Dr. Solomon’s Dilemma presents the conflict that doctors having in treating patients while keeping the cost of helping them down. Hedrick Smith reports from Boston on Marty Solomon of St. Deacon’s Center .We look at an intensive care patients whose been in hospital for seven weeks. Solomon estimates the cost of treating the patient at a couple hundred costs. Right of the bat, Solomon explains the dilemma of treating patients who are running the cost of his hospital up. Smith says doctors are rebelling and fighting HMOS. In theory, they are supposed to give care back to patients. As Smith points out though that entails accepting the cost of the patient while keeping the cost of treating them down.
We go back to Marty Solomon. Smith tells us Solomon has been treating people for over twenty years. Solomon talks about his early experiences how people that he’s known from his past are now his patients. We see Solomon at work. By the end of the day, Solomon will receive a hundred phone call and see over thirty patients a day.
Smith tells us that Solomon is dissatisfied with his work including managing care with patients. Solomon and his colleagues find it hard to treat patients while not letting completely go over the budget of caring for them. We meet the Ceo of Care Group Jim Reinertsen. Care Group is the company that Solomon and his colleagues work for. Care Group is a network of patients and doctors. Kim Saal, Care Group’s medical director says the key to doing is cutting cost while getting doctors to work for them. Every pill and shot is assessed a financial cost. Smith tells us that Care Group provided a billion dollars in health care but lost a hundred million. This is done without any physical proof to back it up. Smith says that the conflict of interest for Care Group is similar for other Boston hospitals and care groups. He mentions Tuffs medical company who is undergoing the same dilemmas. One doctor of General Medicine group says despite the cost conflict , doctors should not lose focus of helping patients. Reinertsen describes factors that to the dilemma like lack of federal payments, increasing cost of technologies and so forth. Smith mentions that this outlook on health care has made the hospital more efficient because they won’t want to accept the full cost of treating a patient if the cost of helping would hurt the hospital financially.
However, as patient, Steve Bookbinder, points out the hospitals shouldn’t always follow the profit/loss model for patients. As evidence, his story is presented. Bookbinder went in for open heart surgery and in three days was released from the hospital. Everything was fine until Bookbinder developed a serious staph infection on his chest. Bookbinder eventually spent three weeks time in the hospital and hospital couldn’t cover the whole cost of caring for him. We move to the case of a pregnant woman with diabetes being treated at Joslin Diabetes Center.. Smith points out that the hospital gets paid for caring of pregnant woman but not so much for her diabetes. We move to a “teaching” hospital in Beth Israel which serves patients but also offers training for young doctors. Smith tells us that the federal government has cut back billions of dollars in aid for teaching hospitals like Beth Israel.
The next part of the episode deals with connection with doctors and HMOS. Specifically the incentive between doctors and HMOS to keep their patients with their hospitals not for their well being but to make a profit. We move from there to issue of Globally captivated contract such as Care Group’s plan with Medicare HMO Secure Horizons. Smith describes this plan as an extreme risk because the care is paid for by a pool of money by doctors. Any money left over is given to doctors. The plan helps out patients tremendously but doctors hate it because it often leads to them losing lots of money. Solomon states “I’ve already lost money on this patient.” We learn about lead changes in a couple of hospitals like Beth Israel. We lastly learn about a patient that died. To stress the fact that the patients are seen as mere numbers, Smith tells us that Dr. Solomon has recorded a patient’s death as a mere number.solely because he was the most expensive patient he had.
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