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

[whitestick]

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_by_the_Bay]

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]

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]

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]

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]

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]

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_by_the_Bay]

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]

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_by_the_Bay]

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

 

[Gotadimple]

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]

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]

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]

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]

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]

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]

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]

Whitestick

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]

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..

 

[Rich_by_the_Bay]

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..

Just a heads up: the future of the primary care model probably will lean toward an outpatient "real" primary care doctor with inpatient care rendered by dedicated hospitalists who confine their practice to hospitalized patients. I have done both, now mostly hospitalist, and likely back to part-time general internal medicine (primary care for adults) when I ESR.

So choose your PCP because you like him or her and feel they are competent; they probably won't end up caring for you in the hospital outside of small towns and other exceptions within 5 years.

 

[whitestick]

Understood. Medical Tourism can only fill in certain blanks. You might want to read this current piece from the Economist - Globalization and Healthcare. [/FONT][/SIZE]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

Making a giant leap, along with RIT's comments about the outsourcing of the real primary care doctor, I can see where the in hospital care can be done in US or India, or other hospital, with reports back to the primary care doctor. It's going to be an interesting world as we move to global care with local control. Wonder how the insurance companies will provide for reimbursement - will they engage in currency arbitrage on your medical procedure done in India, with follow up therapy in China

 

[Rich_by_the_Bay]

I have mixed feelings about medical tourism. On the one hand it makes a lot of sense. With careful research and a little luck, you can obtain comparable quality of care for many or most procedures if you do your due diligence. No different from here.

On the other hand, complications do occur, both long- and short term. You need to have a backup near home unless you are prepared to fly half way around the world every time something potentially related to the procedure comes up.

Most importantly, almost every cheerleader for care abroad has been relatively healthy except, perhaps, for the specific issue in question and some mild chronic illnesses perhaps. The real world isn't nearly so tidy. You need your gall bladder out, and in the hospital they discover diabetes. You are fine and one day a polyp is found but the pathology is iffy, and there is not more tissue to test. Or you develop abdominal pain during a stressful period and your primary care doctor orders a few test which show an unexpected mass in the liver. Health issues can accumulate and gyrate like the stock market.

These are not arguments against care abroad, just a caution to make sure you also have a good care network here. And believe me, if you had a stress test abroad and later develop chest pain here, the cardiologist will probably not "trust" the original resuls just for being unfamiliar or of uncertain quality control. My advice: find a great primary care internist (or GP) where you live. If a specific probem arises for which you are considering care abroad, discuss it with your PCP. Closely.

Be wary of advice about serious medical care issues from people who who have been and are healthy. Not all health care is like a root canal.

 

[heardoc]

s and go with a single payer system. We know it works for France, Germany, Japan, etc.

Oh yeah, you're going to love the systems you think work fine. Until you need to use it. I've seen and had to use them several times, not a pretty picture. BTW, get ready for a 50 - 70 % income tax rate to pay for it.
On the other hand, given the near complete restriction on malpractice claims in those countries, Obama's plan wont stand a chance as his largest contributers are trial lawyers whose bread and butter would go down the drain if their client's could not sue.
For the American future single payer system look at the VA or Medicaid, or don't if you think it's going to be an improvement.