When patient care be under attack? What do you do? Stand up, fight back!

God knows, there are plenty of problems with health care in this country - access, outcomes, etc. When my much beloved primary care physician bailed to practice concierge medicine, it was difficult to find a primary in the MGH-Brigham system who wasn't located a train, two buses, and a walk uphill (both ways) away from where I live. To stay in walking distance of my medical care (admittedly a luxury) I had to settle for having a resident as my PCP. Which is fine in some respects. She's quite good, very responsive, and I like her a lot. But in another year or so, she'll be moving on. I'm trying to convince her to specialize in geriatric primary care, but she seems hell bent on urology. When Dr. O goes, I'll probably get another resident. There are, at present, no PCP's in Boston in the MGH-Brigham system who are accepting patients.

And this is within the non-profit world of medicine.

Everything, it seems to me, is far worse in the for-profit health care systems, which (most? all?) studies seem to suggest have worse outcomes. 

The pressure to spend less on actually delivering care to individual patients, while seeing more and more of those patients in rushed-through, truncated visits is bad enough in the non-profits, let alone in the systems owned by private equity and/or by doctors focused more on profit maximization than on becoming latter-day Dr. Welbys. 

Case in point is Steward Health Care, which was founded in Massachusetts but, post-bankruptcy, is no longer operating here. Among other choice details of their operation: the system didn't pay the bill on a piece of critical equipment, so it got repossessed. Too bad a woman who'd just given birth needed it to save her life. By the time the Steward hospital transferred her to a hospital (non-profit, of course) that had the key device, it was too late. She bled to death, leaving her devastated husband and perfectly healthy baby girl behind. That and a picture of the glowing new mom holding her beautiful infant a short while before she died. 

This woman is not the only one to alleged to have died due to staffing and/or equipment shortages at Steward hospitals. 

Another nifty feature of Steward was its CEO, Dr. Ralph de la Torre, who used the system to fund an extravagent private jet, swanky yacht(s) lifestyle. 

So, while I'm more than happy to see healthcare professionals make a good living, I'm a believer that healthcare institutions shouldn't be run on a for-profit basis.

Apparently, the doctors at Eugene (Oregon) Emergency Physicians (EEP) agree. This is a smallish (40 doctors and PA's), local, doctor-owned practice that runs the emergency department for some local medical centers. They were about to be replaced by Apollo MD, a national corporate for-profit entity. 

EEP pushed back, arguing that bringing in Apollo would violate a 2025 Oregon law that "bans corporations from taking control of a medical practice's operations and finances."

The case garnered national interest because Oregon's new law targets the loopholes large staffing firms have been employing to circumvent state corporate medicine laws.

Most states have laws requiring that doctors own medical practices, not corporations. These rules aim to put patient interests ahead of profit motives. Over the last several years, companies have used a model where a doctor technically owns the local practice, but as Erin Fuse Brown, a professor at Brown University, explains, those physician owners are often not involved in care and cede hiring, firing and other operational functions to the corporation.

Fuse Brown said these arrangements are attractive to hospitals because these companies often promise more revenue and take over the responsibilities that come with running an ER.

"There's worry that these investors or these corporate management companies should not be totally controlling the operations and the clinical decisions of those who are trained to deliver patient care," Fuse Brown said. (Source: NPR)

These rules aim to put patient interests ahead of profit motives which seems to be the heart of the matter for the doctors at EEP, which feared that patient care would be compromised. They also feared that if Apollo started meddling in the delivery of care and they pushed back, they would lose their hours. Which seems like a reasonable double whammy fear: potentially worse care for the patients, potentially worse income for the doctors. 

The EEP pushback was successful. 

The medical center that had been considering going with Apollo decided to stick with EEP. 

Questions are still whirling around about the long-term viability of physician-owned practices. 

Do they need the investment in business expertise and systems that a corporation can provide?

And, as noted in the NPR article, some practices may be nominally physican owned, but those doctor's are owners, not actually delivering any care. So it's not as if Dr. Doug Ross (George Clooney on ER, which I never watched for some reason when he was on it) and Dr. Robby (Noah Wyle on The Pitt, which is pretty much my favorite TV thang) may be owners, but they're hip deep in gore. 

Anyway, happy to see that the little guys at Eugene Emergency Physicians, when they saw that their livelihoods and maybe their patients' lives were under attack, decided to stand up and fight back. 

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