Doctors just want some control
As someone who has been involved in the development of physician-owned imaging centers, surgery centers and other facilities across the country, I can offer a different perspective on why physicians invest in and participate in the development of their own facilities ("Isn't that special," May 12, p. 4).
Your coverage of this issue assumes the promise of financial return is the primary reason physicians invest in their own facilities. In my experience this could not be further from the truth. The possible cash distributions for most physician owners are very small compared with their existing incomes and present a very small incentive to refer. Physicians are developing their own facilities because they are profoundly frustrated with the operation of existing hospital programs.
Many established hospitals offer patients a less-than-convenient access to services on their large and confusing campuses. Smaller, more focused facilities offer much greater patient convenience and satisfaction, which always have a positive effect on the growth of a physician's practice.
Physicians often grow tired over the years of attending endless hospital medical staff and committee meetings and rubber-stamping management and strategic decisions already made by the administration. They want to participate as equals in a streamlined decisionmaking process that really focuses on their specialty and takes their interests into account along with the interests of the facility.
Also, hospital-based programs are run with the facility's economic interests in mind, not the physician's. Imagine the positive effect on the practice of an orthopedic surgeon who can now perform 10 or more procedures in an afternoon in the new surgery center and in less time than in a hospital. Or imagine the effect on the cardiologist who can now get things done for patients on a timely basis because of the highly focused staff in the new heart hospital he or she helped plan and develop and get home two hours earlier every day.
I would suggest that the leadership in our nation's large, established hospitals stop trying to block physicians from developing their own facilities and use that energy to improve the programs in which they expect the physicians to work every day.
Little Rock (Ark.) Cardiology Clinic
Reform physicians, not the law
I have been an active hospital trustee in Philadelphia for the past 40 years, 10 of which I spent as chairman of the board of trustees of a major hospital.
On page 36 of the May 12 issue of your magazine, the subject was tort reform ("Beauty queen seeks tort reform") in the medical malpractice field. There has been a great deal of discussion about tort reform and limiting the rights of insured people to seek compensation.
What I am looking for is an answer to this question: What are the various hospitals and medical societies doing to rid the system of those physicians who are most responsible for medical malpractice in the first place? If we can root out the malpractitioners, lawsuits and insurance premiums will decline.
Howland, Hess, Guinan, Torpey & Cassidy
Huntingdon Valley, Pa.
Right problem, wrong cause
I cannot understand the effort by the Joint Commission on Accreditation of Healthcare Organizations to prevent overcrowding in emergency rooms ("Proposal for new ER standard puts providers on the defensive," May 19, p. 6).
As a healthcare economist I can tell you that about 75% of the reason ERs are overcrowded is that most patients do not understand their health plan benefits. They get a headache, they go to the ER. They don't go through their primary-care doctors. I think the JCAHO should focus on things such as better ways to make county and teaching hospitals profitable so they are not solely relying on taxes. Better yet, create a fee that could penalize for-profit hospitals when they send indigent patients to the county hospital.
Or lobby Congress to make sure Medicaid participants under the age of 40 share some of the financial responsibility. That might stop them from running to the ER every time they get a runny nose.
Senior medical economist
Indiana University Medical Group
What do you think?
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