The worst of for-profit corporate medicine screws caregivers AND patients, again.
A Fourth of July rant on the surprise closure of Hahnemann Hospital in Philadelphia, putting 800 nurses, 570 residents, and 1000 staff out of work. We owe more to our frontline healthcare professionals, trainees, and patients.
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– What is up Z-pac, it’s your boy, ZDoggMD. Hey, this is a real important thing we wanna talk about today. We’re going live here, look, Hahnemann Hospital in Philadelphia, this is a ancient place with a huge history. Now, we’ll ignore the founder of Hahnemann Hospital, who is also the founder of homeopathy, which is abject quackery. But taking that aside, this hospital has been an institution, a safety net, a teaching hospital. The facade of it has been seen in multiple TV shows and movies, “It’s Always Sunny in Philadelphia”. I mean, it is a venerable institution associated with Drexel University Medical School. Thousands of employees and staff, five hundred and seventy residents, and it’s a safety net hospital, so it takes care of underserved people. Now, dozens of people have messaged me recently because of what’s going on there. And they said this is, again, this is where they trained, either they’re alumni or they’re there currently or they’re going through it, and what, and I’m gonna pull up your comments ’cause we’re live here, what’s going on is the hospital had been struggling. I think Tenet Healthcare owned it for a while, series of, you know, corporate owners, and it’s affiliated with the medical school. So you’re talking about any of 570 residents trained there. Now, recently it was bought by American Academic Health Services or something, some company that’s owned by Paladin Health, another for-profit bullshit company. So here’s what ended up happening. The person who was running all this said, “Yeah, okay, we’re gonna save the hospital. “We’re gonna make it more efficient. “We might scale down some of the residency training “’cause it’s expensive or whatever.” Never mind that the Center for Medicaid and Medicare, CMS, pays $100,000 per resident per year for training and there are limited numbers of spots. And so it’s very coveted. That’s why we have a physician shortage. We don’t train enough people. And despite that, in these sort of underserved areas, a lot of our staffing comes from international medical grads in places where American medical grads won’t go. So, now you have people on visas who are dependent, their visa’s dependent on them having employment. And then on the news is where the 800 nurses and the 570 residents, and the thousand-plus staff found out, poof! They’re closing the hospital and declaring bankruptcy by September. Sorry! Pick up your life and figure out what to do. The entire, the hundreds of years of history here, gone, and all these training spots closed. Now imagine you show up in Philadelphia with your family, whether you’re an international medical graduate or a U.S. medical graduate. You settle in, you’re ready to train. It’s hard, you’re a fellow, you’re a resident. And these folks have been interviewed on the news. Suddenly, the hospital says, “Oh, sorry, no, residency’s closed.” Can you imagine what that must be like? Like it’s not hard enough, right, to train, to do residency, to do all this stuff, and then you have 800 nurses who suddenly don’t have a job. And look, let’s back up for a second. On top of all this, the hospital or the university will not release their Medicare money yet, so they can’t take jobs elsewhere yet. They could look, they can apply. People are, other programs are scrambling to try to get some of these folks because, again, we need the doctors. And yet, they’re not released from their Medicare, CMS obligations yet. And I don’t know what’s going on. I don’t know why that is. But we as a Z-pack need to stand up and say “We support the Hahnemann residents from Drexel School of Medicine. “We support them. “They deserve better. “The staff at that hospital need jobs elsewhere, “and we need to support them.” Now the truth is, look, hospitals , hospitals should not be profit centers anyways. They should be cost centers because they are a failure of care. In other words, if you failed prevention, social determinants of health, all the other things, food security, physical security, education, and you end up in the hospital, well, that should be subsidized by somebody because it shouldn’t be a profit center. And when you rely on it to be a profit center like these guys did, right? When you turn out, well, we’re taking care of really poor people in underserved areas, it’s very hard to turn a profit without doing some squirrely shit. Well, what’s gonna happen? Something like this, okay. So the truth is, we need fewer hospitals that are more efficient, and we need better outpatient preventative care, but that is yet another subject. Let’s read some comments, I’m gonna pull up, pull up your comments here, I don’t know why it’s doing this, hold on, the whole computer froze, never mind, I’ma read your comments on here. “So