The Skewed Logic of Hospital CEOs

May 1, 2009 in Medicine by RangelMD

Dealing with hospital CEOs is like snake charming, or defusing bombs, or playing with fire, or kissing sick pigs. You get the idea. It’s dangerous. Things can go south quickly and suddenly.

Of course, for hospital CEOs, dealing with physicians is often like being the personal assistant to Diana Ross. Many docs (surgeons, *cough, cough*) can be prima dannas – high maintenance egomaniacs with legs who feel free to take every little gripe directly to the CEO at any time, day or night.

However, I’m not one of those docs. But it’s not for lack of ego. It’s because I’m an internist with a small practice so I know that I’m the soil just beneath the lowest level on the totem pole in terms of priority to these people. Therefore, I usually don’t bother. But this doesn’t mean that hospitals won’t mistreat even the lowliest doc.

A few years ago I made the mistake of taking weekend coverage for a large physician group. I was quickly overwhelmed with the number of their patients already in the hospital and I asked a certain hospital ER to refer any more patients for this group to their hospitalists who were covering that ER.  I was told by both the hospital AOD and the ER physician that since I was “on call” for this group then I was responsible for their patients and any attempt to defer admissions to the hospitalists would constitute “patient abandonment” on my part.

Except that this was a total legal fantasy. Since I had never treated any of this group’s patients (unless they were already in the hospital) then I had never established a doctor-patient relationship with them. Simply being on call for someone does not create a de facto doctor-patient relationship anymore than simply walking into a bar constitutes a common law marriage with any available women there. Besides, it’s only abandonment if you don’t make arrangements to have that patient seen by another physician in the event of an acute illness and the hospitalists were available.

But I’m a doctor, not a lawyer, dam it! All I knew was that if I stretched myself any thinner, I would be compromising patient care. Then things went south. The hospital chief of medicine calls me up (obviously infuriated at being awakened at 2 am) and proceeds to chew me out, curse at me, and threaten my license unless I agreed to take all of these ER admits. So being the green and inexperienced MD that I was, I put my tail between my legs and went to work. I think I saw 15 to 20 admissions that night (in addition to 30 patients already in the hospital) all without any backup. Sure enough, in my rush to see everyone in due time I missed the fact that one patient, admitted with severe cardiomyopathy, had been left on high flow IV fluids initially started by the ER staff for low blood pressure. Lucky, this patient didn’t go into flash pulmonary edema and die.

The phone encounter that I had with the representative of the hospital staff and administration (chief of medicine) was one of the most disturbing and inappropriate peer to peer conversations that I have ever had.  Combine this with the fact that the hospital was bullying and lying to me and I was more than a little cheezed. I complained to the administration and asked that the chief of medicine call me to explain his actions (if not apologize). I never got any responses. Apparently, I’m lower than the clay under the soil at the bottom of the totem pole to these people. So I left it at that and I avoided this hospital like the plague for years.

Then the hospital administration changed and the new CEO came calling seeking our business. I explained what happened and how the hospital had never addressed my concerns and how horrible it was and how I avoid them because of this, etc. etc. He promised to look into the legal questions and the behavior of the staff . . And I never heard back from him.

Hospitals regularly recruit physicians to work in the community by giving them what is known as an income guarantee even though they can’t contractually force the physician to send patients to their hospital (this would be seen as a kick-back).  However, the more physicians there are in the community, the more business the hospital gets, especially from those who feel a sense of loyalty to the hospital that gave them the income guarantee in the first place.

So, over a year after my meeting with the new CEO, a physician who had been recruited by this particular hospital decides that she wants to join our practice. She is eligible for an income guarantee from the hospital and the same CEO returns to my office to discuss it. Unaware of the history of this particular hospital, our new MD wants to refer her patients there. I agree to bury the scalpel and pledge to support my new partner and this hospital. I know better then to try and squeeze water from a stone.

The CEO promises that he is “95% sure” that he will be able to get the income guarantee for our new physician.  But then he shows up not 2 weeks later and flat out tells me that he has reconsidered. It seems that he just became aware that I have been referring my patients to another competing hospital over the last several years. Well, yea. Wasn’t he listening at our first meeting? Then he claims that this makes this guarantee too much of a financial risk even though we are talking about a new physician and not me.

I don’t get it. Considering that this new physician is coming into an existing and growing practice, the possible financial liability to the hospital as part of the income guarantee is likely to be zero. In other words, the new physician is likely to be making more than the guarantee at the end of a year. Our office manager crunched the numbers and showed them to this CEO as part of the application process. Even if our practice didn’t refer a single patient to them (a highly unlikely event), the endeavor wouldn’t cost them anything!

In the very least this opportunity should have been seen by both sides as a good will gesture in an effort to mend fences and start a new business relationship. However, I think the new hospital CEO saw this as an opportunity to bust my balls and try to get me to kiss his ass as retaliation for sending my patients to the competition. But, how is this strategy supposed to increase his business?  He must think that they have me in such a bind that he can use this as leverage to get an ego blow job out of it. I’m so sorry Mr. CEO for sending patients to that other hospital after your hospital treated me like shit and then ignored me.

Wow. It’s just like being back in High School.

The reality is that we’ll just go to another hospital with the same proposition. And it’s by no means critical to get an income guarantee for a new physician. It’s more of a luxury that ensures that a new physician will have decent take home pay in the first few months that it takes to build up their patient base. However, this experience has taught me many valuable lessons about this particular hospital and its CEO

  1. The word of this CEO (and by extension, the hospital he represents) isn’t worth a dam.
  2. This is the way they treat small business clients.
  3. Their business plan is a one sided affair, their side.
  4. For them, there is no legitimate reason why anyone would hate their hospital.
  5. New CEOs selectively wash their hands of any prior issues you have had.

It’s not as if I needed any reminders of why I didn’t go into business and I have yet to meet a physician who trusts a hospital CEO anymore than they trust a new puppy not to crap on the floor. But I always have hope that there is going to be an exception. Nope. Not this time.

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