Thursday, April 6

Supreme Court Decision Bad for Great Falls Patients

It looks like the Supreme Court fell for it.

The Clinic's surgery center, which has been in business for about five years, has been shuttered by a Supreme Court injunction. The Court granted Benefis, our supposedly non-profit local hospital, a temporary stay against competition. Since it has been in business for years, I wonder why there was really a need for an immediate injunction against the surgery center's operation? Was there really a risk of an imminent harm against Benefit? I really doubt that anything had changed other than ownership.

Ownership seems to be the crux of the Hospital's (and incidentally, one of my honored contributor's) argument. For the past few weeks, Great Falls residents have heard that we cannot trust physician-owned and operated hospitals. As the argument goes, if we submit ourselves to care by a facility whose ownership is by our care providers, we will suddently be subject to all sorts of unnecessary procedures from substandard equipment.

Again, I ask why the practice of medicine is so different than the practice of any other profession? Why is it a good thing to go to an independent mechanic with good references, but an anthema to go to a physician-owned hospital? Why is a physician-owned hospital more likely to screw me?

The market should affect any provider of health care the same way. If a hospital, regardless of ownership, uses shoddy equipment and charges extra for unnecessary procedures, then customers (patients) will vote with their feet and utilize other providers, as long as there are other providers available in the market. Competition keeps everyone honest, and provides a solid incentive to maintain a quality "product."

The Court should swiftly decide this case and allow the surgery center to open. It is worth noting that the jobs of more than thirty families have been halted by this Court decision.


dona stebbins said...

Aaron, I respectfully request that you contact Jack King for the real story.

WolfPack said...

The practice of medicine is different from auto mechanics because of the emotion involved (life and death decisions have that effect on people). I can have a few botched break jobs or be over charged by a particular shop and adjust my purchasing decisions accordingly, not so with heart attacks. In medicine the level of trust by a patient and the patients need can be so great that pure free market principles do not work well. How much elasticity is there in the demand curve for stroke treatment? Due to the very nature of a doctor-patient relationship the doctor is in a highly dominate position, until a suit is filed.

I too don’t see the emergency on either party’s side. The GF Clinic could have waited for the lawyers to hash it out before moving ahead and the Supreme Court could have let business go on while they evaluated the claim expeditiously. Like TSJ said before, both parties are wearing gray hats.

Anonymous said...

First of all Mayor Stebbins, the idea that one will get the "real story" from Jack King is not credible. Jack is a company man.

Second, I see that Benefis again made their "cherry-picking" claim in the paper today. Here's what I find funny about that: Every time they get a chance to make that claim in the paper or on TV, there they are, "Oh, the doctors will take all the good cases, we'll be left with the bad ones, wah, wah, wah."

But on the big day, on the day of their Court hearing, where was their evidence??? Oh yeah, they didn't have any. As the judge found, they offered a bunch of unsupported speculation by Dr. Dolan and others. With all of the money at their disposal, and their teams of high-priced Chicago lawyers, you would think they could have come up with one, teeney, tiny little bit of actual proof, wouldn't you? They couldn't.

And finally, I love how everyone assumes all these doctors will break their Hippocratic oath for a buck, but St. Goodnow, St. Dunn and St. Dolan, oh my goodness, they're just about the patients! Yup, an MBA will be far more concerned about your care than an MD!

dona stebbins said...

As always, I credit anonymous posters with very little, particularly credibility. If you have an opinion or something to share, put your name on it.

WolfPack said...

So the best argument you have is that all doctors can be trusted and all business people cannot? What screening process is there in medical school that filters out all the mere mortals leaving only those unaffected by human failings? The issue we are talking about is a national one. Do a little Google searching and you will find the concern over Physician owned specialty hospitals did not start in GF. You’ll also find that Benefis’s arguments are heard all across the nation from full service hospitals. Why do you think the state had the moratorium in the first place? We are not in the lead on this.

Disclaimer: Just in case I’m giving off the impression that I think all doctors are ethically challenged, I DO NOT. I think most physicians keep their patients interests in mind when advising treatment options. I also believe there are physicians who’s thinking could be significantly swayed by financial conflicts of interest. I’m not alone in this, that’s why drug companies spend so heavily hosting drug information conferences at exotic vacation locations.

Treasure State Jew said...

Look, John Goodnow is a good guy. I have no beef with him, and I might be making the same argument if I was in his position. He has a fiduciary duty to zealosly protect Benefis. I hope we can all try to avoid personal attacks here.

As I have said before, there is plenty of blame to go around for the crappy business environment facing the practice of medicine in Great Falls. IMO, neither the clinic nor the hospital have the right to wear a white hat in our town.

However, I still do not see the imminent harm being done to Benefis by allowing a surgery center that has been open and operating for six years to keep operating pending a court decision.

Ultimately, I think that competition is good, and will result in better care in our town. If the sky was going to fall in because of the operation of that center, why didn't that happen back in 1999 or 2000 when it opened its doors?

Oh, and go back to the Tribune articles from 1998. You will see identical arguments made by Benefis against the opening of the center. Their sky-is-falling argument didn't pan out then, and I don't buy the argument that it will happen now.

As for the argument against physician owned hospitals, I have trouble there as well. For the most part, it has been my experience that most of the doctors treating patients at the hospital either are Clinic docs or work for themselves, anyway. I don't know any details (if anyone does, please post), but it has been my supposition that they pay the hospital for the right to have their patients treated there.

When any of my family has used the hospital, I receive a separate bill from the treating doctors. In some cases, it is a clinic bill, in some cases from that doctor him/herself.

So, if they work for themselves in any case, why would that doctor not have the same conflict of interest at the hospital that they would have at a facility they own?

Anonymous said...

Priceless: Benefis wants to close its competitor because its competitor will harm its business, yet when the Court steps in shuts down the competitor, Benefis cannot even accomdate the patients because it's full!


Uh, Benefis? You've got some gravy running down your chin...

WolfPack said...


The conflict comes from the doctor profiting more from directing you towards a hospital he's part owner of verses only collecting fees if you go to a competing hospital. When the patient is looking for advice on which facility to use, isn’t the doctor going to be hesitant in saying anything bad about the hospital he owns a share of and shares letterhead with? Your post made me think of another reason doctors and hospitals should be disconnected. The hospitals grant doctors the privilege to practice at the hospital thus giving them some ability to quality control treatment. The doctors advise patients on which hospital to use thus allowing doctors to quality control hospitals. This provides us users of the system some protection with each entity watching the other. Granted this would work better if Benefis wasn’t the 800lb gorilla. The fix for this is another larger independent hospital not a doctor owned competitor (hind sight is 20/20). I prefer doctors getting all their compensation from the patient, not from kickbacks for referrals to business partners.

Anonymous said...

dona stebbins said...

I do believe that people need to research specialty hospitals in other cities and the consequences of their proliferation.
Wolfpack makes this point as well. This is really a situation that will have long term ramifications on health care in Great Falls, both in terms of accessibility and affordability.
I am not willing to accept anyone's arguments at face value without doing the homework.

Anonymous said...

Two questions:

Are specialty hospitals good as a matter of public policy?

Is the Clinic transaction legal?

Two different questions, right? If the answer to the second is affirmative, we never reach the first.