I’m a NICU nurse at Hahnemann. Our unit will most likely close next week.” Denise McBride, I’m so sorry, Denise. Please send our support to everybody there. These are Z-packers, guys, whether they watch our show or not, they are part of the tribe of healthcare, and they deserve our support. Francine Ott says “The same companies own St. Christopher’s Hospital for Children.” That’s right, and that’s part of it, and actually the Pennsylvania Department of Health just appointed an overseer for St. Christopher’s and for Hahnemann as they unwind this thing, and they can’t remember when that’s ever happened, and that makes you think, “Well, okay, this is really some squirrely stuff.” And again, listen, whether it’s for profit or not for profit running a hospital, the truth is, the corporatization, the businessification of healthcare has come with huge consequences. Now it had to happen, because this is not a sustainable path we’re on, right, so business had to say “Well, “we have to make it sustainable,” but the truth is, the way we run these hospitals is just absolutely not sustainable, and hospitals know it. They know it. The truth is in Health 3.0 what we have to do is we have to integrate the primary care prevention with our specialty care, with our EMS pre-hospital care and community paramedicine, with our L tax and our SNIFs and our long-term care, and our dementia care, all integrated so everybody’s skin is in the game so that a cost center, be quiet, kitty. I know it’s hard; I know for-profit health sucks. When everybody’s skin is in the game, then you can actually do good for patients and do well financially by actually putting the money where it’s actually gonna help people, even though it might cost somewhere else in the system. But as a whole, the system saves money. Let’s read some more comments here. “This is my home,” says Holly Fog, “It’s a tragedy, not only for nurses and doctors, but most especially for the community. These are underserved community that desperately need healthcare services.” Right, and so what are we gonna do? We can’t do anything now for these patients. They’re gonna have to go to other hospitals, it’s gonna be a huge economic cost to other facilities in the region, and so the whole thing becomes a complete disaster, all because a series of for-profits are trying to fumble and make something profitable. Now I heard people have been telling me on the backend in the private messages that in many ways the purchase of this hospital might have been a real estate play because it sits on a piece of land that’s worth multiple millions of dollars in prime real estate in Philadelphia, so who knows, right? This is all speculation. People are upset and they’re emotional. Now, the bottom line is we have to find homes for these 570 residents quickly. I mean, my heart goes out to them. Can you imagine what that’s like being uprooted? Now a lot of them have families, and now they just settled into Philadelphia, they’re settling into schools, all this stuff is happening, and now poof, it’s gone. It’s hard enough, guys, I just moved. It’s hard enough moving when things are stable and you have a sense of what’s going on, and then to be told, “No, no, no, “you gotta move again.” and it may be a totally different city where they have to move. And Terry Montgomery says, “I do like to know how you feel about Medicare-for-all.” Terri Montgomery. First of all, Medicare-for-all is just a catchphrase. The bottom line is what you’re talking about is universal coverage, and the truth is, if we take government money and pay for this broken-ass system with it, we are committing a terrible crime and what we’re gonna do is we’re gonna doom future generations in this country to abject misery. We can’t do that. We fix the care model first. Fix primary care, fix prevention, build a 3.0 type collaborative model that uses technology to enable human relationships. Then you can worry about how you’re gonna pay for it. I am so tired of people asking me, “How are we gonna pay for healthcare?” That’s not the problem. What are we paying for? It’s crap. It’s garbage. 50% probably of what we do isn’t necessary, it’s over-treatment, over-testing, we don’t practice real, evidence-based medicine, and evidence-based medicine has full of flaws. We gotta get the relationship back into healthcare, really, really focus on what works for our patients at that unique patient at hand, use technology to help us do that, and then we’re not closing hospitals. Actually our hospitals are more efficient, we’re training our residents better, and the truth is we need to expand our training dollars. So if CMS only has $100,000 per resident, and we have limited numbers of slots, why don’t we have more slots? Aren’t we talking about, and again, the US has some of the fewest doctor-to-patient ratios. In other words, and AMA and others have sort of kept this sort of thing, it’s almost a cartel. It’s like the fewer doctors we have, the more each doctor gets paid. Well, yeah, the more they burn out, the more they overwork, the less served our underserved areas are. In