To our medical folks, why can't I select both doctor and hospital that I want

whitestick · 08-13-2008, 11:48 PM

A recent experience has really perturbed me. DW needed a cat scan (2) and a hospital stay (originally planned for surgery) We requested a hospital that we have used lately as it has consistently delivered a very high quality of service for other stays, and seemed to be on the ball for their billing. Our physician stated that the doctor he recommended, highly rated, required a possible surgery slot the next day, and the only one available was at a hospital that we had used in the past with terrible results - nothing deadly yet, but lousy quality of care and service, and terrible billing procedures.
Ok, as it turns out, surgery wasn't able to be done, and a weeks stay at the hospital only confirmed our previous experience including a call from the business office to the patient in the hospital bed at mid-point of her stay, wanting to know how she was going to pay her portion of the bill (we have insurance) - fortunately for their hearing and physical well being, I wasn't at the hospital during that call.

Now we come to getting at the truth - it seems that the doctor recommended, and DW really likes him and he seems extremely competent, does not have "privileges" at the hospital we requested (BTW they are about 5 miles apart), which suggests the reason we were hustled into that lousy excuse for a hospital was because he had privileges there.
What is the process/cost/requirements/needs to get privileges at a hospital and why would a seemingly very competent doctor go to such a place when a much better hospital is available nearby? Should I be concerned that the selection of their choice of hospital reflect on their actual competency, and maybe the doctor isn't really all that?

Rich_in_Tampa · 08-14-2008, 07:36 AM

Privileges cost a lot of money and time for the doctor, as well as a rigorous credentialling process. If 95% of the services needed can be provided at one hospital, it is much more efficient. In my early years I had privileges at 3 hospitals and invariably if I had 3 patients admitted they would be one at each place.

Making rounds was a disaster: drive, park, check in, review hospital mail box, see patient, dictate note, sign dictations from yesterday...It would take 45-60 minutes per patient. It is much faster in one place. Plus you get familiar with the routines, administrators, nurses, etc. Then there are annual membership duties, and on and on.

That aside, the choice of which hospital to be on staff at involves issues of convenience, quality, presence of trusted consultants, public image etc.

Sorry to make it more confusing, but it's a tricky choice. BTW, to my knowledge, this is one of the minority of issues which actually does NOT involve important financial arm-twising) for nonsurgeons. Can't speak for the surgical side, though..

mews · 08-14-2008, 08:56 AM

Whitestick, I would also inform the doctor of the lousy quality of care you got. Write down time, place and morons involved. Explain, 'more in sorrow than in anger' that the hospital is pooping on his image.

A pissed-off doctor can get faster results than 'some stupid customer', which is a shame...

ta,
mews

huusom · 08-14-2008, 11:05 AM

We experienced similar situation as yours recently. DW had to have her surgery done at a hospital 20 miles away because her doctor is not registered at a better and closed hospital.

This problem is caused by our current healthcare system controlled by profits driven insurance companies instead of care providers (doctors, nurses). I'm sick and tired of hearing people calling "universal healtcare" as "socialized medicine" when the facts prove otherwise. Most civilized counties have "universal healtcare" and they work fine. We're paying twice as much for our healthcare and still ranked last compared to countries with universal healtcare. The premiums and out-of-pocket expenses rise 4 times the rate of inflation and the insurance companies keep telling us that medicare is inefficient and wasteful. It's time for us to rid ourselves of the insurance companies and go with a single payer system. We know it works for France, Germany, Japan, etc.

A854321 · 08-14-2008, 11:22 AM

1. The hospital you like may not provide the kind of surgery your doctor does.

2. There may be on-call requirements for both hospitals, and your doctor just doesn't want to take any more call.

3. One hospital may be paying for call.

4. You doctor may feel the medical or nursing staffs at the other hospital are not as good as the one he recommends

5. Your doctor may be contracted by one hospital and not the other to provide services.

6. Your doctor may own a share in the hospital he recommends. He must disclose this to you, by law. This is not always a bad thing, but doctor-owned "boutique" hospitals are certainly resulting in cherry-picking and duplication of services. Once again, he must disclose this to you by law.

