Regarding your coverage of University General Hospital Systems new plan for a boutique hospital chain (Betting big on doc ownership, Dec. 11, p. 6): In my nearly 40 years of operations in hospitals, I have seen a number of announcements regarding the model for healthcare. Once we were told that the system would collapse into three or four capitated providers. HCA has developed, been sold, taken public and gone private. The total number of for-profit hospitals has not changed appreciably since the 1970s. So I take the announcement by another entrepreneur with a grain of salt. Kamran Nezami will probably make a lot of money, but will he change the face of healthcare?
I believe that the ultimate healthcare system must incorporate physicians and other providers into a coherent system of providing care. Integrating physicians into the decision processes is necessary to control the cost of healthcare, prevent unneeded capital expenditures and rationalize the delivery of care. Hospital administrators must learn to listen to the individuals who actually deliver the care. No patient enters an institution except through contact with a physician.
Perhaps the better model is the British system wherein the hospital and specialists are a single organization. Physicians practice outside the hospital and refer all cases that require a procedure or inpatient stay, or they practice solely in private institutions. Primary-care providers are given incentives to keep patients out of institutions.
An equivalent practice in the U.S. would be to not provide practitioners who are investors in for-profit institutions with privileges in the public facilities. This would prevent their triaging cases into the public systems based on ability to pay. Another thought would be to require specialty facilities to maintain a 24-hour emergency room and therefore subject to Emergency Medical Treatment and Active Labor Act regulations. Since the majority of admissions to hospitals come in through the emergency room, this might spread the burden more fairly, although these facilities are most likely being built in areas that have excellent demographics.
There is a lot more that could be said or debated about the issue of limited service providers, but I am not going to worry about the addition of one more investor-driven model.
Chief financial officer
Adena Health System