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‘Business’ of health care

rainey

Say the words “health care” these days and most informed folk will immediately think of the national embarrassment we’ve witnessed from congressional Republicans for the past seven years. Especially the Senate bunch who damned near wrecked the entire system.

But, for seniors, those two words usually first bring to mind our own interactions with the traditional delivery of care that’s morphed into the complicated – and terribly expensive – animal it is today. I’m one.

In the last 20 months, I’ve interacted with 10 physicians and dozens of other medical professionals in three hospitals on both an “in” and “out” patient status. “Up close and personal,” as they say. As a result, I’ve had an education.

If Senate Republicans had managed to pass any of the abortive and secretive “legislation” they devised, it’s damned safe to say the three small hospitals of my recent experience would have disappeared. All are under the same professional ownership and, because of highly creative business practices, exist to serve communities as few as the one we currently live in – population 1,200. They do it well.

Hospitals and clinics survive – first and foremost – because of good business practices and not the care given. If a facility doesn’t “pencil out” business-wise, it won’t exist medical-wise. Plain hard truth.

With Medicaid and Medicare as their most significant sources of income, hospital bean counters have had to be creative. Especially in small communities. Neither government-sponsored program fully reimburses costs of patients who are covered by them. Plus, any hospital that accepts federal funding of any sort – and nearly all do – must serve the uninsured and deal with the uncompensated costs of that care. So, insured and other private pay patients are overcharged to help balance the ledger and keep the doors open. More truth.

Another wrinkle is hiring doctors as staff. Many docs like it because, while most of ‘em will make less money, they won’t have to hire/fire nurses and other professionals, pay office expenses, buy ridiculously priced liability insurance, won’t work nights and weekends, they’ll have support staffs and major equipment readily available and most won’t make hospital visits.

But, to us senior patients especially, that can be a double-edged sword. On one side, hospitals can control costs like salaries and expenses which is good. But, on the other, we’re often just another old 15-minute face who doesn’t get the personal attention or involvement with doctors as we used to “in the good old days.” General practice docs go day-after-day seeing the same types of patients hour after hour with the same types of ailments under a patient load that keeps many from having time for personal interaction or deeper knowledge of patient needs. So care – and the relationship – can seem impersonal and/or sterile

Of the ten physicians seen in my recent medical journey, most had a hard time remembering my name, recalling previous information or test results between visits and had little to no prior knowledge of my appointment needs until grabbing one of the endless charts in the box outside the exam room door as they entered the room.

Adding to the problem, a lot of docs – especially in small facilities – have already retired once and are working part time to keep up their skills while adding to the retirement income. For hospitals, they’re low maintenance and cheaper than full time staff. Keeping costs down. But, part time makes it difficult to schedule consecutive appointments for care resulting in longer periods of treatment or forcing patients to live with the ailment(s) and symptoms longer and – possibly – having to make costly emergency room visits for care between times.

None of this is meant to complain. Institutional medical care has never been better – in my experience. But, as consumers who may – from time to time – have need of serious interaction with the medical community, we all need to understand what’s happening out there.

Small hospitals are no longer as independent. For survival, they’ve been bought and sold – often several times – to assure the doors stay open. Care is often some distance away as facilities have merged or taken on more restrictive “specialty”roles. Some nursing and other support staffs work in more than one location several days a week to keep personnel costs down while trying to provide services to more distant patients. Expensive equipment may be spread among several jointly-owned facilities – miles apart – to avoid duplication but, at the same time, forcing patients to visit more than one hospital for care or drive substantial miles in my case.

And a lot of doctors, who used to more often practice independently or in clinics with ownership, now may be employees with eight-to-five working hours, often seeing patients in more than one location, be unavailable nights and weekends, might never follow their patients admitted to hospitals, while often seeing twice as many patients daily for shorter visits.

You can also add to this changing landscape the increased use of specialists. Again, many are employees or contractors. Seeing more bodies but for much shorter appointments. Some scheduling new patients six to eight months out to manage their practice time and increased patient load in several small communities. Some visiting several locations a week.

Like the Old Grey Mare, health care “ain’t what she used to be.” In rural areas especially. More than ever, business decisions are affecting which will survive. And which won’t. Chain ownerships of hospitals and clinics have altered staffing practices and how major equipment and bulk purchasing decisions are made – and by whom.

Computer systems, while creating huge advances in diagnostics and care, are also depersonalizing many of the traditional interactions between medical professionals and patients.

The availability of care – or the lack of it – is forcing many patients to move from small towns to cities to find the continuing care they need. The number of independent docs and clinics is shrinking. Patients normally seen by physicians are now just as likely to be seen by a physician’s assistant. In some areas, more likely.

For most of us, all this change has been happening with little notice. We seldom think about the structures of medicine or its delivery until we are in need of personal attention. Even then, after diagnosis and treatment, we tend not to look further.

But, all our lives are being quietly reshaped daily by these forces. Fact is, at our house, we’re planning a long distance move shortly. One of the major factors: a 10-story hospital and more than 100 physicians of all stripes right in the subdivision. Recent personal experience has shown these are considerations we need to pay more attention to.

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