NeuroNews

Health Care Problems Not Addressed With Current Reform

  

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Dr. Vernon Rowe, a neurologist in Kansas City and Dr. John Mandrola, a cardiac electrophysiologist from Louisville have never met, but they agree on one problematic health care issue that is not being talked about nor addressed by any pending reform.

Dr. Mandrola wrote an excellent piece on how large hospital systems – by purchasing the primary care practices from which most referrals to specialist originate – have disrupted trusted referral patterns and are potentially compromising medical judgment.

Excerpts from How healthcare reform changes referral patterns? 
As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one's clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes "providers" to consolidate along the lines of major hospital networks this injustice will only worsen.

…few specialists start independently. You join an established group, do good work, form relationships and eventually, your quality becomes known. As it should be: do good work and doctors will trust you with their patients.

Now there is a new trump card for referrals: physician consolidation. Who owns who. For example, hospital X's primary care doctors refer their cardiology (substitute any specialty) to hospital X's cardiologist.  And so on with hospital Y and Z.  Like in this example, as one local oncologist bemoaned to me recently: "referring doctor Y used to refer me all his patients, but since the acquisition, he sends his mom and brother to me, but sends the rest of his patients to his new mother-ship's oncologist."

Isn't it fair that a patient know that their doctor may have signed a contract agreeing to use the 'company' doctors? (Sure, there was a also a clause in that same contract saying the 'company' would not interfere with medical judgement, but we all know that persistent rogue referrals will likely result in an unpleasant fireside chat.)

Dr. Vernon Rowe, in a different area of the country, with a different medical specialty, but with similar experiences as a private practice physician, wishing to keep his practice (and medical decisions) outside of of these large hospital systems agrees:

Hospitals are gobbling up primary care practices to insure that high dollar reimbursement procedures like surgery and testing (hospitals charge three to four times what out-patient centers charge for testing) are kept within the hospital system itself.

The writers of the Obamacare legislation know little of health care delivery. The authors of the regulations implementing that law will probably know even less. If they knew anything, they would incentivize outpatient organizations that work to keep patients out of hospital-dominated systems, rather than incentivizing hospital dominated systems to take over the health care of our country. Remove the exemption of hospitals from stark self-referral and see how quickly hospital behemoths streamline to deliver only they care they should be responsible for. And give the money saved from those inappropriate in-hospital self referrals to health departments across this country if you really want to improve the health of this nation.