I read with interest the post regarding the St. Francis Emergency Room physicians.
As an emergency room nurse, I can tell you firsthand that the administrators at St. Francis Hospital have made some very poor decisions.
They did not renew the contract of the ER docs that have been staffing their ER for 30+ years. By the way,there are at lease 20 doctors in the emergency physicians group, not six as mentioned by the personal friend of the Chief of Staff. Instead, they hired a new group of docs from Ohio, who by their own words call themselves "firefighters" to staff a MAJOR TRAUMA CENTER. These doctors have never staffed an emergency room with more than 15 beds. SFH has 40+ beds.
While I do not know all of the going's on with administration, I do know that their decision to release ECI physicians has everything to do with making money and not with patient care. Never once did anyone from administration come down and talk with the nurses or ancillary staff to see how their decision would effect everyone, they just send down the orders from above.
It is interesting to me that these administrators never seem to understand what it takes to care for acutely sick people. They just look at the numbers and think that we are there eating bon bons. They do not provide the latest equipment or adequtely pay the nursing staff. They refuse to put us on divert when we are overflowing with patients and cannot provide good patient care (because that would reflect poorly and cost SFH a lot of money if we had to turn patients away). The administrators never come to help when we get into a crisis situation and more staff is needed. They do a walk about in the ER and determine if we can go on divert. Then, if they feel it's appropriate,they will give us one hour to figure it all out. Nice.....
Instead we have 4-6 hour wait times and patients lined up in the hallway like a warzone. Of course, they do not understand this because when they or their family members need to come into the ER, they can call ahead and we are supposed to keep a room open for them so they do not have to wait in the waiting room, with the thousands of other Tulsans.
Am I resentful? Yes,somewhat. The staff in the ER work amazingly well as a group to provide life and death care. The ability of the nurses and doctors to work together as a team provides a higher level of care. Administration doesn't account for any of that. I am amazed that you can provide 30+ years of service to an organization and then it can all be gone within six months. Without hesitation, without a goodbye, without trying. These doctors care about SFH but didn't appear to get the dignity and respect they need. The up aboves listened to the voices of the few, not the many. I am disappointed.
The new doctors who have come in do not seem to care about the relationships that need to exist between nurses and doctors. They do not introduce themselves to staff, they do not ask how things are going, they do not seem interested in the long term ability to provide excellent care.
Do I care? Yes, I hope that things will change at St. Francis ER. I know that administration will pour a large amount of money to ensure that these new doctors are successful, because after all, if they fail to provide, then adminstration will look bad. And that, above all things, is something they despise.
I know this to be true.... http://www.tulsanow.net/forum/topic.asp?TOPIC_ID=8124
This devil does not lie....
Typical Catholic hospital. It's ALWAYS about the money!
quote:
Originally posted by breitee
Typical Catholic hospital. It's ALWAYS about the money!
It's not about mercy.....
I've been to the St. Francis ER before. Its where I'm supposed to go under my Community Care HMO.
An absolute nightmare.
I can say this about that ER, the ONLY way I will ever return to it is if I am brought there unconscious and about to die by ambulance.
I will NEVER voluntarily go back. EVER.
I worked there for 5 years during college as a Tech and Phlebotomist. That was 14 years ago.
I had to go there with my baby girl about a year ago when she had a febrile seizure, and thank god I still knew some of the nurses and one of the docs, or else we would have never gotten out of there. It took us 3 hours after we got her fever down to get a discharge. Would have been all night otherwise.
I can't imagine what it's like now with none of the old pro's there. You can't beat DRs Redden, Miller, Wolf, Huffman, Moore, Bartlet, and Jacobs, et. al., for skill and care.
You can still see them at their minor emergency centers in Tulsa. I think they actually own those?
Cannon Fodder and Bruno Flipper care to comment?Spoonbill, what about inaccuracies on my part?
We need your input. Since you, BF deal and CF, are chummy with the muckamucks at St. Francis, tell us again how it goes there! Then tell me I am wrong again.
Husband's-cousin's-BIL was also "released" from his contract as an ER Doc there and it was not so he could go work at full time @ MedCenter...he is having to moonlight in Muskogee, Bartlesville, etc. He says the whole OU group was let go along with another group.
And that's what I know.
I can't comment with any "insider knowledge." I am friends with the Chief of Staff but not on a professional level. I do not talk to him about hospital operations and even when I asked him about the rumor FOTD posted before he merely said the assessment was not accurate. He is not a spokesmen nor really part of the administration.
One thing I do know for sure ERRN, is that your line about me is off the mark. I never said anything about how many MDs staff the ER at St. Francis. I am the one who is friends with the Chief of Staff and I never said that. I don't know how many are in the group, how many should be, where they come from, or anything else.