Europe and other places there are a lot more physicians to patients. And so yeah, they get paid less per doctor and all that, but overall it’s more sustainable, and as a system it’s more, you can manage more the social determinants and other things that we don’t have the time and the capacity to manage currently. Let’s read some comments here. Thank you, by the way, to everyone whose sending stars. It’s a way to give us a little bit of support for the show. We get a penny per star, so thanks for people who are doing that. Let’s keep reading here. “People’s lives and health are not something to profit from.” Stephanie Lovejoy. Now here’s the thing. I’ll disagree in the sense that if we can devise incentives and systems where we can profit by doing the right thing for patients, in other words, those incentives are aligned, that is a beautiful, fundamentally American thing. And it can work. When we were running Turntable Health, we got paid a flat fee per patient per month to do the right thing for patients. And if we did the right thing, then the companies that were paying us, whether it was the insurance company, whether it was the employers that were paying us, could pay us more the next year, or you could share some of that savings. That’s doing good for patients and doing well financially. Those are aligned incentives. Now what we see in Philadelphia here is the misalignment. They’re trying to squeeze profit; it’s not working. Now there’s bankruptcy now. 570 residents, 800 nurses, a thousand staff, 40,000 patients a year, underserved community are not getting care. And that is where a misaligned incentives throw everything into chaos, and it’s what you cannot do. “I work at Children’s in Philadelphia,” says Samantha. “This place was a ticking time bomb “we were afraid would blow up. “This is what happens when you prioritize the wrong things “and forget to serve your staff and patients. “Hoping St. Christopher’s, “the only other children’s hospital in the area “doesn’t get the ax next. “Anxiety this has added is unheard of.” These are our tribe, Z-pack; these are our people. Our patients, our caregivers that are suffering. So we have to raise awareness. Please share this video. Please tell your friends about what’s going on. Please write to your lawmakers. Please, if there are for-profit entities in your area, let them know that this is not okay; this is not the way we behave. These residents, these residents and interns and fellows and staff found out from the news that they were gonna have to scramble for their lives and their livelihoods and their training and their jobs. That is sick. These people who are running this hospital are f-ing sick to behave that way to human beings. Let’s be honest. These are our people, Z-pack. It is sick what they’re doing. And listen, these are residents and interns and staff that are used to being beaten around, used to working in underserved areas, used to, kind of, sucking it up and being resilient and adapting to a system that’s broken. We owe them more than what we’re giving them. “Hello, Ryan, I sent 500 stars.” Thank you for supporting what we’re trying to do. “We tried everything to save TRRMC; nobody cares.” Chris Creech. “Unacceptable,” says Tiffany. “I’m on Medicare; Medicare-for-all is a joke.” Pat Moore. Listen, listen, I want universal coverage in this country. I want universal coverage. I want everyone to be able to get healthcare. But that means you have to fix healthcare. You have to actually make it affordable. You don’t just pay for a shit system, okay? Bernie Sanders is moronic in what he’s saying, which is let’s take our money, the commons, and spend it on garbage. Let’s pay, again, how do we determine Medicare prices? A bunch of specialists go to Congress and lobby and say, “You know, I think we should get this much “for a knee replacement. “I think we should this much for a spine surgery. “I think this much for preventative visit.” And it’s set by fiat. It’s the least competitive, least American thing that you can possibly do. So how ’bout we fix that, and you actually need to actually put patients’ skin in the game. It is important; if they can pay, they should. If they can’t pay, we should help. But we should hold patients accountable, too, which means we need to educate, we need to provide food security, we need to have good education and safe streets and things like that, which means we do need to focus and invest in our communities and law enforcement and all these other things. It’s a multi-factorial thing. Healthcare in this country, we medicalize our social problems, and then we expect our healthcare system to pay for it, and then a hospital like Hahnemann that has been on the front lines of treating the underserved or treating the social determinants of health, can’t make a profit. Duh, because you cannot try to fix our social problems in the healthcare system. It doesn’t work, and that’s why it costs $3.2 trillion and we don’t f-ing get it right. The rest of the world has kind of figured this out; they don’t have it right either, by the way. There’s no system on the