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Medical Marketing: More Money Wasted

There was a series of ads on the radio awhile back that went something like this:

When Mrs. Willis had a stroke, her husband never slept alone. Her daughter never had to go dress shopping for the prom by herself. And her son didn’t have to sit out the Mother-Son dance at his wedding. Why? Because she came to Hospital A…and she didn’t die!

There’s another ad for one of the big downtown hospital’s cancer center (sorry, “advanced cancer center”):

Every cancer, every stage. Your life depends on it!

Let’s see: No one ever dies at Hospital A. And the big downtown cancer center can cure any cancer. That’s certainly what those ads would have you believe. Even the little local suburban hospitals have taken to advertising: Billboards around the neighborhoods, kiosks at the outlet malls, mainly pushing the lucrative stuff like cardiac care and bariatric surgery.

Every time I see this stuff, I can’t help but wonder how much it all must cost. And how much medical care could have been provided to the uninsured instead of enriching the ad execs and billboard owners who are already rolling in dough. Clearly there is still plenty of money to be made in the hospital business, because these people aren’t stupid. They wouldn’t spend this kind of money on marketing unless there was plenty more to be made from it. I believe it’s a little business concept known as “return on investment.” Read more »

*This blog post was originally published at Musings of a Dinosaur*

Physicians Are Biased About Healthcare Reform

From the department of “Credit where it’s due,” in the comments of my post on the Lewin Group, Nurse K pointed out the following:

Come on Shadowfax, you’re blogging about this stuff and you stand to make A TON of money if it goes through…for awhile…until insurance companies decrease your compensation since you’re making more per patient. I know you mentioned this before in like a comment or something, but ER docs stand to benefit (temporarily) probably more than anyone else. HUGE bias on your part.

Much as I (really, really) hate to admit it, she’s absolutely right.  In fact, I’ll go one further: I first got interested in this part of medicine policy because I was mad that I was seeing all these uninsured patients and wasn’t getting paid a thing for my efforts.  I started keeping track of the number of uninsured I saw every day, just as a pet obsession.  It was a sobering number.  After that I started getting a little perspective, talking to patients and seeing their bigger picture, understanding why they were uninsured, learning the particular challenges they faced getting health care, etc.   For me, this cause became something beyond the personal a long time ago and became a moral imperative.

But K is right to note the potential for bias, and it’s fair for me to acknowledge it.  I hope that my integrity on this point is evident.  The fact that I argued in the New York Times for an increase in primary care compensation, with an attendant decrease in the compensation of specialists, including Emergency Medicine, should speak well for my ability to see beyond personal self-interest. (God knows it didn’t make me popular in EM circles!)

This is something which struck me yesterday, reading the med blogs reaction to Obama’s presser.  Quite a few docs mounted their high horse and with great indignation denounced this:

Doctors are forced to make decisions based on a fee payment schedule that’s out there. So they’re looking… if you come in with a sore throat or your child comes in with a sore throat, has repeated sore throats, a doctor may look at the reimbursement system and say to himself, “I’d make a lot more money if I took this kids tonsils out.” Now that might be the right thing to do, but I’d rather have that doctor making those decisions based on whether you need your kids tonsils out…

Now it’s a clumsy clinical scenario written by someone who has no clue about medicine.  But it’s a damned fair point.   Bias comes writ large, as in the Walter Reed orthopod who pocket $850K and falsified his research to benefit Medtronic, and it comes writ small, as in the ER doc who sees a small lac and has to decide whether to use a band-aid or a stitch, knowing that the stitches will pay 10x more.  It comes with the cardiologist who has to decide whether to take a low-grade troponin leak to the cath lab.  It comes with the surgeon seeing a patient with unusual abdominal pain and a slightly enlarged appendix on CT (you can observe or just take out the appy; guess which pays more).

Whether there’s a “fix” for that in the current reforms is debatable.  It harms our standing, however, to deny the possible existence of bias and to claim a moral purity that, as a profession, is not justified.  I think and hope that most of us in these ambiguous situations are able to come to the right decision for the patient the vast majority of the time regardless of our economic interests.  The best way to remain credible is to acknowledge the mere potential for bias and move on and debate the salient point.  Making counter-factual arguments that biases do not exist or that we physicians are too awesomely altruistic to ever be influenced by them does nobody any good.

*This blog post was originally published at Movin' Meat*

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