Robert Wood Johnson Cancer Institute Healthcare costs, new institutes the larger hospital systems are building, and your health. It’s no secret that in the USA we pay more than any other country for healthcare. Yet, when you talk to your local doctor, you may be surprised that they are being paid less by insurers as your insurance premiums continue to rise. Primary doctors help us avoid unnecessary medical interventions and handle many common health problems simply and cost-effectively. As hospitals buy more physician practices and the seemingly efficient 10-minute office visit becomes the norm, health care costs are exploding upward while the quality of care statistically continues to worsen. Few if any small practitioners or groups are buying and erecting new buildings, or even buying and renovating existing ones due to rising costs and a tightening cash flow. Wall Street firms are using their money to buy medical practices such as your anesthesiology group while developing new models to profit from the system. Where are your healthcare dollars really going? Gagnon Cardiovascular Institute MMC Where is all the money going? It’s not going to smaller healthcare practitioners who struggle to survive and provide needed competition in a healthcare system that has become anti-competitive. Many have quit practice or joined hospitals or larger practices that can deal with the clout of the insurance carriers. It’s no longer enough to have the hospital you are affiliated with to protect you with their hospital PPO. While a large hospital will place you in tier 1, making access to your practice less expensive, some small hospitals joined larger hospital systems resulting in the mega systems we have now which reduces competition and offers them pricing power. The result is we are all paying more through higher copayments and healthcare premiums. Hospital systems that have gotten bigger are building new institutes for every symptom or disease. There are kidney institutes, spine institutes, orthopedic institutes, cancer institutes among others. Large healthcare groups or systems have doubled down on the model of minimal primary care but maximal specialist visits. These systems profit from every specialist you visit, who may use the same electronic health record but are highly likely to also recommend expensive procedures, tests, or drugs offered within the system. Hospital-based procedures are often priced multiples higher than similar procedures that were previously done in the doctor’s office. For example, a simple test for lactose intolerance (true story) that was as simple as taking a substance and breathing into a machine cost more than 5x what doctors were being paid. The result was doctors stopped doing the test and then they refer to their preferred hospital to get credit for the referral while you pay for it through a deductible at a much higher price than private offices used to charge. Sleep apnea hospital-based studies are over $4k when in office studies years ago were a fraction of this amount for the same test. The object is to keep all of those healthcare dollars within the system. This internal revenue stream can make minor problems more complicated while costing all of us $$$ in higher copayments and deductibles and healthcare premiums while adding little value to you, the consumer. If you are wondering why your insurance premiums continue to rise, new institute construction may be part of the reason. Segmentation of care is the other. Who you see first makes a difference. When you have pain or another type of symptom that is not normal, you may go to your primary doctor who will evaluate you and perhaps take bloodwork and your vitals. Some are now going to their chiropractor for a more efficient experience that helps them avoid pain management, therapy to a part of the body, and drugs for mechanical problems. Do we really need institutes that have doctors specializing in your symptoms while forgetting to evaluate the person in front of them? More practitioners and people do not necessarily make better care but it does increase the likelihood of messy management of a somewhat straightforward problem. It is true that medical providers have very little training in the musculoskeletal system, resulting in more tests which result in higher costs. Some practitioners are rebelling within the healthcare system by using integrative medical approaches or functional medicine that takes a holistic approach to body systems rather than treating them as if each is separate and not connected. These are styles of primary care based less on procedures and more on managing the problems by attempting to treat the cause rather than the symptom. In the musculoskeletal realm, chiropractors are the only providers who are treating this system holistically, which is how it is built. They believe in treating the patient rather than focusing on just the symptom. Based on a simple model, patients are evaluated and treated the same day without drugs or surgery and consumer reports. Other sources say that chiropractors receive the highest levels of satisfaction as reported by their patients. Hospitals are hiring chiropractors but since Medicare has not fully covered the profession, the ability to earn from the profession pales in comparison to other medical specialists, a fact that needs to change. Fortunately, there is a bill that aims to change it called the Chiropractic Modernization Act. It is also helpful that insurance carriers lost their antitrust exemption at the beginning of 2021, although the damage may have already been done. Large hospital systems may already be too big to fail, with Medicare being the only option to successfully negotiate with them. The healthcare system cannot sustain the current trajectory of costs. Patients have more power to reduce those costs by refusing unnecessary tests and interventions. Insurers have the power to select higher quality practitioners and make them more affordable to visit, although as we have seen, they have done whatever is necessary to cause consolidation while we watch costs rise in response. Is it finally time for a more centralized plan like Medicare to finally be available to all? Should doctors be encouraged to go back into private practice with more competitive reimbursements without predatory insurance meddling, Time will tell. If you are in pain, see a chiropractor first. You can book online with this link.