Here is the previous thread on this matter where I never mentioned the number of ER doctors nor claim any special knowledge in these matters (I never said I "knew how it goes there" either FOTD):
http://www.tulsanow.org/forum/topic.asp?TOPIC_ID=8124&SearchTerms=chief+staff
So all I know about the poster is that she is a nurse, is an instructor at OSU Okmulgee, and is unhappy with St. Francis. I am left to assume that she works for St. Francis as an RN in the ER and that she worked there before the change and is not happy with its result. I can not dispute her assessment of the situation as if my assumptions are true, her information is better than mine.
I can dispute the money scheme to a minor degree. The administration is charged with fiscal responsibility but as a non-profit making money actually becomes a problem. Any profit that is made has to be reinvested in the hospital or donated in some manner (usually indigent care by medical facilities). So I can not speak to the conditions, the equipment or the management of the ER but on a certain level it doesn't bennefit the hospital to make money... I have no better explanation but St. Francis is non-profit and has no real incentive to make large profits (not tat non-profits don't do things that make no sense or they aren't cutting ER expense to bolster another unit).
Basically, I don't know. If a nurse that works there thinks it was a negative change I can't dispute her opinion. I could ask my friend again but he will tell me minimal information again as he is not a spokesmen (any large organization the professionals abstain from talking about internal matters).
So I can hope they hear ERRN's criticism and resolve any situation that exists, I can deny that I made any comment about the number of MDs in the ER, I can tell you the Chief of Staff is a person of great integrity who's opinion on many matters I greatly value, and I can tell you that profit should not be a very good motivator in a "non-profit" hospital... otherwise I got nothin'.
But thank you for your assessment ERRN. While rumors and insinuation are not welcome, an actual opinion from someone who is involved is always welcome in my book. Oh, and welcome to TulsaNow.
CF, surely you know there are lots of ways to spread profits around so as to remain in 'non profit" status. The disparity in wages is huge in these Catholic hospitals. Lots of fat, happy Chiefs, too few Indians. I know from my experience employed in one, that the nurses, techs, phlebotomists and other providers of basic service, are poorly paid, easily fired and generally seriously overworked. Morale is awful. They move from one hospital to another then into clinics and private practices like water. They are the ones providing most of your health care, not the docs. The latest crisis exposed in the re-used needle story recently that caused exposure to hepatitis is an example of the industry's failure to adequately train, motivate and retain quality employees. Nursing shortage? Curiously, they will fire them in a hearbeat for minor violations like talking back to the office manager. The management is typically better trained in technical areas than business areas and thus are extremely poor managers. Ask a hospital employee about their measily raises this year.
PGA is non profit too but somehow that old profit motive works its way through the fog.
quote:
Originally posted by FOTD
Cannon Fodder and Bruno Flipper care to comment?Spoonbill, what about inaccuracies on my part?
We need your input. Since you, BF deal and CF, are chummy with the muckamucks at St. Francis, tell us again how it goes there! Then tell me I am wrong again.
i won't touch it...
she's entitled to her opinion... her assessment of the situation is far from factual...
she's seems to be a little unhappy with the change and the administration at saint francis... perhaps she'd do best to move along...
i doubt this is the venue to get her concerns addressed...
quote:
Originally posted by ERRN
I read with interest the post regarding the St. Francis Emergency Room physicians.
As an emergency room nurse, I can tell you firsthand that the administrators at St. Francis Hospital have made some very poor decisions.
They did not renew the contract of the ER docs that have been staffing their ER for 30+ years. By the way,there are at lease 20 doctors in the emergency physicians group, not six as mentioned by the personal friend of the Chief of Staff. Instead, they hired a new group of docs from Ohio, who by their own words call themselves "firefighters" to staff a MAJOR TRAUMA CENTER. These doctors have never staffed an emergency room with more than 15 beds. SFH has 40+ beds.
While I do not know all of the going's on with administration, I do know that their decision to release ECI physicians has everything to do with making money and not with patient care. Never once did anyone from administration come down and talk with the nurses or ancillary staff to see how their decision would effect everyone, they just send down the orders from above.
It is interesting to me that these administrators never seem to understand what it takes to care for acutely sick people. They just look at the numbers and think that we are there eating bon bons. They do not provide the latest equipment or adequtely pay the nursing staff. They refuse to put us on divert when we are overflowing with patients and cannot provide good patient care (because that would reflect poorly and cost SFH a lot of money if we had to turn patients away). The administrators never come to help when we get into a crisis situation and more staff is needed. They do a walk about in the ER and determine if we can go on divert. Then, if they feel it's appropriate,they will give us one hour to figure it all out. Nice.....
