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Sunday, October 26, 2003The hospitals here — hospitals across the United States, for that matter — covet patients like Robert E. Wilson. Mr. Wilson, 79, has had two open-heart operations, five angioplasties, three cardiac catheterizations and an implanted defibrillator. Just last month, he checked into the Heart Center of Indiana to get his first stent, a tiny bit of wire scaffolding that helps keep arteries open. Mr. Wilson's primary health insurance is Medicare, and Medicare pays generously for cardiac care — so generously that hospitals and doctors scramble after the business. The Heart Center, a 60-bed hospital that cost $60 million and boasts not just the most sophisticated new imaging technology but an executive chef and what it calls "room service," opened last December. Indeed, all four major hospital groups in Indianapolis are investing in new heart hospitals, collectively spending $215 million on multistory buildings with catheterization labs and bedside computers. Most doctors gripe that Medicare doesn't pay well enough, and that's true for the less glamorous specialties - i.e. primary care, but this article is probably correct. My former employer ( a hospital) was busily recruiting cardiologists into their physician office network at the same time they were telling the rest of us good-bye. One of my patients has a friend who works in the administration of another hospital in town (which is also closing down many of their hospital-owned physician practices) who told her that the only specialty that was making money for the hospital was cardiology. Perhaps it's wrong of me to indulge in gossip like this, but short-shrifting other areas of medicine to concentrate only on the profitable seems to be a trend that goes well beyond my community: Amid the building boom here in Indianapolis, some hospitals are laying off employees or scaling back programs, like psychiatric care, that are less generously reimbursed. Preventive care and case management, health experts add, get short shrift. How much difference is there between the reimbursement for simple medical care and complex cardiac care? Plenty: Hospitals will typically not disclose how much they profit from a particular procedure, like a coronary bypass or angioplasty. And Medicare — with little information about the cost of treatment — cannot say, either. But one full-service medical center that is leading the lobbying campaign against specialty hospitals, Sioux Valley Hospital in South Dakota, estimates that it makes nearly $1,500 for a typical coronary bypass under Medicare, while it loses almost $1,800 treating a case of simple pneumonia and $2,500 on a patient with kidney failure. Now that the profitability of cardiac care has been brought to the media's attention, it will also be in the spotlight of lawmakers and Medicare administrators. Expect the reimbursement to go down, and the hospitals that have invested so much to suffer the consequences - which means more nursing lay-offs, residency program cut-backs, and overall poorer patient care. UPDATE: A reader shares these thoughts: This is what ALWAYS happens when we resort to central planning of large, complex areas of the economy by bureaucrats and accountants. It just doesn't work, it has never worked, and it WILL NEVER work. One reason for this is that, as soon as some some number-cruncher is appointed to oversee a program, he immediately believes that he is gifted with God-like powers of understanding in that field, and certainly knows more about it than the lowly peons who actually do the the work. I think that Hillary Healthcare was the finest example of this to be found, at least outside the old Soviet Union. (I once walked out of a lunch presentation by the President of my professional association because she was going on in rapturous terms about the wonderfulness of HillaryCare. Unfortunately, I took the nearest exit, and wound up in the kitchens of a very large L.A. hotel- took a while to find a way out!) Of course, "central planning" doesn't allow for adequate and timely feedback, and this is the ultimate reason it won't work. This problem is not fixable, even with the Internet and all sorts of technology- because the people in charge will not use the information they get if it jeopardizes their programs or their preconceptions. All of this should be blindingly obvious to Americans, but apparently it is not, and we are headed even further down this road with the "prescription drug program", which is going to be a real disaster for our economy. I estimate that the country will be bankrupt not later than the year 2030. posted by Sydney on 10/26/2003 07:22:00 AM 0 comments 0 Comments: |
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