Wednesday, April 01, 2009

During my fifty years in medicine there has been a great transformation in hospitals. Religions were a big part of the hospital business and it really wasn’t a business. Hospitals existed to care for the needs of the sick which included the spiritual needs of the patient. The spirit was in special need and support as the body mended. Patients were hospitalized for long periods of time to convalesce and have diagnostic test.

Insurance came along to pay for hospitalization. It was then realized that hospitals could be turned into business ventures. It was also a setup for fraud and abuse. Medicare came along to pay for the elderly and it became even easier to milk the government. The insurance companies and Medicare retaliated by tightening down on what they would allow for reimbursement and greatly limited hospitalization for things like diagnostic testing and convalescence. Hospitals became more and more acute care facilities with very expensive equipment and high priced personnel to care for complex and serious illnesses. Large volumes of patients became necessary to support this type operation and was an impetus for hospitals to merge. Size was necessary for survival.

Private venture capitalist have acquired many hospitals and turned them into lean mean profit machines. They have cut the cost to bare bones with a sacrifice in quality. Fraud and abuse have become prevalent and legal compliance folks are constantly snooping to make sure reimbursement for care is on the up and up. The religious hospitals have had a nonprofit status allowing them to be tax exempt. To compete the religious hospitals have shortchanged the spiritual aspects of their care and concentrated on making the buck. To me, all of the hospitals are really for profit machines and a dog eat dog business.

We witnessed the demise of a small local hospital this week, which finally succumbed to the pressures of trying to keep up in this world of big players. The amazing thing is that it has survived for the past twenty years. A small staff of physicians who lacked the vision to grow and expand with complex specialty care contributed to the demise of the hospital because hospitals cannot exist without physicians. In a desperate attempt to save the hospital, a few vocal folks, with no insight into the problem, were screaming and even resorting to prayer on the hospital lawn with a misdirected priest in a futile effort to keep the hospital as it was in 1930. There was some hope that a large Catholic Hospital chain would swoop in and save the day by acquiring the facility. The dying hospital would have been no better off without a specialty hospital staff. Religions should get out of the hospital business and concentrate their efforts on their churches that are so neglected and facing a dwindling membership.

The hospitals of old that functioned like spas and resorts have Gone With the Wind. We are now in the 21st Century and, who knows, we may not even need hospitals in the future. We may be treated by someone like Dr. McCoy on Star Trek who merely runs a hand held device over the patient that will diagnoses and treat at the same time. That will be great, to stay on my comfortable porch and not run the danger of acquiring a MRSA infection and be subjected to the horror of the modern hospital bill.


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