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> ...exception to this is Kaiser Permanente They are notorious in the medical community for valuing efficiency above all else. Kaiser also doesn't serve extrem

> ...exception to this is Kaiser Permanente They are notorious in the medical community for valuing efficiency above all else. Kaiser also doesn't serve extremely difficult cases, uninsured patients or patients on Medicaid. Academic hospitals do. Kaiser can do a lot of things differently by virtue of being subsidized by the generosity of the state and the state's highly talented doctors. I don't know how much there is to learn from them. > they make money every time you get sick Nobody at an academic hospital makes money every time you get sick. Discharging patients is a high priority. Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds. To be more blunt, you're not really describing reality. You're describing a particularly cynical point of view, common among people who are unlucky enough to be (or to know someone) rich, sick and not getting better. It's doctor as antagonist, and it tends to emerge in some kind of economic rationalization. Here's reality: Mark Zuckerberg put his name on an academic hospital in San Francisco that has utterly dysfunctional EHR. Everyone in the system—especially the doctors, contrary to what you say—hates it and wishes the money would have been spent to improve it. Even the tech fantasy of magic money wand can't solve this problem. It isn't the fault of doctors ("you know who hates EHRs the most? Doctors"). No clever turn of the phrase or insight is going to provide the answer. Blah-blah-blahing about incentives isn't going to provide any solutions. It's a complex system. The original poster was saying as much. But then all the other commenters go on and start talking about economics, incentives, anecdotes, and assorted conspiracy theories. The guy is studying this! I think he's coming to the right answers.

fny 10y ago
I work at an academic hospital, and I've seen how the incentives drive policy. Frankly, it's terrifying. > Nobody at an academic hospital makes money every time you get sick. Of course they do! Every time you go in for treatment, they make money, and there only incentives for preventative care come from government/Medicare mandates (e.g. hospital readmissions, ACOs.) Let me color the picture a bit more vividly. At a public pitch competition within the university, a department head--and judge of the competition--laughed at an ML start up: "you do realize we make money from the procedures you're trying to prevent." > Discharging patients is a high priority. Hospitals are often penalized for long stays by insurance. > Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds. Aside from tying up resources, high-utilizers can't afford to pay for services and the hospitals treat them at a massive loss. Naturally, a hospital would like to free up these resources for patients who can pay. > It's doctor as antagonist. I never said this, and nor do I believe this. Doctors are victims of this system. I even made the point that doctors hate the EHR because it's been warped by hospital administrators into a billing-centric machine with umpteen documentation requirements at every turn. For this reason, many who went into medicine for altruistic reasons end up disenchanted with the health system that's been wrecked by those running the business.

fny 10y ago

I work at an academic hospital, and I've seen how the incentives drive policy. Frankly, it's terrifying. > Nobody at an academic hospital makes money every time you get sick. Of course they do! Every time you go in for treatment, they make money, and there only incentives for preventative care come from government/Medicare mandates (e.g. hospital readmissions, ACOs.) Let me color the picture a bit more vividly. At a public pitch competition within the university, a department head--and judge of the competition--laughed at an ML start up: "you do realize we make money from the procedures you're trying to prevent." > Discharging patients is a high priority. Hospitals are often penalized for long stays by insurance. > Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds. Aside from tying up resources, high-utilizers can't afford to pay for services and the hospitals treat them at a massive loss. Naturally, a hospital would like to free up these resources for patients who can pay. > It's doctor as antagonist. I never said this, and nor do I believe this. Doctors are victims of this system. I even made the point that doctors hate the EHR because it's been warped by hospital administrators into a billing-centric machine with umpteen documentation requirements at every turn. For this reason, many who went into medicine for altruistic reasons end up disenchanted with the health system that's been wrecked by those running the business.