Instead we have 4-6 hour wait times and patients lined up in the hallway like a warzone. Of course, they do not understand this because when they or their family members need to come into the ER, they can call ahead and we are supposed to keep a room open for them so they do not have to wait in the waiting room, with the thousands of other Tulsans.
Am I resentful? Yes,somewhat. The staff in the ER work amazingly well as a group to provide life and death care. The ability of the nurses and doctors to work together as a team provides a higher level of care. Administration doesn't account for any of that. I am amazed that you can provide 30+ years of service to an organization and then it can all be gone within six months. Without hesitation, without a goodbye, without trying. These doctors care about SFH but didn't appear to get the dignity and respect they need. The up aboves listened to the voices of the few, not the many. I am disappointed.
The new doctors who have come in do not seem to care about the relationships that need to exist between nurses and doctors. They do not introduce themselves to staff, they do not ask how things are going, they do not seem interested in the long term ability to provide excellent care.
Do I care? Yes, I hope that things will change at St. Francis ER. I know that administration will pour a large amount of money to ensure that these new doctors are successful, because after all, if they fail to provide, then adminstration will look bad. And that, above all things, is something they despise.
wow...
"While I do not know all of the going's on with administration" and that, in a nutshell, is the problem with this post...
quote:
Originally posted by cannon_fodder
I can't comment with any "insider knowledge." I am friends with the Chief of Staff but not on a professional level. I do not talk to him about hospital operations and even when I asked him about the rumor FOTD posted before he merely said the assessment was not accurate. He is not a spokesmen nor really part of the administration.
One thing I do know for sure ERRN, is that your line about me is off the mark. I never said anything about how many MDs staff the ER at St. Francis. I am the one who is friends with the Chief of Staff and I never said that. I don't know how many are in the group, how many should be, where they come from, or anything else.
Here is the previous thread on this matter where I never mentioned the number of ER doctors nor claim any special knowledge in these matters (I never said I "knew how it goes there" either FOTD):
http://www.tulsanow.org/forum/topic.asp?TOPIC_ID=8124&SearchTerms=chief+staff
So all I know about the poster is that she is a nurse, is an instructor at OSU Okmulgee, and is unhappy with St. Francis. I am left to assume that she works for St. Francis as an RN in the ER and that she worked there before the change and is not happy with its result. I can not dispute her assessment of the situation as if my assumptions are true, her information is better than mine.
I can dispute the money scheme to a minor degree. The administration is charged with fiscal responsibility but as a non-profit making money actually becomes a problem. Any profit that is made has to be reinvested in the hospital or donated in some manner (usually indigent care by medical facilities). So I can not speak to the conditions, the equipment or the management of the ER but on a certain level it doesn't bennefit the hospital to make money... I have no better explanation but St. Francis is non-profit and has no real incentive to make large profits (not tat non-profits don't do things that make no sense or they aren't cutting ER expense to bolster another unit).
Basically, I don't know. If a nurse that works there thinks it was a negative change I can't dispute her opinion. I could ask my friend again but he will tell me minimal information again as he is not a spokesmen (any large organization the professionals abstain from talking about internal matters).
So I can hope they hear ERRN's criticism and resolve any situation that exists, I can deny that I made any comment about the number of MDs in the ER, I can tell you the Chief of Staff is a person of great integrity who's opinion on many matters I greatly value, and I can tell you that profit should not be a very good motivator in a "non-profit" hospital... otherwise I got nothin'.
But thank you for your assessment ERRN. While rumors and insinuation are not welcome, an actual opinion from someone who is involved is always welcome in my book. Oh, and welcome to TulsaNow.
how do you know she is an instructor at osu okmulgee?
oh i see, her profile shows her real name as tish bryan...
I went to St. Francis ER in an ambulance a few months ago and the treatment was excellent.
I had to go back a couple weeks later for a test, (walk in) and never saw a doc after 10 hours wait, so I left.
My doc insisted I go back & I told her about the wait. She suggested I go to "St. Francis South" instead. It was WONDERFUL. The place was empty and clean and the staff was not stressed.
Try it if you ever need an ER again.
Not a critique Prairie, but was the follow up supposed to be to an ER? I thought those were done at urgent care or regular office visits (I don't know, just what I have done in the past).
and welcome to TulsaNow!
I can't argue with Prarie Shiksa......
She's a comrade.......if she sez so, it be true!
quote:
Originally posted by FOTD
Cannon Fodder and Bruno Flipper care to comment?Spoonbill, what about inaccuracies on my part?
We need your input. Since you, BF deal and CF, are chummy with the muckamucks at St. Francis, tell us again how it goes there! Then tell me I am wrong again.
I have read through this thread, and reviewed the previous thread, and the only conclusion I can come to is that the St. Francis bean counters have lost their marbles for sure.
