We trust physicians to make life and death decisions on a
daily basis for their patients. Studies have shown that upward of 92 percent of
the Medicaid population treated by physician owners are done in their own
facilities. Oftentimes the other 8 percent are taken to the hospital because of
other factors in the patient’s medical history, not because physician-owned
facilities are doing wallet biopsies. A surgery center cannot provide services
for a patient with an American Society of Anesthesiologists score of four and
higher because it is not safe to perform the surgery in the ASC setting. The
patient is more likely to need inpatient hospitalization than is a patient with
an ASA score of one. Medicare frowns on physicians performing an outpatient
procedure knowing that the patient is highly likely to be transferred to an
acute facility for inpatient services because of the underlying medical
condition of the patient.
While there may be some physician-owned facilities that meet
the description of a “villain,” the vast majority do not. Hospitals have missed
the industrial revolution, if you will. Hospitals do not need to be all things
to all people any more. Does General Motors manufacture their own tires? No;
they obtain them from other suppliers. I am of the opinion that physician
ownership should be done in cooperation with a local community hospital unless
the hospital is unwilling to cooperate. Many hospital administrators have
failed to realize that physicians are not the enemy but, if they were to engage
the physicians and align some of the incentives, conquering many of our crises
could occur. We are fortunate here in Tucson
that our hospital partner recognizes this valuable relationship and has
endeavored to make the bonds stronger between it and its medical staff.
Quality studies have shown that specialty hospitals have
better outcomes in terms of infections rates and other quality measures than do
the general hospitals. Patients have shorter stays and better results, for the
most part. Access to care is enhanced, not diminished. Will increasing access
to care improve the overall healthcare of the country or will it decrease
healthcare? The answer is obvious to all but those outside of the system who
think they know better.
— Stuart Katz, FACHE, CASC, is executive director for Tucson Orthopaedic
Surgery Center.
Contact him at skatz@tucsonortho.com.
