Thursday, February 14, 2019

How Hospitals Transitioned From Chairity Care to A Corporate Cash In Culture

The land of the free and the home of the brave is home to some  the most expensive health care in the known universe. What the heck happened? The last I remember,  the  rate for nursing, room, and dietary in a big inner city hospital was 68 bucks per day. The charge was known as the hospital NRD fee and it covered just about everything except for OR fees and pharmaceuticals which were dirt cheap.  A visit to the ER was 28 bucks if you had it and no patient was ever out of network or even asked about insurance.

 Hospital superintendents were paid slightly more than nurses and there were no big bonuses for anyone. We were all in the same boat and everyone knew and respected frugality. This is my anecdotal account of what happened during the transition to the current cash-in culture of today's healthcare. One caveat, these notions have been filtered through what's left of an ancient nervous system that remembers old school nurses who never expected to own much of anything and lots of MDs were content with an apartment.

It's easy to rattle of a list of culprits in the stratospheric rise of healthcare cost. Entrepreneurially motivated physicians and nurses wth the notion that I worked hard and deserve bountiful financial compensation for my work is a part of the story. Patient care in of itself was the old school compensation and material deprivation produced a sense of solidarity among nurses with everyone looking out for one another.

Old nurses like myself really had it easy compared to the all for one, and one for all whippersnapperns of today when it comes to salary. Our basic needs were met without worry and there were no school loans or financial demands. If we needed medical care any MD would gladly see us as a professional courtesy and if a hospitalization was required, our diploma school had a private "alumni room" for our exclusive use. It was the only room in the hospital with genuine Karastan carpeting. Nurses lived the good life without money changing hands. It's no wonder we affectionately referred to our hospital as "Mother."

Explosive growth of technology and electronic record keeping consumes lots of dollars. So do mindless Press Gainey surveys. Old school physicians would argue until they were blue in the face that patients are not qualified to make judgments about the quality of their care. I can see their point. Some of the very best surgeons I worked with were not very touchy-feely, and that's putting it nicely. Dr. Slambow would visit post-op patients with part of his breakfast and/or lunch spilled on his tie and shirt. I can see why folks would question the credibility of a surgeon wearing his breakfast and lunch, but he was one of the best when it came to minimizing post-op complications.

In the late 1970s my humble school of nursing was closed down for good after being in existence for almost 100 years. The building functioned as an oncology clinic for a couple of years and was then razed for the construction of a multi-level, monstrous parking garage. Fancy hospital parking facilities are given short shrift when considering how corporate interests made health care such an expensive commodity. This is where the rubber meets the road (or parking garage) in my woe filled tale. Parking garages are at the root of the problem.
Parking garages became the welcoming mat for hoards of greedy go-getters

Very few nurses owned cars when I was toiling at the bedside. We made do with the CTA, bicycles or good old fashioned shoe leather, those Clinic shoes were made for walking, It's interesting to note that our nursing school was way ahead of the curve when it came to alternative transportation. The first object to greet someone approaching the school was a massive bike rack, usually at least half full. There were no worries about locking your bike. Who would even think of stealing a nurse's bike?

Physicians and the fortunate few that owned autos found ample space on the street or small unregulated surface lots. Patients arrived at the hospital by taxi, bus, or walk-ins. There was no EMS, and trauma patients frequently arrived in the back of police cars or paddy wagons. Chicago police operated unique,  three wheeler Harley-Davidson motorcycles  which could be ridden just about anywhere. I vividly recall a drowning victim from Montrose Beach being hauled up to the ER secured to the back of a police officer's tricycle motorcycle. The officer even went so far as to suggest the road bumps jostled the water out of the victims airway. The patient survived with quite a story to tell. Maybe the cop had a point.

Hospital parking garages dramatically demonstrate the ridiculous profusion of administrative busy bodies, clerical, and unnecessary hucksters attempting to sell everything from pharmaceuticals to medical equipment. Visit just about any hospital parking facility on a Sunday morning to observe first hand how few workers are  really necessary to take care of patients and it's not because administrative big shots and pharmaceutical representatives are attending church. The Sunday morning deserted parking garage syndrome is even more acute at government agencies such as VA Hospitals.

Hospital parking garages are like a beacon to pharmaceutical hucksters. In the old days drug reps were a non-entity. No one needed to sell penicillin because it really did kill strep and everyone knew it. Much of drug pricing today is done with blatant extortion. A marketer of Zyprexa might claim that his drug will negate the necessity of long term hospitalization saving untold tens of thousands of dollars, hence,  his product is worth a ridiculous charge.

Epinephrine was dirt cheap. Everyone  knows what Mylan's Heather Bresch did with exorbitant charges for that "lifesaving" drug. I betcha if drug reps had to ride a bicycle to hospitals they would be few and far between.