Gotadimple · 08-14-2008, 11:24 AM

Quote:

Originally Posted by huusom

This problem is caused by our current healthcare system controlled by profits driven insurance companies instead of care providers (doctors, nurses).

You seem to be confusing the physician's right to select which hospital he/she practices at with a health insurance carrier's network of providers. These are two different things. As Rich in Tampa has explained, there are reasons why a doctor doesn't practice at a particular hospital.

Don't blame the insurance carrier for the doctor's unwillingness to add to his/her time burden -- they don't have anything to do with it.

-- Rita

huusom · 08-14-2008, 03:37 PM

Rita:

I know that a physician can decise where to work but that is not the main point I was trying to make. This whole mess was created by having too many insurance plans and companies. With my current and previous employers, we have to switch insurance carrier every other year just to save.

Year after year, we're paying more out of pockets and higher premiums and the coverage is getting less and less. With the insurance companies, 30 to 40 cents are spent on administration and marketing instead of just 5 cents as in the case of medicare.

I know medicare is not perfect but it works for all american 65 and over. Why can the rest of us have it

?

Rich_in_Tampa · 08-14-2008, 04:07 PM

Huusom, you are not alone in your frustration with a system which many of almost any political persuasion agree is flawed. If you are working, covered, and financially intact it can (but doesn't always) work well. For millions of others it just fails them.

Solutions which funnel more business or influence to the insurers will only prolong or worsen the agony. Read here when you go to the polls next time. It is a pretty objective and nonpartisan summary of the issues.

Billy · 08-14-2008, 04:40 PM

Hmmmm… you might not want to choose this for yourself right now, but might consider it for future health care options.

Medical Vacations: The Retiree Health-Care Solution?

It’s become a big industry and poised for growth as Boomers age. Granted it’s not for everyone but it offers quality care at affordable prices on many procedures.

Billy and I are very familiar with it and have been satisfied from first hand experience.

Be well,
Akaisha
Author, The Adventurer’s Guide to Early Retirement

Rich_in_Tampa · 08-14-2008, 05:30 PM

I split Ladelfina's thoughtful post to a separate thread in the Soapbox due to its political direction.

Gotadimple · 08-14-2008, 08:02 PM

Quote:

Originally Posted by huusom

Rita:

I know that a physician can decise where to work but that is not the main point I was trying to make. This whole mess was created by having too many insurance plans and companies. With my current and previous employers, we have to switch insurance carrier every other year just to save.

Huuson,
I understand your intent, but was only responding to the original thread which asked why doctors don't always practice at all hospitals.

As for changing insurance plans because the cost of coverage is rising, well, that's because the 'system' is broken. It's a vicious circle and there is no simple answer.

People use their benefits and the premiums don't cover the cost of the claims, and that's why the premiums go up each year. Blaming insurance companies because we're using their product seems counter-productive to me, when those premiums are approved by the state regulators.

-- Rita

whitestick · 08-15-2008, 12:17 AM

Quote:

Originally Posted by Rich_in_Tampa

Privileges cost a lot of money and time for the doctor, as well as a rigorous credentialling process. If 95% of the services needed can be provided at one hospital, it is much more efficient.
....

That aside, the choice of which hospital to be on staff at involves issues of convenience, quality, presence of trusted consultants, public image etc.

Sorry to make it more confusing, but it's a tricky choice. BTW, to my knowledge, this is one of the minority of issues which actually does NOT involve important financial arm-twising) for nonsurgeons. Can't speak for the surgical side, though..

Thanks RIT, this would be the surgical side I suppose. I appreciate your response as I had not considered some of those, but I would think that this is a two way street, in that the surgeon would also be evaluating the hospital to make sure it meets high standards. I understand that things change over time, and requires a revisiting to make sure things continue at a high level of service. It just seems that the hospitals are driving the process, rather then the doctors, when it's the doctors/surgeons that are the talent that the patients are seeking for their skill, and as such should be driving the hospital to meet the higher standards.
Or maybe I just don't understand the "business" of the medical system.

whitestick · 08-15-2008, 12:22 AM

Quote:

Originally Posted by mews

Whitestick, I would also inform the doctor of the lousy quality of care you got. Write down time, place and morons involved. Explain, 'more in sorrow than in anger' that the hospital is pooping on his image.

