All these points are well taken. And for me, they highlight a few things:
First, any institution providing health care needs to be independently accredited and supervised by a third party, financially disinterested organization. Although I am woefully ignorant of details, I believe that happens.
Second, it is a patient's responsibility to do their own research about these institutions (and their physician) prior to receiving (at least planned) care. While this is not possible for emergency rooms, it should be possible for just about any other time a patient seeks care. As in every time you go out to purchase something, caveat emptor.
Third, it would be nice if our media would highlight these ratings to try and ensure that the population in an area were aware of them without really trying. Since the media is privately owned, we really cannot call that a resposibility.
Perhaps this is an area of responsibility for our local government?
Fourth, the proliferation of specialty hospitals (or surgery centers, or whatever) are a national phenomena. A tiny market like Great Falls really has little impact on this. We are only along for the ride.
I was only half tongue in cheek when I compared doctors to mechanics. The presence of outside regulators and certifying agencies (in this case the State, the AMA and other bodies) is the real difference. I can look at those ratings and (in theory) make an informed choice based on the past performance and adherence to standards of those providing my medical care.
The rub really starts to come in, and IMO, the Clinic's hat turns a shade grayer, when you start to factor insurance into the equation. The Clinic's MontanaCare insurance program is probably one of the most common employer provided health insurance option in our town. And that program provides real financial incentives to use Clinic facilities whenever possible, and strong financial disincentives to use other facilities in almost any situation.
Pressure from a doc sending me to a Clinic facility in which he has a financial stake I can handle. Paying three or four times more to use a Benefis facility is another thing altogether.
Monday, April 10
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I was at the hospital doing a consultation Saturday. There were 2 beds available as of 2 pm. Hope they don't get a multiple-injury accident or many more admissions. Actually, it is likely they will be full later today. What does Benefis do in these circumstances??
I spoke with 2 internists who know what happens. They stated the hospital is routinely not just full but goes beyond capacity. Earlier this week the hospital was so full that 11 patients who had surgery that day, had to stay overnight in the AM admit area. Its a large room that they just makeshift into cubicles. Many of these patients needed more intensive care both from a nursing standpoint as well as available equipment. The doctors were upset because their patients didn't receive the same level of care as they would have had they been appropriately placed in the intensive care unit or even a regular bed on the main medical or surgical floors. Extra patients have also been kept overnight in the emergency room. One of the internists said that the wife of a very prominent businessman who had surgery was very upset as she was kept overnight in the recovery room after surgery as there was no room at the inn.
At some point when they get even more full, Benefis will refuse admission and send patients to Missoula.
Benefis used to post their census information in the doctors lounge. Doctors were encouraged on full-capacity days to write their discharge orders promptly, so patients could be discharged sooner to make room for new patients. The hospital administration stopped posting this data the past 3 weeks likely because of the lawsuit and how it makes them look.
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