In some ways, last month’s explosive 60 Minutes segment, “Hospitals: the cost of admission,” gets at a central crux of the healthcare problem in America. The segment accuses Health Management Associates (HMA), a hospital system with 70 locations mostly in the southeast, of pressuring its emergency physicians to admit patients regardless of medical need in order to make more money for the hospital.
Without going into the extensive evidence presented by 60 Minutes (or the very strenuous denials of the story issued by HMA), it should be pointed out that this story wouldn’t even have been possible were our healthcare system not so… well, backwards, in the first place.
The plain fact is that right now most physicians get paid by doing more procedures and more tests, and most hospitals make money by getting more patients. It actually makes sense on one level: if healthcare is a business that provides a service, whether it’s a doctor’s visit, an MRI, or a surgery, it makes sense that the providers of that service would make more money by providing more service.
The only problem is that healthcare should be about making people healthier, not selling people as many knee surgeries as the market will bear. Moving from a system that incentivizes more utilization to one that incentivizes good patient outcomes is of course the central goal of healthcare reform.
Emergency physicians are on the front lines of that effort – but admitting patients to the hospital regardless of medical need, as it appears HMA was encouraging its emergency physicians to do, is not only unethical, it’s counter-productive. The hospitals that will succeed in tomorrow’s changed healthcare environment are the ones that work on keeping patients healthy and out of the hospital, not the ones who chase short-term profits with no consideration to patient need.
New rules that penalize hospitals for one-day admissions and re-admissions are a perfect example. Instead of pressuring its emergency physicians to admit patients, hospitals should be looking at strategies like observation medicine units that help reduce those kinds of re-admissions, besides leading to better patient outcomes.
What’s more, long-term studies increasingly support the theory that more tests and procedures can actually lead to worse long-term outcomes for patients. Providing more services does not necessarily make people healthier. That fact is lost on many patients as they ask for that MRI or CT scan and are not thrilled when the provider responds that the tests are unnecessary based on their symptoms at this time.
We all have a part to play in using health resources appropriately. Incentives do change behavior and we need to be careful on how they are implemented. Putting emergency physicians in a mandated position to perform certain treatments, medically indicated or not, is a dangerous and costly position in which to be placed. What is needed is an understanding that the best care is often less care, a lesson each one of us needs to embrace.