A pissed-off doctor can get faster results than 'some stupid customer', which is a shame...

ta,
mews

That's where this thing got really biting. I didn't get to talk to the doctor, but I did talk to his PA and she told me (while holding her hand over her mouth so she wouldn't be overheard in the office) that she wouldn't go there either, and preferred some other hospitals. I understand that is her opinion, but it seems that the doctor would already be aware of it.
When I was working had a job employed in a previous life, as a manger, I could walk through my shop and know what was going on, and how the customers were being treated, by observation, and what I overheard in the halls. I expect the doctors as the managers of my DW's care, would be doing the same. Are my expectations out of whack?

whitestick · 08-15-2008, 12:25 AM

Quote:

Originally Posted by Billy

Hmmmm… you might not want to choose this for yourself right now, but might consider it for future health care options.

Thanks Billy, I have thought about this for some stuff I might have coming up later, but for DW the timing was so short, that there were only a matter of hours between her test and admitting to the hospital.
We have talked extensively about it for myself, but still haven't convinced ourselves of taking that adventure.

mews · 08-15-2008, 08:05 AM

Quote:

Originally Posted by whitestick

When I was working had a job employed in a previous life, as a manger, I could walk through my shop and know what was going on, and how the customers were being treated, by observation, and what I overheard in the halls.

I expect the doctors as the managers of my DW's care, would be doing the same. Are my expectations out of whack?

hmmmm.....

1) the doctor knows, and can't do anything about it.

2) the doctor knows, and won't do anything about it.

3) the doctor hasn't had his nose rubbed it it, and thinks things are ok. Maybe not great, but ok.
[ all together, sing, Cleopatra, de queen of de nile... ]

You won't know until you have a conversation with the doctor. Again, be specific about it - time/place/morons... - and see if the doctor is a competant manager, or not.

good luck!
mews

huusom · 08-15-2008, 10:38 AM

Thank you Rich_in_Tampa for the link.

I like Obama's plan, having a National Insurance Exchange to act as our HR department to negotiate with insurance companies works best. We can decide which insurance policy to purchase and keep it as long as we want. No more pre-existing conditions BS.

Westernskies · 08-15-2008, 04:29 PM

I have a good friend that just left his very succesful surgical practice at 49 years old- He was driving 40,000 miles/year between hospitals in a large city. He took a senior staff position with a medical-products company, a lot less travel and comparable overall compensation... He misses practicing medicine, but not the hundreds of hours commuting between hospitals.

Billy · 08-15-2008, 05:16 PM

Whitestick

Quote:

Thanks Billy, I have thought about this for some stuff I might have coming up later, but for DW the timing was so short, that there were only a matter of hours between her test and admitting to the hospital.
We have talked extensively about it for myself, but still haven't convinced ourselves of taking that adventure

Hi Whitestick,
Understood. Medical Tourism can only fill in certain blanks. You might want to read this current piece from the Economist - Globalization and Healthcare. Some interesting insights on how Medical Tourism could help shape up our system here from the competition angle. But I wouldn’t hold my breath for a quick repair. Still, this phenomenon seems to be gaining some respectable traction.

Akaisha
Author, The Adventurer’s Guide to Early Retirement

murg · 08-15-2008, 09:09 PM

I live in a city with 3 non profit hospitals. One is where I would want to go in the event I had a gunshot wound. The second is where I would go if I were pregnant. The third is the largest,is highly rated, and is an excellent hospital. When I searched for my primary care physican during enrollment in my HMO, my only hard and fast requirement was, are they affilliated with the third hospital. All the doctors listed in our plan showed where they had priveliges. Made it very convienent to select a doctor..