My other conclusion is that FOTARD is still completely mad!
That is all.[8]
quote:
Originally posted by ERRN
They refuse to put us on divert when we are overflowing with patients and cannot provide good patient care (because that would reflect poorly and cost SFH a lot of money if we had to turn patients away). The administrators never come to help when we get into a crisis situation and more staff is needed. They do a walk about in the ER and determine if we can go on divert. Then, if they feel it's appropriate,they will give us one hour to figure it all out. Nice.....
The hospital divert policy for one hour and what criteria has to be met to be on divert isn't up to just the individual hospital, but all of the administrators for all of the hospitals met and developed the new (as of 2006) divert policy. There should be a copy posted in the ER somewhere. The reason for that is hospitals were abusing the old divert policy and using it when they didn't want to move patients fast enough. Since that policy was made, all of the ERs have become overloaded and that forces them all open when they all go on divert.
What Tulsa needs in another large hospital, and not more of small hospitals. That and the small hospitals seem to be more lazy about having to treat real patients. I've heard Owasso's hospitals have been shipping a lot of their patients to Tulsa.
quote:
Prairie_Shiksa
She suggested I go to "St. Francis South" instead. It was WONDERFUL. The place was empty and clean and the staff was not stressed.
Try it if you ever need an ER again.
Just don't go there is you have a really serious medical problem, because you'll end up at St. Francis via ambulance anyway. Most people don't realize they are a low level hospital, just about clinic status.
Originally posted by Mike G
quote:
What Tulsa needs in another large hospital, and not more of small hospitals. That and the small hospitals seem to be more lazy about having to treat real patients. I've heard Owasso's hospitals have been shipping a lot of their patients to Tulsa.
A lot of the problems with er wait times is due to uninsured patients and I think it would help if patients would stop going for toothaches, headaches, cramps, and mild flu like symptoms and save the er for actual emergencies. I can't help, but laugh every time I see a patient come in for something as mundane as a headache and wonder why they didn't see their primary care or use one of the many urgent care facilities. So, the next time you are waiting for four hours... stop *****ing at the er and take it out on the most likely uninsured douchebag to the left of you... they are the reason for your anger.
I tend to believe the long wait times are mis-use or outright abuse of ER's by the public, not necessarily a mis-management by the hospitals. That's why there are minor emergency centers for -you guessed it- minor emergencies! Yet people still refuse to use them.
quote:
Originally posted by Conan71
I tend to believe the long wait times are mis-use or outright abuse of ER's by the public, not necessarily a mis-management by the hospitals. That's why there are minor emergency centers for -you guessed it- minor emergencies! Yet people still refuse to use them.
That's why I believe ER's should have adjoining 24hr minor emergency centers and everyone coming in should be put through triage and sorted accordingly.
Are hospital ERs required to treat patients, even if they don't have insurance? How about the minor ER centers? If the minor ER centers can turn away the uninsured, or require them to pay, and the hospital cannot, this may be the reason that there are so many in the hospital ER with non-life-threatening complaints.
hospital ERs are required by federal law to treat anyone who seeks care regardless of insurance status/financial means...
minor care/urgent cares/clinics can and do turn away patients who cannot afford to pay...
quote:
Originally posted by Nick Danger
Are hospital ERs required to treat patients, even if they don't have insurance? How about the minor ER centers? If the minor ER centers can turn away the uninsured, or require them to pay, and the hospital cannot, this may be the reason that there are so many in the hospital ER with non-life-threatening complaints.
ER have a federal mandate to treat. They MUST ensure a patient is not under the immediate threat of death before they can discharge them. I do not recall the exact language, but there is a whole area of study in that regard.
Minor care facilities and hospitals without ERs do not have to do so.
That is why there is a shortage of ERs. They cost hospitals tons of money and are law suit magnets (working fast = working sloppy). So you are correct that the result is MORE people going to ERs because there are fewer places that are mandated to treat them.
A catch 22 AND a chicken and the egg argument I suppose.
quote:
Originally posted by cannon_fodder
quote:
Originally posted by Nick Danger
Are hospital ERs required to treat patients, even if they don't have insurance? How about the minor ER centers? If the minor ER centers can turn away the uninsured, or require them to pay, and the hospital cannot, this may be the reason that there are so many in the hospital ER with non-life-threatening complaints.
ER have a federal mandate to treat. They MUST ensure a patient is not under the immediate threat of death before they can discharge them. I do not recall the exact language, but there is a whole area of study in that regard.
Minor care facilities and hospitals without ERs do not have to do so.
That is why there is a shortage of ERs. They cost hospitals tons of money and are law suit magnets (working fast = working sloppy). So you are correct that the result is MORE people going to ERs because there are fewer places that are mandated to treat them.
