“What do you mean all hospitals aren’t equal?”

“What do you mean all hospitals aren’t equal?”

I just tried to find electronic advice on choosing the right hospital for a surgery. This isn’t something I’ve ever done before. I work in healthcare, so I wouldn’t ever be faced with this decision, I would just know where to go. But I was wondering, how do other people come to a decision about where they would have their elective rotator cuff repair done? I decided to just do some online research myself, as most people would have to do.

Holy smokes.

I typed in to my Google search field “how to choose your hospital.” An article from Forbes was the first thing that popped up. I like them, so I clicked. There was some useful info on hospital reported infections, Joint Commission accreditation, and a neat point that there isn’t any specific metric to choosing the right hospital. Not too opinionated, but helpful points nonetheless. But then there was a great point; talk to your doctor. Yes, I like the sound of this. Who would know best about hospitals? Doctors. Who would give the best, unbiased opinion about a hospital? NOT doctors.

Here’s why.

Surgeons, like those doing rotator cuff repairs, are often paid in more than one way. It is usually monetarily, but they can also get perks. Take for instance the surgeon who is invested in a surgery center (hot topic in the media for a while). He gets paid on revenue not only from the surgeries he does, but from every surgery done at the surgery center he’s invested in. The jest? He wants you to have your surgery there not just because he’ll get paid for doing the actual surgery, but he’ll get paid from the profit the hospital makes from you having surgery, period. Creepy right? It’s a double whammy for him. So when you ask for his recommendation of where to have your surgery done, infection rates aside, chances are he’s picking the place that he’ll profit from.

Some surgeons don’t have these kinds of relationships or agreements, but that’s not to say that they aren’t swayed by a multitude of factors that determine where you’ll have surgery. Some surgeons have privileges at more than one hospital. Weird right? Wouldn’t they just find the best hospital in their area and do all of their surgeries there? No. That’s because they can pit hospitals against each other for their benefit. Remember I mentioned hospitals making a profit from you having surgery? The hospital can’t translate that profit directly to the surgeon, that’s coercion, and illegal. But, they might offer the best surgery times, days, rooms, staff, free lunches, nice parking spots, and the list goes on. So this surgeon, who has privileges at more than one hospital, actually has commitments to more than one hospital, because hospitals don’t offer these perks without something in return. He only gets all of those perks if he does X number of cases at that hospital each month. So he might like one hospital better, knows it’s a better hospital based on infection rates, accreditation etc. but he’s actually going to book you at the ‘not-as-good’ hospital. Why?

Because he has to make his quota for the month for that hospital too.

I’d say that’s a complication, wouldn’t you?

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