08-13-2008, 11:48 PM	#1
whitestick Recycles dryer sheets Join Date: Apr 2005 Posts: 368	To our medical folks, why can't I select both doctor and hospital that I want A recent experience has really perturbed me. DW needed a cat scan (2) and a hospital stay (originally planned for surgery) We requested a hospital that we have used lately as it has consistently delivered a very high quality of service for other stays, and seemed to be on the ball for their billing. Our physician stated that the doctor he recommended, highly rated, required a possible surgery slot the next day, and the only one available was at a hospital that we had used in the past with terrible results - nothing deadly yet, but lousy quality of care and service, and terrible billing procedures. Ok, as it turns out, surgery wasn't able to be done, and a weeks stay at the hospital only confirmed our previous experience including a call from the business office to the patient in the hospital bed at mid-point of her stay, wanting to know how she was going to pay her portion of the bill (we have insurance) - fortunately for their hearing and physical well being, I wasn't at the hospital during that call. Now we come to getting at the truth - it seems that the doctor recommended, and DW really likes him and he seems extremely competent, does not have "privileges" at the hospital we requested (BTW they are about 5 miles apart), which suggests the reason we were hustled into that lousy excuse for a hospital was because he had privileges there. What is the process/cost/requirements/needs to get privileges at a hospital and why would a seemingly very competent doctor go to such a place when a much better hospital is available nearby? Should I be concerned that the selection of their choice of hospital reflect on their actual competency, and maybe the doctor isn't really all that? __________________ Mens ability to see the future is limited by their horizons of today! Unknown!

08-14-2008, 07:36 AM	#2
Rich_in_Tampa Moderator Emeritus Join Date: Feb 2006 Location: Tampa Posts: 5,889	Privileges cost a lot of money and time for the doctor, as well as a rigorous credentialling process. If 95% of the services needed can be provided at one hospital, it is much more efficient. In my early years I had privileges at 3 hospitals and invariably if I had 3 patients admitted they would be one at each place. Making rounds was a disaster: drive, park, check in, review hospital mail box, see patient, dictate note, sign dictations from yesterday...It would take 45-60 minutes per patient. It is much faster in one place. Plus you get familiar with the routines, administrators, nurses, etc. Then there are annual membership duties, and on and on. That aside, the choice of which hospital to be on staff at involves issues of convenience, quality, presence of trusted consultants, public image etc. Sorry to make it more confusing, but it's a tricky choice. BTW, to my knowledge, this is one of the minority of issues which actually does NOT involve important financial arm-twising) for nonsurgeons. Can't speak for the surgical side, though.. __________________ Rich Tampa, FL (10% retired) As if you didn't know..If the above message happens to contain medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any medical purpose whatsoever. Consult your own doctor for all medical advice.

08-14-2008, 03:37 PM	#7
huusom Dryer sheet aficionado Join Date: Jul 2008 Posts: 44	Rita: I know that a physician can decise where to work but that is not the main point I was trying to make. This whole mess was created by having too many insurance plans and companies. With my current and previous employers, we have to switch insurance carrier every other year just to save. Year after year, we're paying more out of pockets and higher premiums and the coverage is getting less and less. With the insurance companies, 30 to 40 cents are spent on administration and marketing instead of just 5 cents as in the case of medicare. I know medicare is not perfect but it works for all american 65 and over. Why can the rest of us have it?

08-14-2008, 04:07 PM	#8
Rich_in_Tampa Moderator Emeritus Join Date: Feb 2006 Location: Tampa Posts: 5,889	Huusom, you are not alone in your frustration with a system which many of almost any political persuasion agree is flawed. If you are working, covered, and financially intact it can (but doesn't always) work well. For millions of others it just fails them. Solutions which funnel more business or influence to the insurers will only prolong or worsen the agony. Read here when you go to the polls next time. It is a pretty objective and nonpartisan summary of the issues. __________________ Rich Tampa, FL (10% retired) As if you didn't know..If the above message happens to contain medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any medical purpose whatsoever. Consult your own doctor for all medical advice.

