Why do we continue to listen to “experts” who have continually proven to be wrong in their predictions and prognostications? Last week I wrote that “bigger is not better” in many cases. How often have the “experts” in the fields of medical education and public health missed the mark over the past 10 years? The Affordable Care Act (ACA)—aka Obama Care has helped pad the salaries of hospital administrators while at the same time contributing to “burnout” in the medical workplace. Remember: ACCESS—QUALITY—COST? If you are a dean or a department head at a large urban center medical school your salary has gone up while the productivity of your employees has gone down by 15%.
We never had a $18million/2yr. CEO of a hospital system in Idaho until the (ACA)! The Covid political pandemic was an abject failure for socialized medicine in our country. Protocols and algorithms designed by people who had never taken care of a patient at the bedside, took the place of “clinical judgement” and subjugated the doctor-nurse- patient relationship to the back bench. A one size fits all treatment strategy was deployed incentivizing revenue streams facilitated by policies that turned a blind’s eye to “upcoding” and clinical decision making by employed physicians that placed “margins before mission”. At the highest levels in government and at our largest medical schools the publishing of clinical evidence that proved to be contrary to the political narrative of the day was lost in the review board neverlands of “scientific objectivity”.
In today’s Wall Street Journal Dr. Michael P. J. Stanley, a Fellow at The Mass General Brigham Hospital writes that the only way out for medical students, residents, and fellows is to “Unionize”. His diagnosis is on the mark—his solution not so much. Unions will only further fracture the doctor patient relationship. Communal coercion will be between the doctors, the government, and the world of hospital administration and insurance companies leaving patients completely left out of the calculous. Look at Great Briton, Germany, and France where the medical and nursing professions have been unionized for over 30 years. Patients are commodities. Private practice “fee for service” is making a strong comeback in all those countries.
Dr. Stanley does frame his argument correctly:
“Now nearly three-fourths of doctors in the U.S. are employees of a corporate entity and, increasingly, both patients and physicians are finding hospital systems to be as obstructionist as insurance and pharmaceutical companies. Most physicians’ time isn’t spent with patients but on the administrative burdens they were trying to avoid. A 2016 study in the Annals of Internal Medicine found that doctors spend two hours on desk work for every one hour with patients.”
Has there ever been a time or place when government intrusion doesn’t cause more paperwork, more regulatory mismanagement, and less productivity?
What does all this have to do with Idaho? Over the past year The Idaho Health Technology Exchange filed for bankruptcy after receiving over $27million of State funds. The loss may be far greater as several legislators have told me. They have also informed me that the Governor has placed investigating this loss “on the back burner”. I have argued for a long time for outside independent audits of State agencies involved in the distribution of over $100million of transfer payments and for those entities in the private and non-profit worlds that receive these government taxpayers’ funded subsidies to also be subjected to complete audits. No action for audits this legislative session. Why? A simple audit of the lost $27million from The Idaho Health Technology Exchange would be cheap and simple. Where is the inquisitive press on this? What about the IMA/IHA and IACI?
In all my life both in the military and in the private sector managers of people and resources who have been outstanding leaders have welcomed the scrutiny of operational and financial reviews of their activities. It validates that they are doing a good job not only to their boards, but also to the workers within the organization. With a positive revue, there may come some increased earned compensation. When the heads of organizations stifle audits and reviews it leads to suspicion and distrust. When they stifle audits and asked for an increased salary it raises a big “red flag”.
Please Governor Little and The Idaho Legislature open the curtain to the activities of what is going on in our government. Audits have always been the tool by which corruption –legal and illegal, is rooted out of any organization. What do you have to hide?
The Idaho Health Technology Exchange is a simple start.
“If not you who—If not now when?”
2 replies on “Idaho’s Hospitals – Audits Yes – Unions No”
It’s time to reinstitute the prohibition on the corporate practice of medicine and enforce the prohibition with teeth. Doing so would be an uphill climb with the current legislature (cf article on Cronyism as well as what the hell happened to ID Districts 14) but it would go a long way to restoring health care to its former position of physicians working for the benefit of THEIR patients, and not wage slaves to corporations.
I have never been able to figure out how a corporation can practice medicine without a license. If they are using the licenses of their employed professionals, are they fulfilling their agency duties to patients and the State Board of Medicine? Has the Idaho Attorney General ever rendered an opinion on this matter in the past? If a corporation cannot practice medicine how can a doctor compete against it? The answer to these questions may make the idea of enforcing “non-compete” clauses between physicians and hospitals moot!