Yet another injury to our doctors and our health care system

I recently experienced, up close and personal, yet another injury to our doctors and our health care system.

I have an undiagnosed, undiagnosable, autoimmune disease. I am rarely, if ever, without any physical symptoms. I have learned about them and how to manage them. Annoying? Sometimes. But no longer frightening, once my doctors and I understand and incorporate them into my health care plan.

A few weekends ago, I suddenly had a new symptom. It was terrifying. I spent way too much time with Dr. Google, which greatly magnified the terror. I would have been even more anxious if I did not have a way to get help (This was not a symptom that would be helped by a trip to the ER or urgent care.) This could have been a realistic possibility if I were less aware of our crippled health care system’s inner workings. My doctor of several decades, whom I would have previously wanted to see about this particular new symptom, had recently sold the practice. I was uncomfortable the last time that I was there. Something didn’t feel right. So I had already planned to leave the practice, although without the drama of an emergency.

I was able to get an appointment with my new doctor the next day. I only had to wait a short while once I arrived, but I had my knitting, so I was fine. It turned out that my new symptom, which was acknowledged as definitely terrifying, is a very common one that will resolve itself in 4-6 weeks. If it does not resolve itself, the worst possible scenario (I asked) is an outpatient procedure from which I would drive myself home. I got a clear explanation, realistic reassurances, was told what to watch out for and was given a follow-up appointment for 4 weeks.

When I returned home, I had a FaceTime appointment with my college friend. I am teaching her how to knit. I explained what had just happened and how my former doctor had sold the practice; to a private equity firm. I explained what that means. She said, “This is terrifying. How would someone like me know?”

Exactly.

Private equity firms purchasing medical practices and facilities add another injury to our doctors and our health care system. They also injure patients, who are unaware that this is happening or what it means for their health care.

“Private equity firms work by pooling money from investors that they use to buy businesses, create value beyond the purchase price, then sell off the combined portfolio company, and return the profits to the investors. An appeal might be that the equity firm usually focuses on streamlining administrative tasks, using economies of scale for purchasing, improving billing practices, bringing in new vendors, and providing experienced executive leadership.

However, as the number of private equity deals for medical practices increases, some questions have been raised about its potential effect on the quality and delivery of care. It could mean increased utilization of certain services; it could change the way patients are diagnosed or treated if those decisions are influenced by the need to generate a financial return. There may be incentives for doctors to use certain costlier services or refer to providers or labs that are also owned by the private equity firm.

At the initial sale to a private equity firm, there may be a physician or two that sits on the board of the new corporate entity, but it won’t be the physicians driving the major decisions. If the private equity firm is successful and the practice gets sold to a second firm after five years, the physicians won’t have any say in the new company.”

Terrifying? Yes. Patient care should always come first. Quality care is expensive. Money should not be the driving factor in medical decisions. Yes, we have to pay. Yes, doctors should get paid properly. These are givens. But quality care is a must, not care for profit or shareholder rewards.

On the way to see one of the doctors who helps manage my autoimmune disease, I go down a long road connecting to the town where the hospital system resides. All along the road, I pass many doctors’ offices and complexes. It is increasingly populated with signs of one of the two local major hospital systems. These doctors have joined these systems. Not necessarily because they wanted to join, but so that they could survive in practice. I always think of what these doctors may have lost as I pass by all of the signs. Respect, autonomy, long-established collegial relationships, patients, money, the reward of building a strong independent practice, to name a few possible losses. Yet, they chose integrity. Sure, hospital systems have their problems. We have seen some of them during the pandemic, and it’s not pretty. But their goals, for which they are fiercely competing, are quality care. Their leadership is medically focused. And they are regulated, sometimes almost strangled, by regulations. Patients can have some hope of quality of care.

So, who knew what happens when a private equity firm purchases a practice? Well, my college friend certainly didn’t know. Recently, an article on KevinMD stated that doctors have an obligation to educate the public about how health care works. Maybe. But patients have an obligation to educate ourselves and each other as well. I have been impressed by the power of grassroots organizations. They educate, and they create change. Some of the most powerful changes in our nation’s history have started with grassroots. We must continue this tradition and educate ourselves and our legislators about our crippled health care system’s inner workings and how to right the system so that it best serves patients.

Our lives depend on it.