A catch 22 AND a chicken and the egg argument I suppose.
All of our hospitals operate minor care attached to the regular emergency room. I think St. Francis calls theirs Fast Track or something.
quote:
Originally posted by brunoflipper
hospital ERs are required by federal law to treat anyone who seeks care regardless of insurance status/financial means...
minor care/urgent cares/clinics can and do turn away patients who cannot afford to pay...
B..b...bb..but what about those 47 million Americans who don't have access to healthcare?
[xx(]
I was very concerned by the post by ERRN related to the new doctors at St. Francis ER. My best friend works at St. Francis so I know their ER has had some challenges. My family uses their ER for emergency treatment and it has always been good (waits have varied) in the past. We expect to wait when there are people checking in with life threatening problems. From everything I have read long waits are a universal problem for ER's all over the country for the reasons already mentioned in other posts.
I'm an educated consumer and so I thought I'd check it out from the horse's mouth so to speak. I called my friend and asked for the scoop. I got the name of the new group of doctors now working in the ER and googled them.
I found their web site and was pleasantly surprised by what I found.
The group provides ER doctors for 29 hospitals in the US. They have been in operation since 1992 and only hire board certified ER doctors.
Doesn't sound so bad to me. I hope I don't have to find out first hand since I really don't want to have to go to an ER, but I have to question the earlier postings and ask if any of you have actually had cause to go to St. Francis ER since they got there.
I prefer to reserve my judgement til I have first hand experience of their new doctors.
I have to wonder if ERRN is basing her comments on fact or if she is just upset to see old friends leave and needs a scape goat to justify their leaving.
I work for a large corporation too and last time I checked they don't discuss their contract decisions with all their employees. There are always 2 sides to every story. I wonder who ERRN got her facts from. The angry doctors that left or the administrators she is blaming? I think the truth is probably somewhere in the middle.
Go to the link to see "It Pays To Specialize" comparrisons. The Hospital Industry and Big Pharma control the nation's health care.
FORBES
http://www.forbes.com/forbes/2008/0310/086.html
Cover Story
Bad Medicine
David Whelan 03.10.08, 12:00 AM ET
Robert Besse's painful odyssey began when he checked himself into Good Samaritan Hospital in Cincinnati a year ago to get his right knee replaced. The 60-year-old retired pharmacist had worn down the joint skiing and hiking and working on his feet for years. After the surgery Besse recovered for four days in a room he shared with another gentleman who'd had stomach surgery. His roommate's four youngsters would visit for hours, creating a racket, while up to 20 hospital staff a day would come in the room to examine him, bring food or change a lightbulb. A student nurse would wake Besse up to ask if he needed a new pillow. The physical therapist would peel back a bit too far the blue brace on his knee and expose the bloody gauze.
Ten days after leaving the hospital his knee was still oozing lots of fluid. "The pain was off the scale," he says. One of his surgeons took a look and immediately had him admitted to a different hospital, where he declined rapidly. Twice during the first night he was given last rites. But he survived until the morning when the surgeon opened up his knee again and found a raging staph infection that took two rounds of surgery to clean up. "I wanted out of there. I couldn't stand it," he says. He spent the next several months on infused antibiotics and pain medication. He was barely able to celebrate his sixtieth birthday with his family in Breckenridge, Colo. He already has a strategy to celebrate future birthdays: "My plan is stay the hell out of the hospital, period," he says. (Good Samaritan can't comment on the case because of privacy laws but says it has a comprehensive infection-fighting program.)
Hospitals are still the heart of the health care industry, consuming a third of the $2 trillion U.S. health care bill. Some are very good. But many are not, brimming with infectious bugs, systemic error and negative hospitality. And because the hospital industry does all it can to thwart competition, many communities are stuck with the hospitals they have. One in 200 patients who spends a night or more in a hospital will die from medical error. One in 16 will pick up an infection. Deaths from preventable hospital infections each year exceed 100,000, more than those from AIDS, breast cancer and auto accidents combined. The presidential candidates are grappling over the plight of the uninsured, yet you're five times more likely to die from visiting a hospital than from not having health insurance, according to the not-for-profit Committee to Reduce Infection Deaths.
Patients have a choice, but it's not widespread yet. It's called the specialty hospital, a center that focuses on the care of a particular body part such as the heart, spine or joints, or on a specific disease such as cancer. There are 200 specialty hospitals in the U.S. (out of 6,000 hospitals overall), and they often deliver services better, more safely and at lower cost. A recent University of Iowa study of tens of thousands of Medicare patients found that complication rates (bleeding, infections or death) are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A 2006 study funded by Medicare found that patients of all types are four times as likely to die in a full-service hospital after orthopedic surgery as they would after the same procedure in a specialty hospital.
