CMS Shell Game

One physician laments the turning of hospitalists into a tool to sustain hospitals' profit margins as CMS  goes on a cost cutting frenzy. It's a CMS shell game.

I'm so frustrated with American health care that I'm seriously wondering how long I can tolerate this B.S. I just want to take care of sick people. I bring enough value to the table as a hospitalist as-is. I'm going to get very sick and tired of being recruited as a utility in efforts to preserve a hospital's unsustainable profit margin in an era of regulation designed to erode it.

I look forward to the challenge. For years health care inflation has outpaced every rational economic inflationary measure. It rose faster in the era when physicians collected what ever they charged. It has risen ever faster for almost two decades in the era of the SGR, RVU, RUC mess we currently practice in that was supposed to control it. It threatens to destroy the very safety of our government's AAA bond rating.

No matter how you try and divvy up the pot of gold, the fine capitalist minds that run American health care will find a way to maximize their return at the expense of the Medicare National Bank. I am as sure of this as I am that Obama is not responsibly for the recent rise in gas prices (although many like to believe Bush was during his administration).

It doesn't matter. Let me say it again. It doesn't matter. No matter what payment model we eventually come up with, nothing will keep entitled physicians, patients, drug companies, device manufacturers, hospitals and every other pig at the trough from sacrificing their own personal economic interest for the good of the Great National Ponzi Scheme. Human nature is all about maximizing the economic self interest. That's what we get for living in a performance driven world. Our society values money. That is the engine that fuels most lives. This is also the reason why socialist welfare ponzi schemes will always fail in a blaze of glory, when given enough time. And take down great societies in a mass of unsustainable debt from an orgy of FREE=MORE

Why? Because the human race is inherently selfish. And that selfishness will never sacrifice their own economic good for the good of society, no matter how good the speech writer in the TelePrompter is.

The only way to control costs is to stop paying for care. The other is to pay less. And we all know what happens when you pay less. You get less access. So we're stuck.

If you're going to pay less, you had better cost less to too. You had better bring the whole curve down to maintain your operating margins. I see hospitalist medicine as leading the pack in decreasing the costs of providing care. Bundled care is coming our way. I don't know when, but it's coming. Hospitalist medicine is in a perfect position to capitalize on that trend.

I envision a system one day where all patients who enter the hospital get first contact by a hospitalist who performs the medical triage based on their abilities as a physician . This process will be much better once the E&M system is abolished and these archaic payment models are disbanded in favor of bundled care models. No longer would it take me an hour to admit a patient. Without the regulations, I could do it in 15-20 minutes without any loss of quality. That's how you save money. Make me more efficient.

I'm like an HMO within a hospital.

If you want the government to pay for your care, you will have to choose between access and cost. Your government believes you can have both. I'm here to tell you, you can not. Nor should you have the right to. If you want someone else to pay for your entitled care, be prepared to live by their rules, which means restrictions of care that will come in many different ways, the least of which is a physician directed gatekeeper model.

It's coming. The question is when.

Many disease states can be managed by well trained internists. And cheaper too. For that matter, many conditions can be managed by RNs, NPs and PAs as well. The question is, how will it be divvied up. I envision hospitalist physicians making the call. As payment models for hospitals decrease, finding a way to decrease the cost of care will be paramount to a hospital's survival. And hospitalists will be right there to take the lead in caring for those in need.

A form of physician directed rationing. At some point, hospitals will have to stop offering services or find a way to offer them cheaper. Hospitalist medicine is but one aspect of that formula to decrease costs without decreasing service.

And that is one way to survive in the age of overtly rationed health care which is coming to a city near you.