Large tertiary hospitals (not-for-profit) have a poor return on their money because of lack of incentive to be efficient. Pure and simple. I'm a total-joint surgeon and practiced for 20 years at a large hospital. With years of work coercing them to a joint-efficiency model, I was finally doing six cases a day by 4 p.m. Not great, but better than most. However, their nurse-to-patient ratio was poor (1 to 7-11) and they could not keep good staff because of low pay and overworking. They are extremely inefficient, with a large amount of waste.
To improve patient care we (two orthopedic groups) tried to work with the mother hospital on a joint venture. We spent $100,000 and wasted a year. The hospital finally declined partnering so we did it alone. I can now do eight joints in a day, be done by 2 p.m. or t3 p.m., and my patients love the 1-to-4 (nurse-to-patient) ratio. We take all comers without restrictions, even revisions that pay poorly.
But we are efficient and save money where we can. With an active administrator that listens, we improve constantly. Although our mother hospital is making more money each year (without having to pay taxes), they have restricted my practice to four joints a day under the guise of no staff. Without a second room, it takes until 3 p.m. to do these four. Undoubtedly they will claim a decrease in volume because of the specialty hospital.
The success of our hospital model six years ago has led to a large general surgery group joining us and, more recently, a citywide urology group. We are now doing 50-plus cases a day and won an award from TulsaPeople for being the best place to work. Our employees love it because of the way they are treated and paid for what they do.
Competitive business is what made America and is what makes it more efficient. Look at the free long distance and convenience we have today. That would not have happened if Ma Bell had been allowed to keep a monopoly. Big hospitals just dont want to have to work toward efficiency. They like the status quo but have been breaking the Medicare system demanding that they need more money to provide the service.
They dont, and competition is what will drive the price down. Not maintaining the system is what created the problem.
Rod Plaster, M.D.Tulsa, Okla.