners. No one in my partnership wants to be associated with charlatans. These unethical individuals tarnish the reputations of everyone around them. Anesthesiologists in big hospitals that have no say about which surgeons they work with, are forced to act as accomplices when saddled with unethical and incompetent surgeons. As physician owners we have control of who works at our facility and just as important, who doesn’t. Talented and ethical surgeons migrate to facilities they can own partly so they don’t have to associate with the unethical and incompetent. They also have control of quality issues and benefit from efficient service unavailable to them at the big hospitals. Participating in a share of the profits inclines the owners to explore further efficiencies and invariably leads to an ownership “pride” that serves as insulation against any temptation to include the charlatans. ”The Surgery Center of Oklahoma? That’s my facility!” Our partners have no problem proclaiming this to anyone within ear shot.
A note on context. Unnecessary surgical procedures are more of an indictment of the absence of free market discipline than an indictment of unethical doctors. Government and other third party payment arrangements financially separate the physician from the patient and unnecessary surgery is a predictable consequence. The article linked to above uses worker’s compensation case data as a reference. There is no more dysfunctional third party arrangement than worker’s compensation.
Do surgeons do more surgery once they work at a more efficient, physician-owned facility? Here is the story of one of our surgeons. A typical surgical day was 3 ear tube placement surgeries, 4 tonsillectomies and two sinus surgeries. At the big hospital he was scheduled to begin at 730am. He never started before 8:00 or 8:15 for some reason. The “turnover time” (the time it takes to clean a surgery room and get it ready for the next case) was usually 45 minutes to 1 hour, so he “lost” an hour between cases. This surgical schedule, these 9 cases, took all day. It was not uncommon for him to operate past 5pm with a schedule like this. And this was before the implementation of the electronic medical records system. Now it is much worse, adding an additional 20-35 minutes to the “turnover times.”
This same surgeon will finish this surgical schedule at our facility before noon. Utilizing multiple surgical suites and overstaffing our anesthesia group allows us to “gang up on him.” He has two operating rooms and two operating crews and two anesthesiologists. He has no down time between cases. This is not rocket science. This is the best utilization of his time and that of the facility.
What does he do with the half a day he now has, that he wouldn’t have if he’d done these surgical procedures at the hospital? This hardworking surgeon was able to spend the afternoon in his clinic. The more patients a surgeon sees and the more time spent in their clinic, the more likely they will discover surgical illness. So now he does more surgery. Patients can get in to see him easier because he has this clinic time that essentially was created by his participation in our facility. His larger surgical caseload is hardly an indictment of his ethics.
The last paragraph of the article attempts to link physician “self-dealing” with the increase in the cost of medical care. Answer me this: why is it unethical for physicians to own their own facilities and it’s not unethical for facilities (hospitals) to own their own doctors? Don’t you find it interesting that physician ownership is singled out in this article as increasing the cost of care and not the fact that the big hospitals charge 10 times what we do at our facility…for the same procedure!? Do you think that hospital fees 10 times what we charge are a slight motivation for hospitals and their employed doctors to perform unnecessary surgeries? What kind of surgeons benefit a hospital that charges ten times what we do? How about those individuals known for performing unnecessary surgery?
No mention of any of these considerations in the article. I hope that more and more people see this as the vicious propaganda that it is. Also keep in mind that the insurance companies make more money (through the PPO repricing scheme) by dealing with hospitals charging giant fees, as they are awarded a percentage of the amount they “save” a plan by “repricing” claims. Let me make this very clear. Insurance companies want and seek facilities that issue gigantic bills. This is the primary reason insurance companies have aligned themselves with the giant hospitals in smear campaigns against physician owned facilities. These bankrupting hospital bills also provide cover for the claim that “health costs are up compared to last year,” justifying an increase in insurance premiums from year to year, an increase upon which brokerage commissions rely.
The good news is that I haven’t seen pathetic articles like this for a long time. Big hospitals and insurance companies haven’t hurled unfounded insults like this for years. That this specious argument has surfaced once again is a sign of desperation on their part, I think, a sign that their cartel is in trouble like never before. Physician-owned facilities are the worst nightmare of this bunch, particularly one like ours that has posted prices online, revealing without a doubt, the extent to which the cartel has robbed and bilked the sick.
G. Keith Smith, M.D.