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THE
big factor," he says. "Hospital systems are buying up physician
practices to fill their ORs. They're paying enormous amounts of
money for these surgeons, and have to keep them busy."
A growing number of hospitals want their own surgeons, and
want to control every aspect of revenue generated from an opera-
tion. In the long run, Dr. Ruggieri believes, hospital-employed sur-
geons will limit patient choice and access to the most experienced
surgeons, because a health system's primary care physicians will
refer patients to that system's surgeons, who are often fresh out of
medical school and looking for the financial stability of a salaried
position.
It also raises healthcare expenses across the board, says Dr.
Ruggieri, who points out that the cost of surgery depends on the
contracts negotiated with Medicare and third-party payors. Let's
say an independent surgeon and a hospital-employed surgeon take
out gall bladders in neighboring ORs. "The surgeon who's
employed by the hospital gets paid 20 to 30% more for performing
the same procedure, regardless of outcome," says Dr. Ruggieri.
"It's a crazy system."
The buzzwords in hospital systems are patient retention and
leakage. "So if you take a patient out of the system for surgery at
an independent surgery center, that's considered a negative
against the physicians," explains Dr. Ruggieri. "It eventually hurts
their bonuses."
Former U.S. Speaker of the House Tip O'Neill famously said all
politics is local. "Well, all practice is local, too," says Dr. Ruggieri.
"If a hospital system is competing against you, like mine is, you
have to choose a side. Otherwise, when the music stops, there's
no chair to sit on."
— Daniel Cook
