The Business of Medicine

It never ceases to amaze me that medical businesses are not run like a business.  Every business cross-trains employees so that if somebody is on vacation or out sick, the critical elements of that person’s job are performed.  Apparently that isn’t true in medicine.

My GI referred me to Virginia Mason for a lithotripsy and ERCP.  I could have the ERCP locally, but I’m told there’s no point since it needs to happen after the lithotripsy anyway.  I have to go to Seattle for this one.

I waited a week, then called the GI back:

Didn’t you say they were going to call me to schedule an appointment?

Yes.  They will call you.

Any idea when?  I had hoped this would be done by now.

Let’s see, I sent that on the… oh, my!  You should have heard back by now.  I’ll call them and make sure they got our fax.

Thank you.  Do you think I could get their phone number, too, and call them myself?

A call to the place I was referred got me the run around, but eventually someone told me that the person who handles referrals was out of the office for a week and a half, so it’s taking a while to get through all the referrals that accumulated while she was gone.  No, they would not schedule an appointment for me until their doctor said so.  The doctor did have my information, and they’d call me in 1-3 days.

Three days came and went.  A week later I called the GI office back and left a message asking if they could light a fire under Virginia Mason.  This isn’t a plea to fit me in sooner.  Just call me and schedule an appointment!

A few days later, GI called me back and said that Virginia Mason says they’re still working on it.  You’ve got to be kidding me!  My nine year old knows how to dial the telephone, talk to the person on the other end of the line, then write something on the calendar.  What is the problem here?

Imagine if your furnace quit working and the repairman said that he couldn’t schedule a repairman, but he’d get back to you in a week or two to arrange a good time for someone to take a look at the problem.  What if it was 20 degrees out, the faucets in your house stopped working, and there was a stream of water running out from beneath the house?  Would you do business with a company who wouldn’t return your phone calls or send someone to investigate the problem, or would you call around until you located somebody who wanted the job?

I asked GI to please find someone who actually wants my business.  Monday I will be on the phone looking myself, even if that means finding a different GI in a different city in order to get a referral to someone who will actually make appointments and see patients instead of sitting on their pile of faxes.  There must be somewhere else that this procedure can be done:  UWMC, OHSU

I want to earn $910 per hour

It boggles the mind that some people think the cost of healthcare will go down if all doctors become hospital employees.  When a private practice doctor can make a profit by seeing patients for $200, but the fee for the exact same 25 minute appointment becomes $455 when the doctor is employed by a hospital, something is dreadfully wrong.

How can charging more than double be construed as reducing costs?

To me, it seems that patients could put an end to such nonsense by refusing to see a doctor employed by any hospital using such tactics.  Unfortunately, it doesn’t work that way.  Since the insurance reform law passed, it’s getting harder and harder to find doctors in private practice.

For my daughter, it’s impossible.  According to the ACR, there are only five practicing pediatric rheumatologists in my state.  All of them are at Children’s.  If it were me, I’d look for a different doctor – one not affiliated with a hospital extorting facilities fees.  I can’t take my daughter elsewhere, though; there is nowhere else.  We’re stuck.

We recently discovered something that sheds a little light on the situation.  The hospital is requiring doctors to do lots more computer work.  An oddly reasonable administrative ruling has lightened doctors’ patient load to give them time to do that paper computer work.  The problem that the hospital ran into is that if doctors see fewer patients, they’ll earn less money and that puts a huge crimp in the cash flow.  Now I understand the reasoning behind the facilities fee.  Instead of seeing two patients to earn $400, they’ll just see one patient and charge $455.  Half the work, but even more income.

There’s a flaw in that solution.  Tacking on a facilities fee does not mean that the hospital will get more money.  It means that people like me, who would never have dreamed of asking for financial assistance in the past, are now doing it.

Welcome to unintended consequences.

Highway Robbery

Charging a “facility fee” in addition to physician fees for a doctor’s appointment is immoral.  It is a barbaric method of gouging extra money out of people who are sick and desperately in need of a physician.

Imagine if the only physicians available to treat your condition worked 65 miles away at the outpatient clinic associated with a specialty hospital, and you received a hold-up letter:

Starting Oct. 1, we will bill a facility charge for hospital-based clinic visits…

A facility charge includes hospital expenses for a clinic visit that are separate from the cost of the medical provider.  You will continue to receive a separate charge from your medical provider for their (sic) services.  The facility charge includes costs for running the “facility” like supplies, equipment, exam rooms and other hospital staff…

Supplies, equipment, exam rooms, and support staff are simply part of the cost of providing medical care.  The high cost of doctor’s appointments is often justified because that money pays more than the doctor’s salary; it pays the support staff, the rent or mortgage, and the other costs associated with running a business.  Those costs are similar everywhere.  All businesses have overhead costs.  Those expenses don’t justify extra fees, and it is ludicrous for hospitals to think they’re special in this regard.

In an attempt to justify this travesty, the letter goes on:

All our other departments charge a facilities fee, so now the outpatient clinic will be billed the same way.

This is a standard practice for most other hospital-based clinics.

Due to recent funding cuts, we have to find somewhere else to get the money.

The fact that hospital facility fees are charged for hospital services, in no way implies that hospital facility fees are appropriate for outpatient services.

“Everyone else is doing it” isn’t an acceptable excuse when kids say it, and it’s not acceptable here.  First, because everyone else isn’t doing it.  Second, because it doesn’t matter what everyone else is doing (if everyone else was jumping off a bridge, would you do it?).

I am outraged to think that this hospital thinks they can charge every patient seen in an outpatient clinic an extra $255 per appointment.