08-14-2008, 04:40 PM	#9
Billy Full time employment: Posting here. Join Date: May 2004 Posts: 793	Hmmmm… you might not want to choose this for yourself right now, but might consider it for future health care options. Medical Vacations: The Retiree Health-Care Solution? It’s become a big industry and poised for growth as Boomers age. Granted it’s not for everyone but it offers quality care at affordable prices on many procedures. Billy and I are very familiar with it and have been satisfied from first hand experience. Be well, Akaisha Author, *The Adventurer’s Guide to Early Retirement* __________________ Self reliance builds confidence.** Retire Early Lifestyle

08-14-2008, 08:56 AM	#3
mews Recycles dryer sheets Join Date: May 2008 Posts: 153	Whitestick, I would also inform the doctor of the lousy quality of care you got. Write down time, place and morons involved. Explain, 'more in sorrow than in anger' that the hospital is pooping on his image. A pissed-off doctor can get faster results than 'some stupid customer', which is a shame... ta, mews

08-14-2008, 11:05 AM	#4
huusom Dryer sheet aficionado Join Date: Jul 2008 Posts: 44	We experienced similar situation as yours recently. DW had to have her surgery done at a hospital 20 miles away because her doctor is not registered at a better and closed hospital. This problem is caused by our current healthcare system controlled by profits driven insurance companies instead of care providers (doctors, nurses). I'm sick and tired of hearing people calling "universal healtcare" as "socialized medicine" when the facts prove otherwise. Most civilized counties have "universal healtcare" and they work fine. We're paying twice as much for our healthcare and still ranked last compared to countries with universal healtcare. The premiums and out-of-pocket expenses rise 4 times the rate of inflation and the insurance companies keep telling us that medicare is inefficient and wasteful. It's time for us to rid ourselves of the insurance companies and go with a single payer system. We know it works for France, Germany, Japan, etc.

08-14-2008, 11:22 AM	#5
A854321 Recycles dryer sheets Join Date: Jan 2007 Posts: 274	1. The hospital you like may not provide the kind of surgery your doctor does. 2. There may be on-call requirements for both hospitals, and your doctor just doesn't want to take any more call. 3. One hospital may be paying for call. 4. You doctor may feel the medical or nursing staffs at the other hospital are not as good as the one he recommends 5. Your doctor may be contracted by one hospital and not the other to provide services. 6. Your doctor may own a share in the hospital he recommends. He must disclose this to you, by law. This is not always a bad thing, but doctor-owned "boutique" hospitals are certainly resulting in cherry-picking and duplication of services. Once again, he must disclose this to you by law.

08-14-2008, 05:30 PM	#10
Rich_in_Tampa Moderator Emeritus Join Date: Feb 2006 Location: Tampa Posts: 5,889	I split Ladelfina's thoughtful post to a separate thread in the Soapbox due to its political direction. __________________ Rich Tampa, FL (10% retired) As if you didn't know..If the above message happens to contain medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any medical purpose whatsoever. Consult your own doctor for all medical advice.

08-15-2008, 10:38 AM	#16
huusom Dryer sheet aficionado Join Date: Jul 2008 Posts: 44	Thank you Rich_in_Tampa for the link. I like Obama's plan, having a National Insurance Exchange to act as our HR department to negotiate with insurance companies works best. We can decide which insurance policy to purchase and keep it as long as we want. No more pre-existing conditions BS.

08-15-2008, 04:29 PM	#17
Westernskies Full time employment: Posting here. Join Date: May 2008 Posts: 921	I have a good friend that just left his very succesful surgical practice at 49 years old- He was driving 40,000 miles/year between hospitals in a large city. He took a senior staff position with a medical-products company, a lot less travel and comparable overall compensation... He misses practicing medicine, but not the hundreds of hours commuting between hospitals. __________________ Sarchasm : The gulf between the author of sarcastic wit and the person who doesn't get it.

08-15-2008, 09:09 PM	#19
murg Dryer sheet wannabe Join Date: Mar 2007 Posts: 23	I live in a city with 3 non profit hospitals. One is where I would want to go in the event I had a gunshot wound. The second is where I would go if I were pregnant. The third is the largest,is highly rated, and is an excellent hospital. When I searched for my primary care physican during enrollment in my HMO, my only hard and fast requirement was, are they affilliated with the third hospital. All the doctors listed in our plan showed where they had priveliges. Made it very convienent to select a doctor..