Page 15 - OctSam2019

CORPORATE
MEDICINE

found to be disproportionately located in
high income areas.
This is not intended to say all for-profit en-
tities are flawed or corrupt. A recent case
study examining Md Anderson (corporate
entity) touts it to be an excellent example for
others to follow. It is a non-profit hospital
with some for-profit agreements. An exam-
ple of a for-profit entity that has reported
improved outcomes is the Pediatrix Medical
Group, a subsidiary of MEdNAX Inc. For-
profit corporate medical groups keep a close
eye on their finances while attempting to bal-
ance costs, patient well-being, and patient
outcomes. This is not an easy task. We need
updated outcome studies comparing the ex-
What can we say then of the American corporate isting models that deliver care so that we can build a better delivery
medicine experiment? Here are some examples of system; a system that strives to continually provide for a patient’s
where it went very wrong. well-being.
Corporations have dominated dialysis units. The two largest, Market forces drive for-profit organizations and corporate med-
davita and Fresenius, have been cited as doing a poor job keeping icine is no exception. Corporate influences are reshaping reimburse-
patients alive. A 2011 study in Health Services Research found that ment policies and competition, driving a shift from a solo practice
for-profit chains had a 13% higher risk of mortality than not-for- to a group practice. Those who argue that market forces will solve
profits. davita has paid out hundreds of millions to settle claims the problems in healthcare, either fail to acknowledge or fail to un-
of overuse of potentially harmful drugs and of committing derstand that these same forces are devoted to a corporate ethic
Medicare fraud. A 2002 meta-analysis found that patients in a for- (loyalty to shareholders) and not to patients. At the same time, physi-
profit hospital had a higher risk of death compared to not-for-profit cians also need to be financially able to provide services, but they
hospitals. are typically more focused on the well-being of the patient.
So, looping back to the largest hospital system in America, how These divergent allegiances in healthcare are all-too-often ignored
have they behaved? In 1993, the government launched what became by our politicians. It is unfortunate that our destiny as practicing
a 10-year investigation of various allegations, one of which was over- physicians is, and will continue to, be defined in political terms.
billing Medicare. In 2003, the government received around $2 billion Therefore, we should all be involved in preserving the integrity of
dollars from HCA in criminal fines and civil penalties. The Justice medicine, whether we champion the cause of the solo practitioner
department called it the “largest healthcare fraud in US history”. or that of “big medicine”.
In 2016 in Texas, Austin hospitalists sued TeamHealth (a com- Our patients have been defined as “consumers” by big business.
pany St. david’s Healthcare uses) alleging they were being pressured That is such a misuse of the word consumer. To be a consumer
to make medical decisions that make money for the hospital. Texas, means you have a choice. Our patients often have no choice of who
like many other states, has created “corporate practice of medicine they see or what medicine they try first. We must defend those
laws” that forbid a business from practicing medicine; hence, the choices and we must incorporate the patient’s experience when de-
lawsuit. veloping policies. We have a moral obligation to reinsert ourselves
Although there are gaps in the literature, a 2014 study found that into the discussion of how best to deliver care.
for-profit entities had inferior outcomes. Some physician practices
are operating under a corporate roof, yet it’s unclear how it will af- Bexar County Medical Society has a superb Legislative and Socioeconomic
fect patient outcomes. A 2016 study in Health Affairs of retail clin- Committee that regularly meets with our local politicians and judges. As a mem-
ics found higher costs (by 21%) for “low acuity conditions“ such as ber of BCMS, you can begin there; I know I did. The staff at our society is
colds. Also in this study, free standing ERs and retail clinics were friendly, supportive and knowledgeable. Please reach out.

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