In previous notes, I have discussed the umbrella term "big medicine" which captures the idea that most of the major decisions pertaining to our healthcare system are now being made by the federal government, health insurance companies, large health systems, pharmaceutical companies, and pharmaceutical benefit managers (PBMs) (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"; The Transition to "Big Med": Need for Emphasis on Standardization and Cost; The Institutionalization of Healthcare; Consequences of Big Medicine?). One aspect of this consolidation of power in healthcare is the decline of private medical practices thorough the purchase of such practices by hospital systems. A recent article discussed some of the ethical problems associated with this change (see: Whistleblower Doctor Warns About Hospitals Hiring Physicians). Below is an excerpt from it:
There is a good chance that your once-independent doctor is now employed by a hospital....Broward Health [recently] agreed to pay $70 million to settle allegations that it engaged in "improper financial relationships" with doctors under laws prohibiting kickbacks in return for patient referrals. Giving doctors incentives to generate medical revenue is widely deemed unethical because it tempts them to order unneeded treatment or send patients to lower-quality providers. Physicians with a financial interest in a medical facility tend to prescribe more procedures than those who don't, studies show. Lawmakers have repeatedly tried to ban or limit such behavior at least since the 1970s. What happened at Broward Health and numerous other hospitals suggests they haven’t succeeded....Hospitals, burdened with large, fixed costs and anxious to ensure patient referrals and revenue in a changing industry, are doing the opposite."Doc binge buying rolls on" was the June headline in Modern Healthcare, an industry magazine. A third of doctors now work directly for hospitals or for practices with at least partial hospital ownership, estimates the American Medical Association. Broward Health is a taxpayer-supported system with five hospitals and a publicly appointed board. More than a decade ago it launched an expansion drive that included hiring previously independent physicians and paying CEO Frank Nask and other executives large bonuses if the institution increased revenue and the bottom line....Although Broward Health paid an enormous sum to settle allegations of wrongdoing, it did not admit those allegations, which is typical in such cases.
It's clear, at least to me, that the hidden employment of community physicians by large hospital systems constitutes a major problem and is leading to both ethical lapses and excessive spending for healthcare. One solution is for increased prosecution by the Justice Department of such cases under the Stark law which prohibits improper financial inducements to doctors in return for patient referrals. As to what actions that patients should personally take regarding their choice of physicians and to protect themselves from inappropriate referrals and excessive use of services, here's another quote from the article cited above:
What should patients do? Ask their doctor who he or she works for.... If the doctor is employed by the hospital and recommends surgery or some other expensive treatment,..."research the indications for the procedure" and "consider a second opinion" from an independent practitioner.