A smaller company gets purchased by a bigger company. They chop duplicate services, trim the excess, adopt efficiencies, and make a profit. It happens every day. It is the world of big business. And now it's happened to me and my company. One giant hospital system moves in and swallows up a small one. My ED group recognized it has to join a bigger group or it gets pushed out. And every day healthcare is less about health or caring. It is about business.
Everything seems fine in the beginning but slowly all the power and decision making is centralized farther away from the frontline workers. It starts with small changes. Administrator X is no longer with us and now administrator Y who lives in East Buddha will be managing that department. Case managers are now expendable because they don't improve the financial bottom line. Benefits for staff slowly get cut. Mangers get "promoted" and now manage four departments instead of one. And by the time services to patients start to diminish, there isn't anyone you can talk with to make changes. Power is centered three states away. It would take a year to make the slightest change.
Slowly but surely healthcare has been infiltrated and is now controlled by business interests. The vast majority of our hospital systems are run by business people. Of the thirteen highest executives in our hospital system, exactly one is a physician. We clinicians, providers and nurses, have yielded all power for the sake of a buck.
I'm not sure who to blame for this. The change came slowly at first but now feels like it is so powerful it is unstoppable. The very high cost of healthcare needed some business sense. Clinicians specialized in medicine, not finance. I don't blame the business community. They are just doing what they are trained to do. Trim the fat, make a profit. But who is looking out for patients? And is anyone looking out for clinicians?
Everything is online, systemized, and efficient. But healthcare has lost its soul. It has become palpable in my department and even in myself. Making positive change feels harder. The system is a nameless and faceless place. Does anyone take ownership for quality? The websites look good and they make you feel like a kind hearted doctor is waiting to care of you. Doctors and nurses would like it to be that way. But an efficient system doesn't allow much room for hand holding and talking and educating.
Do big systems really save money? If they do, who is reaping the financial benefit?
"Hospital costs during 2010 in the U.S. constituted $814 billion or 31.4 percent of all healthcare expenditures. Furthermore, the cost of care will only continue to rise as we shift into a consolidated healthcare system and programs like Medicare allow higher payments for services performed in hospitals as opposed to independent private practices. One widely reported example found a Nevada patient whose echocardiogram bill came to $373 before the physicians’ practice had been purchased by a hospital system and then increased to $1,605 after the merger." - Ray and Norbeck, Who's to Blame for Our Rising Healthcare Costs, Forbes Oct 2013.
In the ER we do good work and we can make good money. But I worry what the future will look like. It shouldn't be patients versus doctors. We should be in this process of caring for health together. But there is a very big elephant in the room with us. That elephant is business. And for right now, they are captain of the ship. I'm just not sure that's a good thing.