There is a good chance Your once independent doctor is now employed by a hospital. Dr. Michael Reilly, a Fort Lauderdale, Florida, orthopedic surgeon, believes this is not good for physicians, patients or society.
For years he saw Broward Health, a nonprofit Florida hospital system, hired community doctors, paid them millions and tracked them revenue generated from admissions, procedures, and tests.
“We’re making money from these people,” Brown’s health CEO told Reilly, according to a federal whistleblower lawsuit filed against the system by Reilly and the US Department of Justice.
Broward Health last month Agreed to pay $ 70 million To settle allegations that it engaged in “inappropriate financial relationships” with doctors under laws prohibiting kickbacks in exchange for referral of patients.
Incentivizing doctors to generate medical revenue is widely considered unethical because it motivates them to order unnecessary treatment or send patients to lower-quality providers. Physicians with financial interest in a medical facility Tend to determine More processes Compared to those who do not show studies.
MPs have tried to ban or limit such behavior at least since the 1970s. What happened at Broward Health and several other hospitals shows that they have not been successful. Now that hospitals everywhere have come under the purview of their respective doctors, Reilly is worried that things will continue to happen.
“We’ve got to get hospitals from the business of hiring doctors,” he said in an interview. “It is potentially harmful to the patient, and it is terrible for health care.”
Hospitals burdened with large, fixed costs and eagerness to ensure patient referral and revenue in the changing industry are working the opposite.
“Doctor Roll on binge buying” June’s headline in Modern HealthcareAn industry magazine. A third of doctors now work directly for hospitals or at least partially for hospital-owned practices, the American Medical Association estimates.
Brownard Health is a taxpayer-backed system with five hospitals and a publicly appointed board.
More than a decade ago it undertook an expansion campaign that included hiring independent physicians first and paying CEO Frank Nask and other executives large bonuses if the institution boosted revenue and the bottom line.
It agreed to appoint orthopedists and cardiologists for more than $ 1 million a year – far above average for such specialties. This led to orthopedic surgeon Drs. Arrow also paid to Yoldas Team Doctor for Florida Marlins Baseball team, approximately $ 1.6 million in 2009.
He said his lawyer rejected Reilly’s employment deal with Broward Health, calling it illegal. His whistleblower complaint, which was originally filed in 2010, was quashed last month.
The lawsuit states that the system carefully tracked returns on its investment in other doctors, recorded the value of referrals and pressured them to increase volume if they lagged behind.
Although Broward Health paid a large amount to settle allegations of wrongdoing, it does not accept the charges, which are typical in such cases. CEO Nask retired last year. No one in the system has been charged with criminal wrongdoing.
Yoldas did not respond to interview requests. Nask did not respond to messages left on the number listed in his name.
Reilly responded carefully when asked if the doctors employed by Broward Health were ordering non-urgent procedures. He is concerned about possibly being sued by a system with “deep coffins”, he said.
“I was not allowed to review the medical records,” he said. But when he occasionally saw patients who were recommended for surgery by those doctors, he said, “I never agreed with the previous opinion.”
Reilly preferred to work as an independent – on staff in hospitals but not employed by him. He was not compelled to generate revenue by ordering procedures, he said.
If Broward Health pushed a brand of prosthetic knee, he felt it was wrong for a patient, he could do the operation elsewhere. If he had concerns about the system’s radiology department – as some doctors did, according to the lawsuit – he could refer people to a different facility.
Fewer and fewer doctors have the same freedom, Reilly worries.
Some believe the AMA is underestimated Share of physicians employed by hospitals. Hospitals particularly desire to appoint primary care doctors, which according to the lawsuit, generate the most referral benefits for Broward Health.
Not only does hospital employment “dramatically” boost the likelihood that a doctor will refer to that hospital, but also the likelihood that patients will end up at a high-cost, low-quality facility, A recent study finds From Stanford University researchers. Like Broward Health CEO Nask, many hospital bosses meet Bonus for increasing revenue and profits.
“I would wish the hospital-physician employee contract would go away,” said Reilly, now retired and entitled to $ 12 million of the whistleblower settlement. “You can tell about any hospital, and I will tell you that there is a component where the contract is governed by referral.”
He suspects that accountable care organizations – collaborative groups of doctors and hospitals that focus on keeping patients healthy and not on maximizing revenue – will change the dynamic.
Hospitalization of physicians “not only fosters an environment to inspire physician referral, but also blunts physician innovation, discovery, and ingenuity,” he said.
What should patients do? Ask his doctor what he works for, Reilly added. If doctors are employed in a hospital and recommend surgery or some other expensive treatment, they said “research the signs of the procedure” and “consider a second opinion” from an independent physician.