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the consequences of corporate health care

Has anyone noticed how impersonal medical care has become? Try calling a physician who belongs to a group affiliated with a large hospital or to schedule a laboratory study. A sinking feeling comes over you as the phone automation system drones you through the menu of numbers often leaving you to guess which one best meets your reason for calling. By the end of the call, you feel like you've been on some sort of conveyor belt in a high-tech grocery store.

More and more physician groups are selling their practices and being subsumed into large hospital conglomerates' umbrella. Why do they do this? It's more cost-efficient to be a part of a hospital system that will take care of all the details associated with running a practice. No more day-to-day management issues to worry about, such as rent, maintenance, taxes and employee issues. Other reasons involve the complicated system of reimbursement from insurance companies and Medicare. Now, theoretically, doctors can concentrate on what they do best: practice medicine.

Over the last several months I have conducted my own research and spoken to a number of doctors and their staffs. As a personal injury lawyer, I spend much of my time working with doctors and health care providers who are addressing the needs of my injured clients. Part of our job is to understand our client's injury and to help them navigate the complex highways of medical care. We work with insurance companies along with billing departments of the various health care providers. Here are my observations.

Hospitals are among the largest employers in this country. Take any given community like ours here in the Lehigh Valley. St. Luke's Hospital & Network and Lehigh Valley Health Network are our largest employers. Thousands of families depend on people being sick. It's a bit like the queen bee and hive system. All of the worker bees have to produce to support the queen. While providing care is their underlying mission, let's not forget for one moment that they are not much different than any other large corporation. The more money they can make, the more hives they can spread. Just look at our hospitals, and the dozens of locations and outpatient locations.

To service all of these locations, very sophisticated business models have been created. These models or cells (cannot get away from the queen bee analysis) create complicated management systems. Phone systems, accounting methods, employee manuals, office meetings and overlord bean counters now replace the small intimate setting of most of these small groups.

Rebellion and resistance can only be expected as nurses and staff, who come from small intimate practices, run up against the big business model. One doctor told me that the meetings are endless and unhappiness pervades. Most patients have relationships with the staff in their doctor's offices. Let's face it: There is nothing more personal or concerning than your and your family's health. How upsetting is it to call and get a message that tells you to listen carefully because the menu has changed, and then ends with someone you don't know and who does not know you?

So is this the future? I am afraid so. Everyone I have talked with feels helpless and demoralized. Health care can make us live longer and healthier but it is coming at a new cost. One staffer told me that the elderly are overwhelmed with the new systems. She said "they don't have the patience" to go through the new learning curve. She said she spends a large part of her day comforting many of them because they get so upset.

Perhaps the bigger question is how will this affect the quality of care. My personal experience is that it is of great concern. The one consistent part of medical care has been the direct link between doctor and patient. Doctors are more isolated now than ever, and one doctor told me he has a difficult time navigating through the corporate way of doing things. Going or gone are the days when a doctor can have the hands-on style of treating that has been the hallmark of the doctor-patient relationship. Corporate management style is great for big impersonal companies, but not for the very personal nature of health care.

Dennis F. Feeley

(note: the above piece appeared in the Morning Call newspaper on Monday, September 26, 2011)

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