As you know, I rarely discuss my first profession at this blog (pharmacy), and I don’t think I’ve ever discussed MBA education here either, but this needs to be said. Here goes.
As I sat last night in one of my law classes discussing health care “reform” (PPACA) and the new laws surrounding Stark and and Anti-kickback legislation, I grew more disturbed. Here’s why.
In pharmacy school (one of the most heavily regulated professions of all–pharmacy–), we learned about how to not only put tablets in a vial (which sometimes I think is the perception that this is ALL pharmacists do–for the record, we do more) but now, we teach about how to put new services and other products into the pharmacy to improve the lives and health of our patients. In MBA school, they call this “vertical marketing.” That is, it is serving the patient population of communities in different ways, through the same organization. For example, having a pharmacy provide Medication Therapy Management (MTM) services to their patients, and have durable medical equipment (DME), and sell other over the counter drugs on top of filling prescriptions–all 3 are available at the same store. Cool. Great. It’s convenient for the patient, and good for the store, even the community around the store. You can go to one store to get all 3 things or services. Vertical marketing is a marketer’s/MBA’s biggest dream!
However, now with new health care reform (PPACA), Stark, and Anti-kickback legislation, that same dream of vertical marketing for the MBA can now be an illegal nightmare for health care professionals. For example, if a doctor owns a lab and sends her patients there without disclosure and list of other labs in the patient’s area (as if the doctor could know that off of the top of her head), that could be self referral violations under Stark–which means, potential loss of provider status, fines, and yes, even prison time.
Who created Stark, you may ask? But of course! Congress. How many medical professionals are actually in Congress and understand good patient care? Not enough. This “health care reform” law is being made by non-medical professionals (mainly lawyers). But here’s what I think needs to be said about all this: the more regulation you put on top of health care, the less likely you are to get students into the professions, and less likely you are going to have health care providers at all.
Case in point: primary care. There is a current shortage of primary care doctors in this country, and it is only going to get worse. But then again, as students racking up hundreds of thousands of dollars of debt, I honestly don’t know how medical students could justify return on their educational investment to go into primary care anymore. If all they can do is work as a doctor, making half or a third of what a specialist makes, with a crushing patient load and pressure from managed care to see a new patient every 8 minutes, how long would it take to pay off a couple hundred grand in education debt? FOREVER! Why do that if they can go specialize, make at least twice the salary, and not have the onslaught of patients?
There’s also some major changes on doctors owning hospitals in health care reform, i.e. less of it happening now. Here’s what I think as a patient, and a business owner: I WANT my doctor to be invested in the place and community where I’m getting care. I want her to CARE about my surrounding neighborhood. I want her to make enough money to be comfortable and ensure that she’s able to pay off her student loans, and I would be happy to go to her lab, because she got me in when I was sick and took care of me! She takes care of me, so I’d be thrilled to help her out in return. We all do this, each and every day–help others out who help us!
Now, Stark and Anti-kickback came about because some were abusing the system, and technically it only directly applies to Medicare. But should EVERY doctor be punished? Why can’t a doctor own a lab next to her office to make it more convenient for the patient and maybe even able to provide better care? The argument (by the lawmakers) is that there’s no arm’s length deal between a patient and her doctor, and that makes it unfair competition. Do lawmakers really think we as patients are that naive? Frankly, I resent lawmakers assuming that the population of this country is that stupid and ignorant.
I think a lot of these “laws” on “reform” are actually fragmenting health care and making it more cumbersome and difficult FOR OUR PATIENTS, especially for our elderly patients, who, by the way, are going to be the biggest population in need of medical care from now until the Baby Boomers come to end of life. Can you even imagine a 90 year old patient driving from her doctor’s office, across town to a lab for her bloodwork, and then across town yet again to get her DXA?
My point…? One education’s utopia (the MBA and the pharmacist who creatively busted their hump and grew a business by vertical marketing to help their patients/customers and YES, their businesses too) has turned into a nightmare for health care now. I recently heard we spend more than 2 days in line waiting every year for various appointments. Isn’t there value in vertical marketing and getting all your products and services from the same place? I don’t see Congress putting Stark and Anti-kickback legislation on to big box retailers…(at least yet…)
With the most expensive health care system on the planet, you think we could do better. I know we can. And if you’re a lawmaker reading this post – PLEASE don’t try to fix the problem by slapping on more legislation! You’re going to regulate us out of having a doctor to go to when we are ill.