Parking garages and the influx of money seeking hucksters changed how doctors and nurses thought about their patients. Money changing hands at every corner of the hospital amidst a bean counter culture changed who people were. Mega bucks doled out in bonuses to administrative big shots who never helped anyone except for themselves became the rule. It was so  much better when all I had was a Raleigh Super Course bike to ride to work and to heck with all those monstrous parking garages.


28 comments:

  1. Do you remember house calls by family physicians? The for profit health care system is probably the main culprit in our slow decline of life expectancy in this country. But, hey, at least some people are getting fabulously wealthy.

    ReplyDelete
  2. Jono your comment brought back memories! When I was a kid the local doctor did actually come to your home - you could book a home visit at no cost!

    As a teenager my best chum's Dad was our local family doctor (when local doctors also did deliveries and tonsillectomies etc) and I remember many times when our family would be over at their house for dinner and the phone would ring and it would be Sister from the local village hospital saying Mrs X was about to deliver, and off he'd go - only to come back hours later and sit down wearily at a dried-up baked dinner that had been put in the oven to stay warm for hours and hours... he never complained.

    Now doctors here refuse to work on weekends. It's strictly 9 to 5 and nights off. As for house calls - no way! It's all about convenience and money... which they make a heap of. You should see the cars they drive - gold Jaguars with number plates saying things like "DOC-01". It's the "it's all about me" culture I'm afraid.

    ReplyDelete
    Replies
    1. OFRN, House call physicians are making a come back, at least for home bound patients. It gives me hope that everything comes full circle, maybe I'll work long enough to see corporate culture money hunger go the way of that scoliosis sling you mentioned in an earlier post. A young nurse can dream.

      Delete
    2. I'm too old to be a dreamer, but house calls would certainly be wonderful for folks confined to their home. House calls were way before my time. Thanks for taking the time to leave a comment. It warms the cockles (whatever they are) of my heart to have youngsters peruse my foolishness.

      Delete
  3. I should probably quit belly-aching about contemporary hospital culture because it's beyond my foolish level of comprehension. A trip to a modern hospital used to feel like a trip to a parallel universe where money and personal possessions of the folks toiling there are the focus. Now, I feel like it's a visit to another world far removed from what I knew and loved. Maybe I should stick to writing about terrazzo floors and those lovely, huge gleaming porcelain scrub sinks in the hallowed halls of the tiled temples of yesteryear's ORs. I still have wonderful memories of finishing up a difficult trauma case with Dr. Slambow where everything was going to be OK again for the poor soul on the table. I probably took home about 9-10 dollars for crawling out of bed at 3AM, but the memory is priceless. I only hope the affluent youngsters of today's healthcare scene feel as good, as I do about what they did when they are old and wrinkled up like me.

    Whew..I think I'm going to write about pilonidal cysts or something to distract myself on my next post!

    ReplyDelete
    Replies
    1. I feel your pain OFRN. Our public hospitals here are at least still free - but I can't afford to see a specialist doctor as it will cost me around $150.00. When did it become too expensive for a patient to have an appointment with a doctor? Sue. (Sorry I forgot to put my name on the post above in reply to Jono)

      Delete
    2. You sound like you need a laugh OFRN. Have you ever seen this clip from the wonderful British BBC production called "Getting On" about two old-time rather world-weary nurses working in a geriatric ward with a rather OCD woman doctor? A poo was found on a chair... enjoy! Cheers, Sue.

      https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjV_qmRrb_gAhWCfn0KHWQcDU4QyCkwAHoECAYQBA&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Dblib3a9FLCE&usg=AOvVaw3glc-zqQEGuJmcqVYWUjTh

      Delete
  4. https://youtu.be/blib3a9FLCE

    In case the first link didn't work - Sue.

    ReplyDelete
    Replies
    1. And another lovely episode from Getting On - two old school nurses trying to come to grips with new technology. I should mention that Jo Brand, who plays the older nurse, was in fact a nurse before she went into acting. Enjoy! Sue

      https://youtu.be/L70Y-QbH3s0

      Delete
  5. The "Getting On" series was not broadcast here and I found it delightfully funny and foolish; right up my alley. I especially enjoyed the clip from the episode about committee of nurse's discussing hand sanitizer. So realistic and so funny.


    The two nurses figuring out a fancy bed brought back lots old memories. When electric beds were introduced in the mid 1970s the older nurse thought they would never catch on because they were an electrocution hazard for patients.


    It was good exercise cranking those old manual beds up and down and it was another reason to be in the room with a patient.


    Thanks for the video tips, Sue.

    ReplyDelete
  6. Do you know which episode the one about the hand sanitizer was OFRN? I can't seem to find that one, or not on YouTube.

