In the past few weeks, the press has pointed out many instances of HMOs forcing their guidelines on our hospital patients. Just when the brouhaha of sending mothers with their newborn infants home on the date of delivery has died down with a rash of laws to allow two days, instances of outpatient mastectomies have surfaced where women’s families have to provide rather basic and skilled nursing care. Many families are rather squeamish about managing the bloody drainage. But even more important, the risk for infection has increased greatly. This of course not only jeopardizes life, but will in the long run increase health care costs. When this was told to one HMO, the reply was that they were in it just for the short haul. They could not be concerned about ten years in the future or even about next year.
A professor at UCSF in a postgraduate class deplored that hospitals were no longer the Home of the Sick but rather just a way station. He cited examples of patients being referred to UCSF from remote parts of the state for kidney transplants. After two days, these patients go to nearby motels where family members do most of the nursing care. They report to the outpatient department daily until they are ready to return to their home in distant communities. The chance of complications including sepsis increases. That this can even happen, he felt, indicates that there is no physician in the medical institution directly in charge. The insurance carrier or HMO that pays the bill is calling the shots.
The fact that long-term health care costs don’t enter into the equations only points out the immediacy of the racket. HMOs are not in the business as a continuing long-term player. As George Anders of the Wall Street Journal has pointed out, doctors will eventually get this figured out. Meanwhile the HMO raiders will have made out like bandits just like the corporate raiders of the last decade.
As physicians, we must regain control of the heath care machine that is totally out of control before we’re replaced with bureaucrats, MBAs, physician assistants and health care workers developed by organized medicine to the detriment of our patient’s health. We might as well regain control, because the public holds us responsible whether we like it or not.