Bob's Words of Wisdom

Profits vs Patient Outcomes

When assessing any corporation or for that matter a business entity it is important that you have an in-depth understanding of those personnel who are running it. When we look at today’s medical facilities such as large integrated hospitals, we find many times that management does not understand the problems that must be delt with by those personnel who perform the daily critical care and diagnostic services required to effectively run a cost-efficient facility.

Wall Street and Medicine are the two highest paid job categories today but there is one real difference. On Wall Street, you are incentivized and paid for your performance because missing one small detail can cost hundreds of thousands or even millions of dollars. The best managers understand how to assess risk in their business from the ground up and most have spent time in the trenches learning all aspects of how a company should function to be efficient and effective. Successful managers on Wall Street who learn the business from the ground up run the most efficient companies and are consistently profitable.

In medicine, it is not much different except they deal in patients’ lives. A misdiagnosis or inattentiveness in a critical care situation can cause the death of a patient. This ground-up learning process in many cases has been skipped over in the current corporate medical world and instead of bottom-up learning they attempt to hire the best from elitists colleges that fit their criteria. Unfortunately, we find most corporate hospital executives have limited experience with the day-to-day operations of their support personnel, which means they don’t have the basic knowledge of how a hospital functions. Their only relationship is what they may have learned as an intern or in the educational process of becoming and functioning as a practicing physician. Anyone dealing in the healthcare industry will tell you that when you are dealing with people’s lives you must learn how best to respond to their needs. This means as a manager you must know and trust all your support personnel, especially nurses, orderlies, and pharmacists. Most hospital managements don’t have a clue as to how important these support staff are to a patient’s wellbeing and have little or no bedside manner reducing patients to nothing more than another object to be examined and diagnosed.

Many of these executives don’t understand the daily pressures placed on their employees because in most cases they are understaffed and don’t understand what duties they perform. I ask you how many times the head of a large medical facility has had to empty a bed pan three times in an hour after working a 16- or 20-hour shift? I can tell you they don’t have a clue and therein lies one of the problems. Corporate medical executives don’t see the day-to-day problems encountered by their staff at the patient level and therefore have a difficult time assessing the pressures placed upon their employees. They sit in their ivory towers and pontificate to those who work for the medical facility as the omnipotent dictators.

The other more serious problem which gets worse every year is that both doctors in private practice clinics and hospitals are paid on a scale dictated by private insurance companies or a socialized medical system like Medicare or Medicaid. The people running these health insurance companies are under the gun to cut costs to keep expenses down and profitability up. Socialized Medicine presents Its own unique set of problems with their transfer of payments as their rules are set by bureaucrats who sit in Washington D.C. They only look at numbers while each year costs increase along with more paperwork that must be filled out by physicians or hospital staff. Many physicians in private practice have left their practices for the simple reason that the costs associated with Socialized medicine are so onerous that most lose money in private practices. They retire and we wind up with a shortage of competent physicians. Sure, computers and standardized coding have eased the clerical burden. Unfortunately, computers can’t perform the same services a nurse has to provide to patients in an ICU ward or run lab tests essential for a critical diagnosis.

I submit that if all the corporate heads in a hospital were to take the time to learn what each job in their facility entailed not only would performance improve but so would working conditions for the employees. Medical facility executives need to understand the importance of not only hiring quality personnel but employees who take a vested interest in giving their patients quality healthcare and they need to retain these quality personnel. The reason medical facilities around our nation are going to the use of traveling nurses is because they don’t have to deal with the cost of all the benefits required by full time local personnel. By the same token the local nurses have a vested interest in providing quality care to the people who live in their community unlike the “Traveling Nurses” who work there for a short time and move on. We see the same thing happening in many of the clerical jobs in hospitals as management shifts these jobs offshore because they don’t want the burden of the higher benefits, they must provide to permanent local staff.

