Integrated Delivery Systems - Ethical Issues
I am finally back! I have spent most of the past year researching the impact of an integrated delivery system in my own community on local independent physicians and the on ethical concerns it raises. Both independent physicians and patients are negatively impacted. I am still in the process of submitting the information to the general council of Adventist Health, but will begin posting some of the issues and concerns online.
Part 1 looks at the practice of deliberately concealing the physician network of physicians employed or owned by Adventist Health/FPMG and the ethical concerns of concealment. Part 2 shows the incredible power to completely shift referral patterns to specialists within 3 months in such a massive system. Part 3 highlights how this way of doing business harms independent physicians and patients. Part 4 explores the stated reasons of 'community need' and the reasons that seem to be the motivating factors, market share and revenue. There is also a list of those physicians that are employed or owned by Adventist Health in Central Florida and questions patients should ask to keep THEIR welfare above corporate goals.
Adventist Health is by no means the only system involved in this type of behavior -- which is all the more reason some of these questions need to be raised and brought to light.
What has been YOUR experience in such a system -- whether you are a physician, healthcare professional, patient or other?
Labels: integrated delivery
posted by Dawn L @ 11:23 AM
4 comments
4 Comments:
Dear Dawn: Just wanted to clarify, FPMG doctors have the freedom to refer their patients to whomever they choose. They are NOT under any obligation to refer within FPMG or Florida Hospital. Getting money/bonuses or anything else for referals is ILLEGAL. FPMG is smarter than THAT.
Dear Anonymous, thank you for your comment. I have heard in the past from more than one person connected to healthcare that there is a clear expectation to refer 'in house'. And that makes sense to me at some level.
If what you say is true, I do wonder about a couple of things and maybe you can help clarify them-- if you know and are willing:
(I don't mean this as a rebuttal to your comment -- I am trying to understand, especially in light of your comment).
1. If FPMG physicians have that amount of freedom, how does patient steering to certain FPMG physicians happen? For example, how do you get so many patients to a newly recruited physician from out of state who is not known by patients or physicians to the extent that the new physician can surpass surgical volume of any of the best surgeons in Orlando in 3 months? It's not reputation and if it's not pushing employed physicians to refer, how does that happen?
2. FPMG invests a LOT of money in setting up its recruited physicians. How does it recoup costs, especially with primary care that usually get lower reimbursement, unless there is some expectation of downstream referrals to Adventist employed/owned specialists and services?
What are your thoughts?
Your links on your blog are no longer functioning. Did you take them down or have they been moved?
I found a few glitches in the page formatting and I will be gradually putting them back up one by one this week. Sorry for the inconvenience!
The only pages from the series that are up right now are the Intro, the List of Adventist/FPMG employed physicians, and the page to download a list and a recent report that summarizes the main points of the series. I am updating the list right now to include Lake, Pasco and Volusia counties.
The Intro is at:
http://www.ethicalhealthpartnerships.org/FloridaHospitalReportIntro.html
The list of physicians is at:
http://www.ethicalhealthpartnerships.org/Adventistphysicians.html but as of 2:30pm today does not have the other county updates.
And the page for the downloads is:
http://www.ethicalhealthpartnerships.org/Adventistphysicians.html
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