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Who employs your doctor? Increasingly, a private equity firm

nytimes.com

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Re: Who employs your doctor? Increasingly, a private equity firm

#81

Post by wpietri »

cscurmudgeon wrote: post #71
verteu wrote: post #39

Earlier quoted context omitted.

> As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc. No? They used "a within-facility differences-in-differences design to address nonrandom targeting of facilities" so they're measuring the change in outcomes at the same facility before & after takeover.

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while.

Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.

Re: Who employs your doctor? Increasingly, a private equity firm

#82

Post by boondoggle16 »

raphman wrote: post #66
leoh wrote: post #44

Earlier quoted context omitted.

> You can’t win with the incentive game. I agree that incentives are frequently and perhaps typically exploited, especially when crafted carelessly or not iterated upon, as most incentives seem to be. I would be eager to contemplate a clinical outcome based incentive scheme.

Wouldn't this incentivise doctors to only accept cases with a high chance of quick success? Young child with cancer? Nope, not worth the risk. Patient with mental health problems? Takes too long, outcome not easily measurable. Obese patient with back pain? Let's do surgery instead of investigating and treating the root causes.

No, this is way too simplistic. They can be judged on relative performance of cases.

Just like schools, you can tell which teachers are good, even in districts with bad kids.

Re: Who employs your doctor? Increasingly, a private equity firm

#83

Post by uLogMicheal »

lordnacho wrote: post #46

To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised. For PE however, they've found a way around it, using the machin…

On top of this, most of it is leveraged capital at a fraction of the actual cost, so the risk is almost vacant for the firms. Corrupt banking leads to infinite leverage for the super-wealthy to buy up / control it all. They do not need to care because they risk little and still profit even if it crashes because the tangible assets have shifted to their side of the gap.

Re: Who employs your doctor? Increasingly, a private equity firm

#84

Post by boilerupnc »

gruez wrote: post #21
balderdash wrote: post #7

I’m the furthest thing from having any knowledge here, but it feels like it should kind of be like how law firms can only have lawyers be owners with the idea that owners need to be aligned with codes of professional conduct/ethical obligations to clients etc

That model works well for professional services (eg. lawyers, accountants, consultants) because require very little capital. Everything from the office they work in, to the computers they type on can be leased. The same can't be said for hospitals, which cost hundreds of millions to build and equip. How are you going to raise all that capital from only the doctors? They're rich, but not that rich. Moreover, the payba…

There were a number of physician owned hospitals. Here's one compiled list [0] circa 2013. ACA seems to have limited growth of these hospitals [1]. My view with a local flavor of this in Indianapolis (St.V Heart Center) was pretty positive and matches with the WSJ articles assertion. When doctors feel in control and view the hospital as a reflection of their own community - holistically the entire operation embodies and reflects that from the doctors to the nurses to the staff themselves. Similar to how a small-town practice reflects the values of the doctor who runs it and depends on its reputation. Some of these hospitals have been sold off and I've heard nurses and doctors lament of the better times when they felt more autonomy when the doctors made the decisions based on shaping a hospital that they'd like to be admitted to rather than the vision from an MBA.

"Specialty physician-owned hospitals focused on cardiology and cardiac surgery were found to deliver higher-quality care than nonprofit hospitals, with lower rates of hospital readmission or mortality for high-risk surgery. Physician-owned specialty hospitals for orthopedic procedures, such as hip and knee replacements, offered lower costs and higher quality than nonprofit counterparts."

[0] https://www.beckersspine.com/lists/14578-56-physician-owned-...

[1] https://www.wsj.com/articles/end-obamacares-ban-on-physician...

Re: Who employs your doctor? Increasingly, a private equity firm

#85

Post by cscurmudgeon »

wpietri wrote: post #81
cscurmudgeon wrote: post #71

Earlier quoted context omitted.

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.

> If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while.

My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades.

Edit: Some resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/

https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700...

https://www.hsph.harvard.edu/miguel-hernan/research/causal-i...

From 1999:

https://liberalarts.tamu.edu/sociology/wp-content/uploads/si...

Re: Who employs your doctor? Increasingly, a private equity firm

#86

Post by kjghkjghkjgh »

thfuran wrote: post #65
kjghkjghkjgh wrote: post #60

Earlier quoted context omitted.

How would vaccines and new drugs be invented without any profit incentive?

Isn't a lot of that coming out of universities already?

Many are but they also work with for profit pharma companies to fund the work.

Re: Who employs your doctor? Increasingly, a private equity firm

#87

Post by synetic »

cscurmudgeon wrote: post #78
synetic wrote: post #30

Earlier quoted context omitted.

But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare. All systems have ration care but it is immoral for someone to profit by denying care. Profit motive does not make for a good healthcare system.

> But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare How does one profit from denying services?

Is this a serious question? You can’t think of a scenario in which a company in America profits from denying care? You should research insurance companies and understand how it is they make a profit.

Re: Who employs your doctor? Increasingly, a private equity firm

#88

Post by synetic »

kjghkjghkjgh wrote: post #51
synetic wrote: post #30

Earlier quoted context omitted.

But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare. All systems have ration care but it is immoral for someone to profit by denying care. Profit motive does not make for a good healthcare system.

Should a Lasik surgeon provide Lasik to everyone regardless of their ability to pay?

The lasik surgeon in your example isn’t profiting by denying care. Their profit does not increase by declining service.

Re: Who employs your doctor? Increasingly, a private equity firm

#89

Post by swagasaurus-rex »

tryptophan wrote: post #35
alach11 wrote: post #4

When possible, I prefer people who work for me to have incentives that are aligned with mine. PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests. I was talking to my wife’s obstetrician about this last week and he also feels strongly about it. He’s paid a flat salary and gets no financial benefit for a c-section vs. an inductio…

Flat salary is an incentive to do the easiest option or least work. You can’t win with the incentive game. One nasty way that can manifest is to under test because if you don’t find anything you don’t have to do anything.

Perverse incentives have a particularly gnarly likelihood of a feedback loop which causes even more destruction.

Healthcare in America is a prime example. So is higher education, in which the lenders and universities collude to raise prices as much as possible.

Re: Who employs your doctor? Increasingly, a private equity firm

#90

Post by oatmeal1 »

MereInterest wrote: post #54
VancouverMan wrote: post #32

This is the kind of economic distortion that should be expected when onerous government-imposed regulation of practitioners, medication, and medical devices creates barriers to entry that reduce competition. While such regulation may have been imposed to try to increase safety, quality, and consistency, for example, it also ends up interfering with the incentives of the participants. The lack of real competition, com…

Alternatively, this is the kind of economic distortion that occurs when excessive de-regulation removes the floor of a market, allows local monopolies to flourish, and allows a system in which the most profitable action is to let people die. While such deregulation may have been imposed to increase competition, it also interferes with the incentives of the participants. The lack of real oversight, combined with the i…

Strongly disagree with this comment. The most powerful monopoly one can hold is one entrenched by the will of the government. Every time the people have asked the government to step in and regulate healthcare, corporate lobbyists have crafted the laws in such a way to weigh down any potential competitors.

In the US, the more regulated a market is, the more likely people are to demand further regulation, because they incorrectly blame the free market when the market is anything but free.

The unnecessary deaths in US healthcare are largely attributable to waste and incentive mis-alignment; the person paying for healthcare isn't the one receiving it, so it is no wonder patients receive poor care.

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