    Glad you got a chuckle, cheers, Sue.

    ReplyDelete
  7. ASzHSCF8F68 is the episode on YouTube


    I just love the administrative person leading the meeting-so out of touch with the clinical environment. A yin/yang situation of funny/sad.

    This

    ReplyDelete
    Replies
    1. Rats I can't find it. Sounds like a good episode.S.

      Delete
  8. I became an ER nurse ten years ago, which was already solidly into the Hospital Age of Foolishness but still somewhat close to days past when an ER really was just for emergencies. One of my mentors was a graduate of the now-defunct hospital diploma program over 40 years ago - the stories she would tell about how things used to work in-hospital just make me envious. There are a lot of great advances in medicine, and all things must change to keep up with the times, but when it comes to the way a hospital works I do wish those old days I only heard about had lasted longer.

    ReplyDelete
  9. Thanks for stopping by Shrtstormtroooper. Your mentor is a good bit younger than me, so you can imagine my experiences are probably even more extreme. It was really wonderful working in old hospitals when true charity care ruled the roost. The lack of financial pressure was probably the most liberating. It did not really matter how little money we made, life was grand and all of our needs were met and then some. Life was very good.

    Oldfoolrns like me can be quick to judge contemporary healthcare in terms of their old school, feel good value system. When my mental sclerosis recedes to brief spells of plasticity the realization that cures in old time hospitals were few and far between tempers my memories. Dr. Salmbow said it best when he argued that the only truly successful surgery was for trauma. Post op pain with those huge incisions was unbearable and every surgery was an -ectomy of one variety or another. So different from the laproscopic repair and replacement work done today.


    Whippersnapperns of today work in a radically different and more challenging environment but at least you are providing quality, curative interventions albeit to a heavy burden on yourselves.

    We had it easy compared to you.

    ReplyDelete
    Replies
    1. Le sigh. There is a happy medium, but it would involve administration giving up million dollar bonuses and cutting some of the Chief Blank Officer titles and instead focus on providingprovidin patient care via more staff support. But I think I'm just yelling at the clouds with those ideas...

      Delete
    2. Also, note to self: stop replying to blog posts via phone. The typos! So distressing.

      Delete
    3. Hope OFRN doesn't mind me responding to your posts Shrtstormtrooper - but a video posted 26 April 2018 here that I sent to OFRN might interest you. It's a nursing recruitment video from New Zealand (I'm in Australia so just next door) from 1965 and when I started nurse training here in January 1975 - ten years later - believe me not much had changed. Our hospital care is free of charge here so we don't have quite the same problems as you have, but I agree with OFRN nursing was in many ways an easier job back in our day! Good luck, Sue.

      Delete
    4. You can find it if you click on 2018 and scroll down, it's called The New Nurse. Cheers, Sue.

      Delete
    5. So different from the recruitment and orientation videos today - thanks for this!

      Delete
  10. Sue, that video is priceless. It always reminds me of Mr. Peabody in the old Rocky and Bullwinkle cartoons when they fired up their Wayback Machine for a journey back in time. The incessant smiles of the old . nurses and the inner peace they radiated brings back old memories. I watch it when ever I need a boost!

    ReplyDelete
    Replies
    1. Love those cartoons! Living near Frostbite Falls, Minnesota also gives me an interesting perspective. "Every dog should have a boy."

      Delete
    2. I like those old Clutch Cargo episodes too with Spinner and Paddlefoot.

      Delete
  11. Sue, that video is priceless. It reminds me of those old Rocky and Bullwinkle cartoons when Mr. Peabody fired up their Wayback Machine for a journey to yesteryear. The old nurses radiate a sense of peace and satisfaction that is missing today. I view the video whenever I need to boost my spirits. It's a classic.

    ReplyDelete
    Replies
    1. I watch it from time to time too OFRN and it seems to have disappeared from YouTube, I can now only find it on your website! I think the attraction is I could step into that video and almost everything would be completely familiar to me - whereas hospitals today are in many ways almost unrecognizable from what I knew... And yes we did have that kind of manner, very calm, only the Charge Sister could dish out patient meals (it was a tradition that we continued simply because it was part of the honour of being the Sister in Charge), we held the patients' hands as they were wheeled to the Operating Theatre, and had all the fun and camerarderie of living together. We even had those lattice things on the wall for holding letters like they have in the film! The days before mobile phones and emails... and we used to escort discharged patients out of the ward just as Nurse Scott does in the movie...

      I love the moment when the Sister giving the lecture on serving meals takes something off one of the nurses - the nurse gives her such a look! Have you noticed that moment? I do wonder what was going on! Cheers, Sue

      Delete
    2. They do have nice smiles all the nurses in the video don't they - I think the problem is we miss those days OFRN. I know I do. Sue

      Delete