One of the more important questions we need to ask of the major medical facilities that serve our state is why we pay such exorbitant compensation to those who run these medical facilities We have had past corporate executives running Tax Exempt Hospitals who were paid multi millions of dollars annually while doing little to address the staffing problems when they first started to occur. These are medical facilities that the taxpayers of Idaho are funding through their tax dollars as these medical facilities pay no property or income taxes. These large medical facilities have become no more than Corporate medical care which I believe are run more for profit than for the betterment of their patients and communities. When profitability and executive compensation become more important than patient outcomes it is time to take a good hard look at just where the practice of medicine is heading in our State.

In my opinion, we should be dumping these corporate bean counters and replacing them with people who have been in the trenches and understand the day-to-day problems of running a large medical facility. They need to pay attention to the patients’ needs and not which piece of real estate they will acquire next in their portfolio. They need to be accountable to the public who subsidize their Tax exempt status by keeping clerical jobs here in our state instead of shipping them overseas. They need to hire local nurses and pay them a living wage instead of ducking the obligation of paying for their benefits by hiring Traveling Nurses. It is time to hold these entities and the people who run them accountable for their actions. One more thing. The public is entitled to know just how the well over $100 million in federal Covid money was spent by these entities if they expect us to continue to subsidize these facilities.

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4 replies on “Profits vs Patient Outcomes”

I was the chief of staff of a medium sized hospital for a two year term. This was at a time when patients belonged to their physicians and not to insurance companies or large “health care organizations”. I regarded my role as an advocate for both patients and physicians. My model was Theodore Roosevelt’s tenure as the NY Police Commissioner. I would poke my nose into every department at the hospital, directly questioning the working people on what was working and what would not. I also declined the stipend that the hospital offered the position on the theory if you take the King’s shilling you become the King’s man. I also kicked out of the medical staff meetings all the hospital employee hangers on, telling hospital administration that we would call one of them in if we needed to talk with them.

Physician morale soared as did employee, and metrics of patient care soared. The only folks who were unhappy were the administrators. What effect this had on their bottom line (corporate and/or personal) I had no idea, nor did I care.

This is an EXCELLENT article!! Our healthcare in this Nation has become, for the most part, ALL ABOUT THE MONEY. It isn’t like it used to be. Even the non-profits (supposed non-profits) seem to be driven by cost-cutting and money-making — who suffers from that? The patients. It has always been my belief that to make a profit off of the sicknesses and ill health of people is immoral. NOW, for the last decade, hospitals have basically kicked out people’s “treating physicians” and in their place they use what they call Hospitalists. These physicians know nothing about the patients they see and most often they don’t even bother to contact the patient’s regular treating doctor. They don’t know the prescribed meds and often just toss them and start over — not always with good results! I went through this with my father in 2020. He was almost 97 years old at the time. His hospitalization did not end well and in speaking to his doctor of over 25 years, I learned that he was never contacted about my dad’s admission. He told me the hospital was NOT letting treating doctors come in to care for their patients — they want the money for themselves! IT IS ALL ABOUT THE MONEY. Corporations and the Hypocratic Oath do not mix well. Something must be done and socialized medicine is NOT the answer.

I have been in the commercial construction industry for 30 years and can tell you firsthand that we are continually hired to tear down a wall and stand it back up 2″ from its original spot. These non-profits have so many ways of hiding their profit. Where is the public oversight.

The pharmaceutical industries are more powerful than any standing government on earth. they have bought and paid for court systems, governments, media, and medical facilities in their entirety. They have no fear of any repercussions.
There are no doubt great doctors, surgeons, and nurses who care about their patients and their oath. My life has been extended many times in the past due to their care. However, the hospitals are rife with those who do not care and are there to serve the hospital administration who bow the knee to their masters. This is evident in the way we are treated when we walk in the door and muzzled with a mask by a 22-year-old assistant.
I have yet to look on my surgeon’s face. They are true believers in the lies they are told to perpetrate for access to the facility we are paying for.
Where is the outrage? Where can we turn? They are the only game in town.

Great comments right on target. As to your question “Where is the Outrage?” You will find it here every week we just need to get more people to read it instead of u tubes and social media.

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