Banning the Corporate Practice of Medicine

Guest Post from Dr. Gene Uzawa Dorio:

Two decades ago, I admitted a patient to the Intensive Care Unit for a heart attack. His children were grown, and he looked forward to retirement purchasing an RV to relax and travel the country with his wife.

Invasive cardiac technology had not evolved, so he remained in the ICU on intravenous medication to control his symptoms. On the fifth hospital day, his wife brought a letter from the insurance company denying any further payment in the unit. His conversation the next two days centered around this letter, and as you suspect, the stress exacerbated his heart attack and he died.

Nowadays, it is commonplace for insurance companies to deny doctor ordered care with a simple explanation: “not covered.” Medication is changed without physician authorization, diagnostic procedures are denied, and hospitals pressure doctors to discharge patients, sometimes too early.

The public must wonder why educated professionals are now marginalized in medical decision-making within their own field.

Government has always been leery of business involvement in medicine with legislation to prevent unscrupulous profiteers affecting patient care. Laws enacted to protect the public and ban the “corporate practice of medicine” (CPM) are overseen by States, and therefore varies throughout the nation.

In California, hospitals are generally not allowed to hire or directly employ physicians for fear it will taint their medical judgement. Control of doctor salaries, pay raises, bonuses, and retirement might lead to coercion compromising care.

Healthcare corporations, including hospitals as well as insurance and pharmaceutical companies, are wealthy special interest groups with swarms of lobbyists influencing State legislators. With vast media PR, they have convinced the public of their solution to control spiraling health care costs. Protective CPM laws have been whittled away distorted by healthcare corporations as “archaic” and “detrimental” to advancing patient care. They want shareholders to benefit, while the public suffers.

Interference in doctor decision-making is now more profound in all aspects of medicine. Specifically, templated strategies have been crafted by hospital lobbyists and administrators to legally avoid the appearance of physician controlled employment. Instead they have signed contracts with doctor groups (ER on-call specialists, radiologists, pathologists, anesthesiologist, cardiologist) controlling them financially, and often influencing patient care.

With this also comes internal political influence. The physician Medical Staff is recognized legislatively as being independent and “self-governing”, but votes to elect leadership are shepherded by administrators toward those doctors who reside under their influence.

Controlling this leadership is a goal of hospital administrators. With this power comes the ability to eliminate physician whistleblowers through sham peer review; hiding unfavorable statistics; setting harmful policies and procedures; establishing distorted criteria and standards; and filtering complaints from doctors and hospital staff. Ultimately, it establishes an autocracy without democracy.

The corporate practice of medicine is really the corporate control of medicine. This is why doctors are marginalized in decision-making, yet the public has not grasped this reality. On the horizon, medical care will only deteriorate as these healthcare corporations further erode protective CPM laws.

To what degree must the public be financially assaulted with increasing premiums, larger deductibles, non-covered medical fees, and outrageous hospital bills before they say “enough?” And when will we realize the complex legalese and barriers placed before us when we are told: You cannot choose your doctor; you cannot go to a specialist; you cannot have a CT scan; you must change your medication; etc.?

The corporate practice of medicine is overwhelming American healthcare, and will only worsen until it is recognized by physicians and the public.

Gene Uzawa Dorio, M.D.

For comments:

3 thoughts on “Banning the Corporate Practice of Medicine

  1. So you think payers should pay for everything without question? Where do you think all this money will come from? You think premiums are high now. They would be astronomical without contractual limits. Sooner or later you run out of other people’s money.

  2. I have worked for corporate medical America and it was a very disillusioning experience. Insurance companies are only concerned with the bottom line and not with the patient. I did post-acute authorizations and pre-authorizations for a very large company. Though there was never a word said about denial rates, there was always subtle pressure to “meet the metrics” – which is only done by denying more cases. A Medical Director’s success in such a job is measured largely by these metrics, and they are tied to bonuses at most levels of the company (even nurses are subject to the same pressures). As a 30-year veteran of solo general surgery, as one who disdained hospitalists and “uber-consulting” and as a guy who took doing the right thing for every patient with the utmost reverence, these practices were insulting. I felt like a traitor and a true member of “the dark side”. I have encountered some small companies who actually seem concerned about their members but I will never again work for one of the “big boys”. Trouble is, I am afraid that little if anything can be done about them. They have so much power and so much money, and the little guys (ie, the patients) have absolutely no idea what is being perpetrated upon them. What a sad state of affairs…………….

  3. I appreciate your viewpoint as well as the commentors. Unfortunately, the problem you described won’t be fixed in a day. But it is fixable starting today.
    I created a full healthcare reform plan that (as it’s implemented in phases over years) will address major health events BEFORE they become major health events. And it also places impetus of healthcare back on the patient while providing opportunities for quality care before patients are in a crisis.
    The PDF of the plan is on my website: Rallying around a central idea, especially in this election year, we might have a chance at resoundly defeating government and 3rd party intervention in healthcare. I welcome your thoughts and comments.

    Brian J. Dixon, M.D.

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