HealthGrades is a quality review firm that ranks hospitals by their complication and mortality rates (adjusted for the health of the patient on admittance). According to HealthGrades, specialty hospitals don't always outpace traditional hospitals in quality of care, but they are overrepresented in the top tier. Three of the nation's top ten cardiac programs are at specialty hospitals in South Dakota, Indiana and Texas. Three of the top ten hospitals for total joint replacement surgery are specialty centers in Oklahoma, Ohio and Georgia.
"Specialization is a law of nature," says Robert Tibbs, a neurosurgeon and part-owner of the Oklahoma Spine Hospital. "Spine surgery is an elective procedure. One of the biggest risks to any surgery is infections. Here we don't have sick people." Last year, out of 1,773 patients who slept over at the hospital, only 7 got an infection. That's one-third to one-ninth the rate seen for similar patients at a big hospital. At Oklahoma Spine anesthesiologists are practiced in putting patients under in the prone position for back surgery. At a big hospital few anesthesiologists would be skilled in that particular task. "You don't take your Ford to the VW mechanic," says Tibbs' partner Stephen Cagle.
In most industries the lumbering, unresponsive incumbent gets wiped out by the nimble newcomer, or at least is spurred to improve its ways. The nation's public education system has the charter-school movement to keep it honest. Microsoft has Google. But over the past several years the hospital industry, through legally questionable bullying tactics and arduous lobbying, has all but stamped out expansion of the specialty hospital sector, the only real competitive threat it has ever faced.
________________________________________
In combating the threat, the large, all-purpose hospitals don't talk much about infection rates or medical results. They have a very different weapon, something that politicians find as scary as methicillin-resistant staph: the "conflict of interest" charge. Doctors who send patients to hospitals they own will be tempted to overprescribe. So the arrangement should be outlawed. This thinking finds its way into federal laws that prohibit kickbacks for medical referrals and forbid doctors to own part interests in providers they refer business to. A loophole in the law allows referring doctors to own a hospital outright, which explains how some specialty hospitals came into existence. But the conflict charge remains potent in the battle to stop new specialty hospitals.
After fierce lobbying by the hospital industry, Congress in 2003 passed new Medicare rules that effectively banned new physician-owned specialty hospitals. The ban was extended until August 2006. Since then only a couple dozen specialty hospitals have been built. With Democrats controlling both houses of Congress, there is currently a move to restore the ban and make it permanent. Last year California Democrat Fortney (Pete) Stark Jr., chairman of the House subcommittee that controls Medicare spending, added a specialty hospital ban to a bill expanding the program for health insurance subsidies. The bill died in the Senate, but the issue will doubtless come up again this year.
Stark, who 20 years ago helped write the laws that regulate what businesses physicians can invest in, has been trying to ban doctor-owned specialty hospitals since the 1970s. "These doctors are not entrepreneurs. They're getting a kickback from referring patients," says Stark. "They make enough money." Of the patients who prefer smaller facilities: "If that's what they want, back rubs and silk robes, go to India."
The specialty hospitals say that the kickback argument is a smokescreen. Three-quarters of the doctors who refer patients to specialty hospitals have no financial stake in the hospital. Blake Curd, a 40-year-old hand surgeon who is an investor in the Sioux Falls Surgical Center, has been going to Washington every six weeks for the last two years begging legislators not to outlaw his industry.
Curd says he makes 95% of his money from fees that do not flow through his hospital's coffers. The main benefits to him and his partners, Curd says, are that patients are happier because the staff is skilled at doing one kind of surgery and that the hospital can see more patients because the place runs smoothly. HealthGrades rates Sioux Falls Surgical Center as the best place to get a knee done in the region.
Specialty hospitals are only a more dramatic step in the long-term expansion of medical services beyond hospital walls. Labs and X-ray machines have been gone for years. A cataract removal used to mean a week in the hospital. Now it's done in an hour in a strip-mall office. Same goes for getting a knee scoped or a colonoscopy.
The specialty hospital movement got off the ground 20 years ago when Alan Pierrot, an orthopedic surgeon in Fresno, Calif., decided to start adding services to an outpatient surgical office he was already running. In 1984 he got together with 76 other doctors as investors. Two years later they lobbied the state legislature to allow them to add a recovery ward, X-ray unit and kitchen to convert the surgery center into a hospital.
Slipping in under the radar of the big-hospital industry, the Fresno Surgery Center became the best place in the city to get knee or hip surgery, according to HealthGrades' research. The established providers did not welcome the competition. The chief of Saint Agnes Medical Center, a nearby big hospital, told Pierrot that he had done a "disservice to his community."
