The greed and inefficiency of hospital conglomerates is destroying health care. Thanks to the costs of electronic medical records (EMR) and the Health Insurance Portability and Accountability Act (HIPAA) imposed on physicians, independent practices –- especially primary care — can no longer afford to stay in business. They are forced to sell out to hospitals who are more interested in paying administrators huge salaries rather than patient care.
This was highlighted by a recent anti-trust suit filed by St. Francis Hospital against Hartford Hospital. Over the past decade, Hartford Hospital (full disclosure, I am on staff at Hartford Hospital) has acquired Backus Hospital (Norwich), Charlotte Hungerford Hospital (Torrington), Hospital of Central Connecticut (New Britain), MidState Medical Center (Meriden), St. Vincent’s Medical Center (Bridgeport) and Windham Hospital (Windham). The bean counters now rule. And one of their most notorious actions was to close obstetric care at Windham Hospital resulting in women – mostly poor and minority – to trek up to an hour to another hospital while in labor.
Salaried doctors are powerless to fight this.
Small practices are selling out to the hospitals. While doctors once complained about malpractice costs and trial lawyers, a much subtler but business-killing cost arose when the government promised physicians a one-time $44,000 payment if they adopted EMRs and cutting Medicare (the program that cares for the elderly and disabled) reimbursements for those who refused to comply. This was further exacerbated by the requirement that the software be HIPAA-compliant, theoretically to protect the privacy of patients.
Many doctors complied, believing this would be a great deal, but then quickly realized that software engineers made trial lawyers look like pikers. Maintenance costs, updates, scribes to collect the required data soon consumed hundreds of thousands of dollars and small practices were left with the alternative to close or sell out.
They sold out. Hospitals argued that this consolidation would reduce patient bills because of increased efficiency.
Of course, it was a scam. The software costs to integrate these practices was massive and the hospitals started to charge “facility fees,” that is extra charges that were rarely covered by insurance and on top of the copays!
The conventional wisdom is that the Democrats support Medicare-For-All while regressive Republicans oppose it. But the reality is that both parties are bought and paid for by the insurance companies and the hospitals – which have enormous political clout because of the numbers of people they employ.
Democrats have had numerous opportunities in the past to pass Medicare-For-All but have instead passed legislation such as Obamacare, forcing patients to buy lousy health care while the insurance companies laughed all the way to the bank. Furthermore, if the Democrats passed Medicare-For-All, the legislation would still be riddled with EMR and HIPAA requirements as health-care bureaucrats, administrators, data crunchers and software engineers – all making six and sometimes seven figure salaries – are part of their base. This would make it impossible for doctors to accept as the overhead costs would be too onerous.
Republicans should support Medicare-for-All. The useless Obamacare and Medicaid (the program for the poor) should be jettisoned and these citizens should be placed on Medicare. This would do more to solve racial inequality in health care than all the sensitivity and diversity training that is permeating the medical profession now. Of course, anyone who prefers private insurance would not be forced to take Medicare-for-All.
Doctors who participate in Medicare should be able to use any software system or paper records they wish – not the overpriced government-required software. The so-called HIPAA privacy rules are archaic and should be repealed. They do nothing more than make the software unaffordable. And as anyone who has Googled their medical problem knows, there is no privacy. The social media conglomerates sell your search data and the next thing you know – you are getting pop-up ads for products related to your search.
The result, doctors would immediately tell the hospitals to get lost and restart their own practices. There is nothing like competition to give patients quick competent care. No more five-minute taped monologues every time you try to make an appointment. No more three- to four-week wait times. No more facility fee rip offs. No more seeing another doctor every other time you are sick. No more watching doctors peck useless information into a computer while refusing to answer your questions because some bean counter is forcing her to see six patients an hour. No more bankruptcies from cascading medical bills.
If Republicans want to start winning more elections – even in Blue States like Connecticut – Medicare-for-All is the way to go.
Joseph Bentivegna MD is an ophthalmologist in Rocky Hill.