Forbes Magazine has published what may be the most one-sided health care article I’ve ever read. Its author, David Whelan, depicts your local community hospital as a kind of mini-Microsoft that uses underhanded tactics to squelch legitimate competition:
Over the past several years the hospital industry, through legally questionable bullying tactics and arduous lobbying, has all but stamped out expansion of the specialty hospital sector, the only real competitive threat it has ever faced.
This preposterous assertion contains so much BS that I hardly know where to begin shoveling. For starters, the suggestion that specialty hospitals constitute fair competition for community hospitals is ignorant at best and dishonest at worst.
A specialty hospital enjoys a government-mandated advantage over a typical community hospital. Whereas the latter is required by law to treat every patient who crosses its threshhold, the former can cherry pick the lowest risk patients with the best insurance coverage. That is what produces the following outcomes:
There are 200 specialty hospitals in the U.S. (out of 6,000 hospitals overall), and they often deliver services better, more safely and at lower cost.
This is hardly surprising considering that the really sick patients are back at the community hospital sucking up resources like nobody’s business. And Whelan neglects to mention the many cases in which the community hospital has to pull the specialty hospital out of some clinical ditch:
Widespread concerns about specialty hospitals using 911 services to handle emergency care cases first surfaced in January as a result of the death of a patient transported from a surgical hospital in Abilene, Texas, to a community hospital.
Community hospitals have no objection to legitimate competition—if all parties are required to fight by the same rules. It is not, however, reasonable or fair to force us into the ring wearing handcuffs.
Comments 5
I take it that the irony of hospitals fighting each other over profitable patients is lost on you, as is the shocking rate of hospital infections. And how could a specialty hospital ever have the same procedures as a general hospital? Would you send a heart patient to the MD Anderson? So instead of having a planned mix of general/specialty facilities, you want perpetual war and waste.
Posted 07 Mar 2008 at 5:32 am ¶So instead of having a planned mix of general/specialty facilities, you want perpetual war and waste?
I think the NHS illustrates the nightmare that results from the kind of “planned mix” that you advocate, Marc. NHS waste is the stuff of legend and the “war” is between the British people and the system that is supoosed to provide care.
Posted 07 Mar 2008 at 9:20 am ¶That’s not a response to your situation. If you think that bribing cardiac surgeons to remain in your hospital while a rival service sets up on you doorstep is a sensible step then let’s hear it.
Posted 07 Mar 2008 at 9:59 am ¶Catron,
True, the rules are uneven, but let’s keep in mind that the big hospitals are not asking for an even playing field. That is, they aren’t asking for some version of EMTALA to apply to specialty hospitals or rules against “cherry picking” (although the evidence that specialty hospitals do that is mixed at best.)
What big hospitals (such as the American Hospital Association) are asking for is a complete cessation of all physician owned specialty hospitals. They want no hospital to be more than 40% physician owned and no physician can have more than a 2% ownership. Those are the rules the AHA has been trying to slip into a host of bills on Capitol Hill, from Medicare Physician Fees, to SCHIP, to, now, Mental Health Parity.
Such rules aren’t “fair competition”. They amount to trying to drive the competition out of business–or at least prevent more competitors from entering the market.
Posted 07 Mar 2008 at 3:42 pm ¶Let’s keep in mind that the big hospitals are not asking for an even playing field.
Maybe a better way to phrase it is that community hospitals don’t want to be subjected to unfair competition.
They amount to trying to drive the competition out of business.
The current regulatory environment forces community hospitals to participate in a gunfight armed only with a knife. I think that’s what the AHA is fighting.
Posted 07 Mar 2008 at 10:03 pm ¶Post a Comment