Pierrot's idea, that patients sharing the same symptoms might benefit from being away from other kinds of patients and being cared for by staff skilled in one sort of procedure, had precedents. Doctors in Thornhill, Ont. built the Shouldice Hernia Centre in 1945. Dr. Shouldice rejected the idea that a hernia should be given to a young surgical resident or treated as a bread-and-butter procedure. By 1983, according to a famous Harvard Business School case study, the hospital's 12 surgeons were each performing 80 hernia repairs a month, which is 20 times the number done by the typical general surgeon. Shouldice surgeons use techniques and quality controls that have made the hospital an international destination for patients whose initial hernia repairs have failed. The average chance of a hernia recurrence after repair at Shouldice is less than 1%. The U.S. average is 5% to 10%.
Pierrot's success in Fresno attracted copycats--until the big hospitals started fighting back. The office of Cindy Morrison, vice president of public policy at Sanford Health in Sioux Falls, S.D., is headquarters for the antispecialty-hospital movement. In an aggrieved tone she gives the rundown of why specialty hospitals must be shut down. Only doctors can admit patients to hospitals, she says. Hospital administrators cannot. So it's unfair for doctors to own hospitals.
Morrison's employer has a history. In 1999 its cardiology and cardiac surgery group stopped using the big hospital and left to build what is now called Avera Heart Hospital of South Dakota. The fleeing doctors say that Sanford Health's chief executive, a charismatic onetime college basketball star named Kelby Krabbenhoft, tried to force them to become employees. Krabbenhoft wanted to dominate the Sioux Falls market by creating an integrated system in which the hospital owns a health plan and a huge practice of primary and specialty doctors who all refer to one another. The hospital employs almost 400 doctors.
According to Krabbenhoft, the heart doctors wanted ownership of Sanford's cardiac catheterization lab, which was built with nonprofit money, and were threatening to leave if he didn't give it to them. (The doctors deny making such a threat.) Krabbenhoft compares the docs to "Enron's Ken Lay" and "guys who rob banks."
The doctors bolted anyway, and built the $55 million Avera Heart Hospital with help from a public company called MedCath and a nearby Catholic hospital. Krabbenhoft made countermoves to hang on to some of the cardiologists, paying one of them $1.5 million a year for ten years to remain on staff, plus bonuses based on how much ancillary business he generated. Specialty hospital doctors grumbled that the compensation was designed to injure a new competitor--and represented the same kind of conflict-of-interest pay that the big hospitals objected to. Krabbenhoft says he was trying to retain his cardiology program.
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But Avera was a big success. HealthGrades calls Avera one of the top ten cardiac centers in the country. Only 1.2% of heart failure patients died there between 2004 and 2006. Sanford Health across town came in at 4.4%. Morrison contends that the specialty hospital cherry-picks healthier patients.
Prices are also 9% lower than at the big hospitals in town, says Jon Soderholm, the heart hospital's president. (Sanford says it's impossible to accurately compare prices.) The only thing that the heart hospital is guilty of, in Soderholm's mind, is having a 70% market share. "They're all frigging dinosaurs," says anesthesiologist Donald Schellpfeffer, who helped start the Sioux Falls Surgical Center, a specialty venue, in 1996.
Oklahoma is another flash point in the battle between the generalists and the specialists. The incumbent there is Oklahoma City's O.U. Medical Center, a cornerstone of its community for a century and the home of the state medical school's teaching hospital. Since 1997 it has been run by the $25 billion (revenue) privately held HCA.
Nine years ago the Oklahoma Spine Hospital popped up across town, owned by a handful of its doctors. In 2002 the Oklahoma Heart Hospital opened up across the highway from the spine outfit. Both are giving ou Medical the fits. Two years ago J. Andy Sullivan, a pediatric orthopedic surgeon and chief medical officer of the university-affiliated hospital, told a Senate committee that the little spine hospital, and the six other specialty hospitals like it in the city, were an unethical distortion of the free market. Its doctor-owners were stealing his most profitable patients. Sullivan, a town hero who crawled under the rubble of the Alfred P. Murrah building to amputate a woman's leg with a pocket knife, was a persuasive witness. Medicare soon implemented its own ban on new physician-owned specialty hospitals.
Several months after Sullivan returned home from Washington he attended a meeting with 50 other surgeons in town to discuss lapses in trauma care, which Sullivan and HCA blamed on specialty hospital doctors. Stephen Cagle, one of the surgeons from Oklahoma Spine, got up to speak and addressed Sullivan: "You're nothing but a corporate prostitute." Sullivan fired back but in a recent interview says he shouldn't have called the other doctors "unethical" in his remarks to Congress.
