Sunday, March 9, 2014

The Factories We Call Hospitals

Most of us were raised with a special reverence for hospitals. They were the temples of healing where we took ourselves and our loved ones to be helped and healed and when that happened, we were very grateful. But things have changed quite a bit since I was a child and most of my neighbors were treated at the main hospital’s clinics for everything from vaccinations to tooth care. It wasn’t a pleasant trip, I can assure you, but I don’t remember anyone ever being turned away or being dunned for a bill everyone knew they couldn’t pay. Everyone in the neighborhood was poor, had a lot of kids and depended on as little charity as they were willing to accept.

Things have changed enormously as medicine has become big business with major investments not only in advanced technology like robotics and special, highly sophisticated lab equipment to marque physicians who bring highly paid teams with them. Just recently, one hospital was singled out for special mention and, perhaps, it deserved it, but I have to wonder if they were bearing the brunt for all the others who were wiping their brows thankful in the knowledge that they weren’t mentioned.

The hospital in question is one of the oldest in New York City and has always had a fine mission to help the poor, the elderly and the helpless. If you went into one wing on the ground floor, you’d see the plaques that tell the history of this storied institution. But even this fine hospital has now found itself on the horns of a dilemma.

What is the problem? Well, when you have a gifted cardiologist who does more procedures than anyone else in the U.S. and earns over $4M a year in salary that raises one red flag. But when it was discovered that the hefty number of procedures was probably aided by a bit of, shall we say “creativity” in scheduling procedures, it begins to take on another aura and it’s not pretty.

According to a new report out of Medicare/Medicaid, a review of procedures noted that patients who were given cardiac cauterization were turning up in the Emergency Room for their procedure. Yes, you have to wonder why they were in the ER if they had already been scheduled for the procedure through the physician’s lab. Good question.

The patients, upon being interviewed by investigators, freely revealed that they had been coached what to say when they went to the ER because that would insure that they would get the treatment and it would be paid by insurance. I think it’s the medical equivalent of an end run around the defense.

One patient, with whom I had contact, (no not a cardiac cath patient) at a major hospital, was asked to be involved in a research study. She said she didn’t think her insurance would pay for all the procedures they wanted, even though they might have been helpful to her docs, and that’s where more creativity came into action. She was told by the senior resident supervising the research that they would make sure she had all the diagnoses she needed to get reimbursed for all the procedures. Almost verbatim, he said, “We can make sure you have everything you need to justify the procedures.” This guy must sell used cars on the side.

Does this sound ethical to you? Not to me. When she decided she could not go through with this charade, she received a dire warning as she got up to leave. “You could leave this office and drop dead right now if you don’t go into this research,” he said in his sternest voice. She decided to take the chance and she hasn’t dropped dead but I’m sure others were scared into becoming subjects.

When salaries are tied to the number of medical procedures performed, what do you suppose the result might be? Everyone can be tempted as we even heard Pope Francis say regarding his having taken a rosary from the coffin of a dead priest. We’re all human but if you tailor it so that you tip the scales in the direction of money rather than medicine, you have done all of us a disservice.