The Games We Play

I have criticized hospitals, patients, and insurance companies in my prior diatribes against our current health care system. Now, its time to take on physicians. What are we doing incorrectly? What are the games we play?

Our current health care system emphasizes specialization but as a byproduct it breeds laziness. It promotes waste and inefficiency. And physicians profit from this.

Lets say a surgeon is paid $5,000 for a gallbladder operation. The patient and the insurance company aren't paying the surgeon $5000 just to take out a piece of tissue. They are paying the surgeon to do a procedure and make sure the patient does well. This involves making sure the post-op course and well as the intra-op course are uneventful. However, here is what really happens. The surgeon pockets the $5,000 but before he does that he gets a primary care physician to see the patient prior to the surgery and get him tuned by doing all the pre-operation work. He removes the gallbladder but the operation is complicated by significant blood loss. Afterwards he forgets to make sure the patient's regular home medicines are ordered correctly. After the surgery, he consults medicine, renal, and cardiology to help him manage the patient post operation. This basically involves making sure the mistakes he made are managed. The surgeon sees the patient the day after surgery and then ignores the patient for the rest of the hospitalization.

Meanwhile, the renal, cardiology, and general medicine teams all bill the patient for their time, when in fact all they did was make sure the patient's chronic medical problems weren't worsened by the surgeons incompetence.

Its a win win for the medical system and the physicians. Everyone bills the patient separately for the same job. Lets examine this with an airplane analogy. You pay $500 to fly to Paris. When you get your credit card bill you find out that the pilot charged you $500 for taking off and then a separate pilot charged you $500 to land the plane. The stewardess charged you $50 to bring you those little bags of peanuts. By the way, those little bags of peanuts also ended up costing you $100. Total cost: A Total ripoff!

How about a new model for physician compensation for inpatient care. The surgeon gets paid $6000. However, this is the total amount that a patient or the insurance company will pay the hospital. If the surgeon wants a consult to help him manage the patient, he has to pay out of this total lump sum. So, if he wants a renal, cardiology, and general medicine consult because he forgot everything he learned in medical school, his total take home pay is less. But the patient pays one time for one procedure.

By the way, good luck getting your hand on any of the primary billing data for any hospital. That stuff is guarded like it is a national secret. No hospital will make public exactly how much profit it makes on individual procedures. Trust me, I've asked. Even I can't find out how much the things I am doing are costing the patient or how much profit I am making the medical system.

http://www.youtube.com/watch?v=xskFo75Wdhs