PART 3 (Click Here for Part 1)
So why is this political? Because the tests that are ordered, the specialists that get consulted and ultimately the care that you receive in the hospital is determined by who employs the Hospitalist.
Years ago hospitals started buying medical practices of all kinds. The reasons behind this are numerous and varied and too many to effectively be covered in this post. As a result, these hospital employed practices are pressured to keep the money all in the family. They are expected to use the hospital that employs them for all the labs, radiology and other procedures that their patients might need. This isn’t written down anywhere because in fact to do so would be illegal. The Stark laws (www.starklaw.org) govern financial incentives for physician practices specifically prohibiting kickbacks. Initially it was a few specialties like Cardiology, Neurology and Primary Care practices. Now the hospitals own a representative practice in almost all areas of medicine. They typically own the majority of the Hospitalist groups and ensure that this group gets the majority of the ER call. This ensures that the majority of the patients getting admitted stay in a hospital-employed group. This employed group feels the same pressures to keep the money all in the hospital’s pocket. How do they do this? They only ever consult with specialists that are also employed by the hospital to the exclusion of other groups that may be available or even preferred by you or your family.
Ultimately this means that the hospital gets the entire pot of money for your admission from the insurance payments for your stay to the doctor’s fees and all the procedures you had done. This is big, big money. Now imagine the longer these doctors stay in the system, they get put on committees. They start making policy and move up the chain of command in the hospital administration. After a decade of this, the entire administration is filled with doctors who have never run a practice, balanced a checkbook or dealt with the vagaries of a medical practice. These administrators surround themselves with other physicians like themselves who enforce their world view on the rest of the medical staff – employed or otherwise.