Two-Thirds of U.S. Physicians get Orders from a "Boss" on Who, and How to Treat
January 29, 2013 • 12:17PM

Two-thirds of the doctors in the United States no longer practice medicine independently, but they are now in the employ of other entities, to the point where the American Medical Association, in November 2012, issued five guidelines on the "conflict of interest" involved.

Dr. Mark Shelley, a Pennsylvania physician, noted this in his presentation on, "Reversing the Monetization of the Human Spirit" in U.S. health care, at the Jan. 26 Schiller Institute conference in New York City. Shelley denounced making lives into commodities. He said that, by the time the AMA starts talking about "conflicts of interest," you know that it's an accomplished fact.

Shelley reported that today, only 36% of of all U.S. practicing physicians own their own practice (in whole or in part), which is way down from 57% in 2000, and way below 85% or more in the 1960s.

The first of the AMA's "5 Principles to Address Physician Employment Conflicts of Interest," issued last November, is that, "1. A doctor's paramount responsibility is to his or her patients. Additionally, given that an employed physician occupies a position of significant trust, he or she owes a duty of loyalty to his or her employer. This divided loyalty can create conflict of interest, such as financial incentive to over- or under-treat patients...." The AMA's advice? Just "strive to recognize and address."

- Medical Conglomerates -

Among the places physicians now work—besides various groups associated with medical facilities, insurance companies, clinics, etc.—are new, giant for-profit treatment systems, which have come about over the last 20 years of deregulation/privatization of the U.S. health-care delivery system, following on the post 1973 rise of HMOs. Among the biggest health-care conglomerates:

UNIVERSAL HEALTH SERVICES, INC. Founded 1978. Operates in 36 states, with 218 facilities, and 65,000 employees.

HEALTHSOUTH CORP. Founded 1984. Operates in all 50 states; U.K., Saudi Arabia, Australia. 1,800 facilities.

TENET HEALTHCARE CORP. Founded 1995. Operates in 10 states; 49 hospitals, with 57,000 employees.

The conglomerates have arisen by picking over the remains of community hospitals, and dominating health care "markets." In recent years, hundreds of non-profit public hospitals have been forced into bankruptcy and shutdown. The closure of the 500-bed D.C. General Hospital in 2001 is emblematic. Among the latest example, is the former Southeast Louisiana Hospital, a state-run, non-profit, which on Jan. 2, 2013, was privatized into the for-profit Northlake Behavioral Health System.

- Obamacare Punishes Hospitals for "Re-Admissions" -

A heavy, new assault against medical treatment is under way from the Obama ACA (Accountable Care Act), to financially penalize hospitals for conducting too many "re-admissions" of sick people, after they were discharged from the hospital. The new HRRP (Hospital Readmissions Reduction Program) is to cut Medicare spending by $8.2 billion from 2013 to 2019, say the Obamacare statisticians in charge.

Of the 3,282 hospitals in the HRRP, fully 66.7%, or 2,189 are to get a pay cut for Medicare patients they treat, according to the report in the Journal of the American Medical Association (JAMA) this month.

For example, in Boston, Massachusetts General Hospital will get docked by 0.5% of its Medicare reimbursement from the Federal government, because its re-admission rate of sick people is considered excessive.

Teaching hospitals, which tend to have complex cases of elderly patients, and safety-net hospitals serving the poor, predictably have the most need for re-admissions, and they will now be penalized.

These various particulars all manifest the intent of the Obama ACA from the start: kill off the "costly," especially the old and poor.