My Ex is getting Married

It was front page news in my town that a family practice clinic was being purchased by the local hospital. Before I reflect on this, you need to know I was once a partner in the clinic but left over 10 years ago. Similarly, I was on staff, on the board and chief of medical staff at the hospital that is purchasing my ex-clinic. So, my reflections could be biased by my prior experience.

The stated reasons for the change in relationship are that both parties will benefit. The clinic has had a hard time recruiting new doctors and they see the new hospital ownership as a way to help this. The hospital sees the move as a way to be bigger: “A deeper bench…We’ll have about 650 employees…” Neither of these reasons hold water, but they reflect the dismal situation we have come to in our health care environment.

First, bigger is not always better for the consumer. Bigger bargaining power may allow the hospital/clinic more leverage to bargain higher payment from insurers. Then our insurance rates go up. Just four years ago the US District Attorney and the Idaho Attorney General sued to unwind a larger hospital purchase of a much larger medical clinic in the Treasure Valley on the grounds it was anti-competitive. The court upheld the suit and the clinic purchase was nullified.

Second, the only way the hospital can help recruit and retain primary care physicians is to shift some revenue to pay primary care doctors more. Think about the high-paid physicians the hospital supports now. Radiologists (who make three times what a family doc does) have hospital-funded scanners and hospital-paid technicians to do the scans. Surgeons (who make 3-4 times what a family doc does) have hospital-paid operating rooms and nurses to help them perform their well-paid surgeries. Is the hospital going to somehow pay the specialists less so the family docs can make more? Or will the nurses earn less? Or will health care costs just go up as they have?

What we pay for in health care is the problem, and maybe this consolidation will address this, though neither executive cited this as a goal. If we don’t start paying for value in health care and move away from paying for procedures, we will just keep having more procedures, more things done, and we will not be healthier. Did you know this is the third year in a row that US life expectancy has decreased, despite ever increasing health care expenditures?

I hope our local hospital shares this vision for adding value to our community instead of promoting more procedures. But here’s the pudding. The hospital dropped two community services, hospice and an adult day health program, because they didn’t “make money”. But they now have a full-time marketing director and development director, as well as bill boards all around town touting their care. They maintain a “critical access” designation while they spend money to drum up business. Does this make our community healthier? I’m sure it bumps their revenue.

So, the clinic purchase may benefit both entities, as any good business deal should. But will it make our community any healthier, make health care more accessible, affordable and appropriate? I hope so.


About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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