Specialty hospitals' financial success is part of what rankles their large competitors, especially given that they get paid the same for a given procedure. As she walks by the player piano in the lobby of the Oklahoma Heart Hospital, chief operating officer and nurse Peggy Tipton explains that the $108 million hospital did more than 1,000 bypasses and valve repairs last year. Its patient charts and drug ordering are all-digital. It has a one-to-one nurse-patient ratio in critical care and one-to-four in the rest. Patients are transported by nurses, not orderlies. The elapsed time from when a patient arrives at the er to treatment in the cath lab is never more than 90 minutes.
When an ambulance carrying a patient in full cardiac arrest arrives, Oklahoma Heart's ER workers apply ice packs. That preserves brain cells, yet isn't done in most hospitals. "Before they built this the doctors listed everything they didn't like about other hospitals," Tipton says.
The big rise in hospital errors and infections has spurred Medicare to reconsider how it pays for services, potentially refusing to pay for procedures ordered as a result of medical error. This plays into the hands of the specialty hospital movement. But don't expect their quality advantages to win the day in Washington. Political action committees associated with HCA, the American Hospital Association and the Federation of American Hospitals have already donated $2 million this election cycle to political campaigns. "The only way to solve this is to put the cat back in the bag," says Charles (Chip) Kahn, president of FAH. At the state level hospitals still rule. Hospital safety advocates expect the California Hospital Association to kill a new bill that would force hospitals to report staph infections. Shouldn't patients be able to comparison-shop for safety? "Consumers do not have the ability to do that," says Deborah Rogers, a vice president at the CHA.
During one of hand surgeon Blake Curd's recent Washington forays, he got a meeting with Representative Stark, who laughed him off, he says, and told the doctor his profession had missed the boat on owning hospitals years ago: "You guys abandoned your post and let the hotel management crowd take over."
Curd thinks a ban is coming but that once it's all settled doctors will find a different way of delivering health care that works. "We're wily," he says. "Physicians innovate in health care. Hospital administrators do not."
unless the stark laws are fixed to rein in these specialty hospitals, they will kill traditional hospitals and limit everyone's access to care...
guess who gets to go to a specialty hospital? only those with insurance/cash... zero uninsured...
these boutique hospitals don't have ERs so EMTALA laws don't apply, they get to cherry pick...
the surgeons have taken the highly reimbursed procedures and moved them to hospitals they (the surgeons) own... it seems like fair play until you realize that, in a traditional hospital, those high dollar cases offset all of the indigent care...
and don't think this is about quality of care, it is about physician greed...
quote:
Originally posted by FOTD
Go to the link to see "It Pays To Specialize" comparrisons. The Hospital Industry and Big Pharma control the nation's health care.
Wrong, it is the insurance industry that is the problem... they do nothing, they are an interloper taking a piece of the pie for shuffling money... at least hospitals and pharma provide services/goods...
quote:
Originally posted by brunoflipper
quote:
Originally posted by FOTD
Go to the link to see "It Pays To Specialize" comparrisons. The Hospital Industry and Big Pharma control the nation's health care.
Wrong, it is the insurance industry that is the problem... they do nothing, they are an interloper taking a piece of the pie for shuffling money... at least hospitals and pharma provide services/goods...
My father retired a long time ago, but he used to be a physician. When I was a kid he had a nurse and one billing person. The billing person would take money, or lick stamps and mail bills to the patients or their insurance companies. If the patient didn't pay their bill or the insurance company refused to pay for services they were dismissed as a patient and told that they could come pick up their records at their next convenience. Just like with any other service business.
An office visit was about $45 and medicine was cheep.
Today I bet there are 8 to 10 administrative / insurance / accounting and support people for every doctor now, and the docs are making less money! So where do you think all of the money is going?
quote:
Originally posted by Gaspar
quote:
Originally posted by brunoflipper
quote:
Originally posted by FOTD
Go to the link to see "It Pays To Specialize" comparrisons. The Hospital Industry and Big Pharma control the nation's health care.
Wrong, it is the insurance industry that is the problem... they do nothing, they are an interloper taking a piece of the pie for shuffling money... at least hospitals and pharma provide services/goods...
My father retired a long time ago, but he used to be a physician. When I was a kid he had a nurse and one billing person. The billing person would take money, or lick stamps and mail bills to the patients or their insurance companies. If the patient didn't pay their bill or the insurance company refused to pay for services they were dismissed as a patient and told that they could come pick up their records at their next convenience. Just like with any other service business.
An office visit was about $45 and medicine was cheep.
Today I bet there are 8 to 10 administrative / insurance / accounting and support people for every doctor now, and the docs are making less money! So where do you think all of the money is going?
Long time gone....good old days.
Hell, I remember house calls.
Dating myself sounds so monogamous. (a wise saying?)