Who could possibly be hurt when you restrict what services hospitals may provide?

Credits: Grocery Store Image by Vectorportal.com

I know, you had to read that twice, it’s stupid and was hard for me to write, but basically, it’s the exact and very short-sighted action that the state of Massachusetts just took.  You can read the details in this 11/27/2021 report by Fierce Healthcare (https://www.fiercehealthcare.com/hospitals/mass-calls-hospitals-to-reduce-elective-procedures-amid-staffing-shortages).  But let me sum it up for you, in more personal terms.

Firstly, you should know that “non-urgent” is defined as a service that is “scheduled in advance.[i]”  That is supposed to reassure you that if you got in an accident or had some emergency like a stroke or heart-attack, that you COULD still be treated.  And after all, if a procedure isn’t urgent, do you really need it?

I know, I know, the state of Massachusetts currently has LOWER hospitalizations than “almost every other state in the nation” but gee, instead of just letting hospitals postpone procedures IF AND WHEN they have an influx of critical patients, why not just issue a blanket mandate now and save doctors having to make a medical decision later.  It’s not like they’re trained to make medical decisions or anything.

Well, YOU could be hurt…

Now, let’s think about medical procedures that are usually “scheduled”.  Maybe you are slowly going blind from cataracts and are finally at a point where you need new lenses.  Maybe you are finding it too hard to walk and need a knee replacement, or you’re in agony due to a sports injury and need surgery on your shoulder or foot?  (well, don’t worry about those, because they can provide you with opioids and we know how great that will turn out![ii])

Maybe you’re a woman suffering debilitating pain from fibroids and want a procedure such as a hysterectomy or ablation?  Or, it might simply be that you, woman OR man, have decided that you no longer wish to have more children and you’d like a tubal ligation or vasectomy?  How about a lump on your arm?  My doctor assured me that it was “almost certainly” not cancer.  You might understand I still wanted it removed and checked, DESPITE having to “schedule” the procedure.

That’s the harm to YOU.  Does it hurt anyone else?

YES!  The reason the state claims to be worried and taking preemptive action is perceived staffing shortages.  We don’t want to burn out our front-line workers, do we?  (of course not, and THAT is sincere.)  Except for two things.  First, “scheduled” procedures don’t have to be performed in an operating room and generally do not require an ICU bed or even an overnight stay in a hospital. And secondly, how in the heck do you think hospitals get the money to pay doctors and other staff?

Where does the money come from?

Did you think hospitals have an unlimited amount of money and they just keep staff sitting around on the off-chance that a massive influx of patients MIGHT occur?  Massachusetts says they observed the loss of 500 medical/surgical beds across the commonwealth.  No Duh!  During COVID, we also canceled scheduled procedures, not just due to capacity, but because we weren’t sure how the virus spread and we didn’t have vaccines.  But those “scheduled” procedures are EXACTLY what keeps most hospitals open and operating.[iii]

When doctors are NOT treating someone with COVID or performing open-heart surgery, they see patients for routine reasons.  “Hey Doc, I have this weird pain that’s been bothering me a while…” or “This lump is starting to scare me.” Or even, “Please doctor, every month I have to miss work because these cramps make my life hell!”

When mundane things like that happen, the doctor does NOT shout “Get this patient into surgery, we have to operate STAT[iv]”.  They say things like “Let’s check those eyes.” or “Let’s have a look at that lump, we might need to SCHEDULE a biopsy.” And when they DO that, then things like this happen:

  • The doctor, physician-assistant or nurse may examine you.
  • A lab test might be ordered, performed, and reviewed.
  • Further procedures might be SCHEDULED and performed.
  • And most crucially to the operation of the hospital, a certified “coder” will translate statements like “let’s look at that lump” into a CPT code like 73222 “Diagnostic Radiology Procedures of the Upper Extremities” so that SOMEBODY can be billed, and the hospital can pay for electricity, supplies oh yeah AND SALARIES for their staff.

In short, if you cut-off the majority of services that a hospital or clinic is allowed to perform, they will have no other way to fund excess capacity that might be needed in unusual circumstances.

How about an analogy?

I’m sorry, I know you didn’t want to know how hospitals stay in business, and apparently neither do regulators in Massachusetts, so how about a grocery store analogy?

Margins for many “staple” products such as bread, meat, rice, milk, flour and so on are razor thin.  Your local grocery store doesn’t make enough money from selling those things to keep the doors open.  They also sell OTHER products, like imported olive oil, almonds, or maybe alcohol.  If the government said “We see that you’re OK now, but we’re worried that if there was another supply-chain issue you MIGHT not have enough stockers to put out rice and flour, so we want you to STOP SELLING ALL OTHER products NOW and keep your staff rested.”  “Don’t try to hire more staff, that would be silly.”

Bottom Line

When an emergency hits, hospitals already have plans in place to delay non-critical services.  It’s a form of “triage” where they treat the most critical patients (that can be helped) BEFORE less critical cases.  So, my infant son with a high fever and fluids coming out both ends, had to wait until the elderly woman with a heart-attack could be helped.  That’s common sense and the right thing to do.  The hospital did NOT need to be told to preemptively turn-away nervous parents on the off-chance that a heart-attack victim MIGHT show up.  The hospital worked it out, all by themselves.

Don’t stop patients who CAN be helped from BEING HELPED. Which will allow hospitals to earn money to provide staff that can, on a moment’s notice, shift gears from hysterectomies to pandemics.

 

Additional Info:

[i] As defined in the linked article.

[ii] I can’t believe I have to state that my statement is intended to be ironic, but when a state FORBIDS medical procedures when both capacity exists AND when it could help keep staff employed and hospitals in business, I guess we have to be explicit.

[iii] An exception to the rule are CAH’s (Critical Access Hospitals) which are small, unprofitable facilities, located in rural or under-served areas.  These hospitals will never perform enough scheduled services to pay for a full-time ER staff but without them there will be no coverage for that area.  So, the taxpayers step-up and keep them operating.

[iv] Did you know that “STAT” is short for the Latin word “statim” which means “immediately?”  STAT is just so much cooler than saying “Now!”

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