Healthcare’s perverse financial incentives

A hospital puts profits over patient safety

First do no harm.

That’s part of every medical school graduate’s oath. It should be the motto of anyone working in healthcare.

But I just read a disheartening piece of investigative journalism in my local newspaper, the Seattle Times, about a hospital where I trained, worked, and received care. The story highlights how the perverse financial incentives in healthcare (do more, get paid more) undermine patient care and safety.

…the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a humble home where nuns served the poor — and placed patient care in jeopardy, a Seattle Times investigation has found.

Specifically, the report focused on the neurosurgery department, which includes procedures for back pain, stroke and aneurysm.

The hospital recruited the “best” neurosurgeons from around the country. They were encouraged to do more complicated and invasive procedures.

The doctors in the neuroscience unit are incentivized to pursue a high-volume approach with contracts that compensate them for large patient numbers and complicated surgical techniques.

As a result,

Patients have undergone surgeries that are more invasive than available alternatives, [and the hospital] was flagged for having high rates of blood clots, collapsed lungs and serious surgical complications.

What’s the incentive? Money, of course. In 2015, five surgeons were able to bill $67 million in medical charges. In one year. That’s mind boggling to me.

Related post: Perverse incentives – Where’s the outrage?

Surgeons “operate” on several patients at once

How is that even possible? Because the surgeons are doing more than one procedure at a time.

…current and former staffers said those doctors will sometimes do little in the operating room once the patient is under anesthesia. Instead, the surgeons will leave less-experienced doctors receiving specialized training to handle parts of a surgery. That allows the primary surgeons to be in another operating room — a practice known as “concurrent surgery” — to maintain high volumes.

It’s not uncommon for experienced surgeons to oversee trainee surgeons who do the actual procedure. What makes this more egregious, I think, is that the underlying motive seems to be about volume and profit rather than training a new generation of neurosurgeons.

Other staff and doctors brought their concerns to hospital management, but they fell on deaf ears.

The complaints include explicit warnings about inadequate patient care, inappropriate surgeries, poor documentation, a lack of accountability for postoperative complications and dubious decisions that resulted in patient harm and death.

Those objections have been largely suppressed by a leadership team that has been accused of disregarding clear problems, according to the records and interviews.

(There has been some fallout from the Seattle Times story. As I was writing this post, it was announced that the hospital CEO had resigned in the wake of this investigation.)

Patient, protect thyself

The saddest part of the article was an interview with a patient. An ex-Marine, he underwent a spinal fusion. His surgeon assured him that he could perform the surgery “with his eyes closed.”

That’s great, but that doctor wasn’t the one performing the surgery (although the patient didn’t know that).

The trainee surgeon made a mistake that left the patient unable to swallow for months. He had to be fed through a stomach tube.

What’s a patient to do?

It’s difficult to protect yourself entirely, and sometimes bad things happen even when the surgeon and staff have the best skills and intentions (read that consent form carefully!)

As a former surgical nurse, I know that surgeons like to perform surgery. It’s what they are trained to do, and it’s how they make a living.

Before undergoing surgery, especially a complicated surgery, get a second opinion from a surgeon who will not benefit financially from your decision. He or she will be more likely to discuss the downside of surgery and your non-surgical options.

I’ve written several posts on patient safety and protecting yourself during a hospitalization, as well as choosing a doctor and hospital. Nothing is perfect, but being forewarned about possible conflicts of interest can help.

I’ve also listed a few helpful books and guides at the bottom of the post.

I wish I could say this article surprised me, but it didn’t. Our behemoth healthcare industry, in general, pushes profits at the expense of patients and patient safety.

But I know there are doctors and nurses and others who are upset at the status quo and want to bring back patient-centered care, increase patient safety, and decrease ever-rising healthcare costs.

That gives me hope  🙂


Frugal Nurse

More information patient and hospital safety:


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