Dr. Weeks’ Comment: For the past 20 years at the Weeks Clinic we have accepted payment solely from patients because we committed to serve only patients. It was that simple. When third party payers (insurance companies etc.) pay the doctors, it should not surprise you that, as is the case with the proverbial “piper”, the person who pays “calls the tune”. It is shocking to acknowledge that “your” doctor works “on” you but actually “for” the third party payer. But think about that conflict of interest. (Hint: this economic disconnect whereby the consumer / patient is not the one who can hold the doctor/hospital accountable) is the first true reform if we seek real health care reform!) Can you argue with this logic? If you are not paying for your care, you are not the one who needs to be satisfied! Here below is an articulate example of how third party payers create a conflict of interest which traps many of my well-intended medical colleagues. Dr. Lawrence Huntoon, editor of the Journal of The American Association of Physicians and Surgeons (www.aapsonline.org) , issues a clarion warning to patients to seek out doctors who are fee for service and therefore who have no conflicts of interest interfering with their ability to care for patients.
“…Physicians, for example, who previously referred patients to specific specialists based on years of trust and experience in the specialist’s skills and abilities, are increasingly being told to stop referring to those doctors and to refer patients only to physicians employed by the hospital or who are in the ACO or EPO organization…”
Thanks to ObamaCare, and the accompanying expansion of Accountable Care Organizations (ACOs), independent physicians are being squeezed out, and in some cases, deliberately driven out of business nationwide.
Hospitals and large physician groups are combining to form Accountable Care Organizations, designed to cut health care spending. In some cases, hospitals are combining with insurance companies to form Exclusive Provider Organizations (EPOs) that limit choice to a small panel of physicians. Hospitals are also employing more physicians as hospitalists in an effort to maximize profits by controlling the care hospitalists provide.
Some physicians, beleaguered with increasing and costly administrative burdens imposed by government and insurers, have sought refuge in these new care models, perhaps not fully realizing what loss of autonomy means for their patients. The developing culture in these ACO, EPO, and employed physician models is that physicians quickly learn to do as they are told and not criticize or speak out when the system is not working for their patients.
Physicians, for example, who previously referred patients to specific specialists based on years of trust and experience in the specialist’s skills and abilities, are increasingly being told to stop referring to those doctors and to refer patients only to physicians employed by the hospital or who are in the ACO or EPO organization.
Physicians who disregard such warnings and who choose to act in the best interest of their patients are at risk for being terminated from hospital employment or deselected from the ACO or EPO. If the hospital, ACO, or EPO has monopolized the market, the physician may be unable to sustain an independent practice. Physicians soon learn to “cooperate.”
Physicians who refuse to become employed and controlled by a hospital, or who refuse to refer patients requiring hospitalization to hospital-employed hospitalists, may lose their hospital privileges because of a hospital’s abuse of the credentialing or peer review process, known as sham peer review. Trumped-up and/or false charges are frequently used in a kangaroo court peer review process in the hospital. If the attack is successful, it not only eliminates the physician victim from the hospital, but often ends his career as well.
In some cases, physicians who oppose a hospital’s agenda are labeled “disruptive physicians” and are sent to distant re-training centers that specialize in treating “disruptive physicians”—at enormous cost, all paid out of pocket by the physician.
As part of the “treatment,” physicians are frequently coerced to take psychoactive medications under threat of loss of their livelihood.
Some treatment centers also use lie detectors if they think the subject physician is not being forthright in his responses. One physician, who was interviewed under condition of anonymity, described the process as “brain scrubbing,” similar to “Soviet-style punitive psychiatry.”
Another physician, a whistleblower who was a strong advocate for patients, learned the hard way what can happen to a physician who criticizes the way a hospital is being run. According to sworn testimony, a hospital chief executive officer hired an operative who was allegedly connected with the Mafia to set up the physician by planting a gun in the physician’s car. Based on an untraceable “911” call about a fabricated incident of road rage, the whistleblower physician was arrested in the hospital parking lot and taken to the police station, where he was strip-searched, booked, and thrown into a cell for five hours. Tires on two of the physician’s cars were also mysteriously slashed, an action that placed his daughter’s life at risk when one of the tires blew and the car flipped on the freeway.
If hospitals, ACOs, and EPOs succeed in eliminating independent physicians from the hospital, who will be left to protect the interests of patients? And what kind of treatment can patients expect from organizations that abuse physicians in these ways?
Lawrence Huntoon, M.D., Ph.D. (from the Buffalo, NY area) is a board-certified neurologist who runs a third-party-free practice in Derby, New York. Dr. Huntoon earned his M.D. and Ph.D. degrees from Louisiana State University Medical Center in New Orleans. In 1980, he received the highest award offered to LSU graduates, the Chancellor’s Award for scholarship, leadership and professional excellence. He completed his internship and residency training at the Dent Neurologic Institute at Millard Fillmore Hospital in Buffalo, New York. Dr. Huntoon is a past president of the Association of American Physicians and Surgeons (AAPS), and is currently serving his fourth term on the AAPS board of directors. Dr. Huntoon is also editor-in-chief of the Journal of American Physicians and Surgeons, a position he has held since 2003. Dr. Huntoon has written and lectured extensively on medical care issues and the importance of the patient-physician relationship.