Thursday, May 15, 2014

Thanks for the donation, doc?

I guess we would call this a success, but it doesn't feel like it to me.  Indeed, it feels like someone is taking advantage of the good will of doctors.

Here's the story, reported by Adam Ragesua at Marketplace.  Excerpts:

Across the country, a few hospitals have come up with a counterintuitive way to save themselves money: offer minor surgery for free.

The doctors work on Sundays for free, while the facilities and diagnostics are donated by the Medical Center of Central Georgia.

 “This is a way that we can support this program, with patients that we would likely see anyway, that would be in our system because they have a need that hasn’t been taken care of,” said Roz McMillan, one of the hospital’s vice presidents.

In other words, Lammon Green’s lemon-sized cyst was probably going to land him in the emergency room eventually, and since he’s uninsured, the hospital would’ve ended up eating much of the cost.
Cutting the thing off before it gets that bad is a much simpler procedure.

By donating their services instead, the hospital is saving themselves thousands of dollars in the long run, said Laura Ebert, who runs a program called “Surgery on Sunday” in Lexington, Kentucky that started in 2005.

Is this sensible or simply a perverse result in states that have chosen not to expand Medicaid?  But it goes further than that, as Adam reports:

Low income people in many states are getting insurance through an expanded Medicaid, but their deductible for an elective surgery could be as high as $10,000.

“Hernias and gallbladders and things that we do on a regular basis are considered elective surgery, not life-threatening, so therefore they’ll have to pay their deductible,” Ebert said.

That means people are likely to put off their surgery. The problem gets worse, they end up in the E.R., and Medicaid reimbursements are low -- so again the hospital gets stuck eating some cost.

As long as a hospital has a doctor willing to donate her time, it might be cheaper to take out that gallbladder for free.

Sorry folks, but this is sick.  Now, Adam adds in a comment:

Maybe this is the thing I didn't communicate effectively: all of the free surgery programs I'm talking about here were started by surgeons as their own volunteer enterprises. They then got the hospitals on board to donate facilities, materials, and liability coverage, and I wanted to explain one of the hospitals' motivations for doing so. I didn't include a skeptical doc because I simply didn't encounter one -- it was their idea to donate their own time on Sundays.

That is lovely, for sure, but in my mind it still remains wrong that this should be necessary as a solution to this problem created by state governments.


Ray Collins said...

In response to the last sentence of your post, I have known US doctors and dentists who will only practice in Mexico because of the problems created by the state and federal governments there. I am totally unsympathetic to your viewpoint. Every government program everywhere has flaws that require someone to take the initiative in order to compensate for them.

Paul Levy said...

Sorry, I'm not sure I understand. You think it is all right that MDs should donate their time because of the construction of the state's health care reimbursement system?

Anonymous said...

Let me understand Paul. Are you saying that the doctors are required to donate their time? Wasn't clear from the content of your post and comment.

Paul Levy said...

No, not required, as Adam explains. But they feel it is necessary to offset state policies. I appreciate their good will, but why should this be happening?

Nancy Thomas said...

I am left thinking of the free dental clinics that are overrun with patients...and the kindness of dentists and dental students. This is America and we have to line up for care because we continue to think of our mouth as separate from the rest of our body? In RI, HealthSource is running Facebook ads urging people to get dental insurance. Of course, once you do it covers only the most basic care. And continues to say that putting metal fillings in your mouth is ok, even when most dentists refuse to and only use porcelain, so again, we create a have and have-not system of care.