planet that has figured it out. So people are like, “Well, look at Japan, “and look at Germany.” They have some good things, it’s true. We can steal some of those ideas in a uniquely American way. What is going on, Cat? Why are you meowing so much? Don’t you understand I’m on a rant here? In a uniquely American way, we can transform healthcare in a way that no other country can do it, because they are sclerotic, it’s a bureaucracy; they’ve already done this thing. It’s like, we can do it here, and it’s on us, it’s on the front line, right, with our leaders, with our enlightened administrators, our enlightened leaders, to do this. And a closure of a hospital like Hahnemann is a great, it’s a wake-up call to say, “Look how we’ve screwed these people. “Look how we’ve screwed it up.” You don’t think this is a crisis? You don’t think we’ve gone to war in this country for less than our own goddamn healthcare system has done to us, caregivers and patients? We have bombed countries for less than what our healthcare system has done to us. We balance-bill patients; we make them bankrupt. I just got a message from a woman, whose husband tried marijuana, high THC, ended up having a psychotic break, went through the healthcare system, got admitted, all kinds of drama, terrible things happened. Hundred thousand dollar lien on her family from the hospital bills, and he ends up hanging himself. What the fuck are we doing to our own people in this country? And we’re out dropping bombs on other countries because, you know, they pissed us off over oil. We can fix this. We can fix this, and it can be an American fix. It can be about competition and price transparency and fixing education and fixing food insecurity and fixing prevention. We know how to do it. There are for-profit companies in this country, IVIORA Health and the CareMores and the Oak Streets and the ChenMeds that are fixing preventative care for our seniors in Medicare Advantage, in a private/public partnership. Medicare Advantage for profit, doing the right things for patient, making money, and innovating. Holy shit, that’s America. That’s what we need. So I’m tired of hearing about socialized medicine; I’m tired about hearing about Medicare-for-all. What I want is everyone in this country to get amazing healthcare in a uniquely American way that takes the best ideas from the left and the right and the center and Germany and Japan and France and America and doing it in a way that no one else has done. We are the goddamn city on the hill, America is. This is the 4th of July. If this doesn’t wake us up, the closure of Hahnemann Hospital, in Philadelphia in a town where shit got real in 1776. This is the 4th of July. Wake up America. It’s on us. We can do it. No one else in the world can do it. Jesus, I got riled up. Goddammit. All right, let’s read some comments. “ZDoggMD for president.” Thank you Molly. Very kind of you. I don’t wanna be president. “This country has dropped the ball on mental health.” Crystal Webber. So has everywhere, Crystal. “Hospitals will seize your bank account over a bill.” Chris Creech. So hospitals, and my friend Marty Makary at Hopkins has written about this, and his book’s coming out. We have an interview with him that’s gonna air soon. Hospitals sue their own patients in their own community. There is one hospital, I think it was in Virginia, that sued something like 20,000 people in a city of 27,000 people. It was something crazy over medical bills. Okay, this is sick. This is a sickness that we have. And listen, yes, we have to hold patients accountable; yes people who can pay should pay. But to go bankrupt over medical bills, that is a uniquely American disaster, okay? And again, you guys know me. You know I’m not some Communist; you know I’m not some right-wing nut. I am square in the center with a little bit of Libertarian thrown in, and I’m telling you we can fix this. It’s a 4th of frickin’ July, we can fix this in a uniquely American way. Let’s scroll back. “I’m upsetting the cat,” says Margaret Lee. Cindy Snoddy says, “ZDogg should be director of Health and Human Services if he doesn’t get elected.” No, no, no, I’m a terrible manager of people, Cindy. No, no, no. I’m more of a this; I’m not a that. But thank you. “Health problems start in childhood.” Chris Creech. So this is the thing, Chris. The adverse childhood experiences that drive so much adult illness do start in childhood. And they can be intervened on, they can be ameliorated, there’s so much we can do to make it better, but we have to focus on these things. We have to give it our attention and money and resources instead of blowing it on unnecessary spine surgeries and knee arthroscopy and over-screening and over-testing and all the crap that we do, unnecessary paps on people that don’t need paps, unnecessary care variation where doctors are doing different shit to people based on, you know, across the street you might get totally different care and they don’t even know what each other is doing. When are we gonna fix this? We crash a jumbo jet every day or week with medical errors; our quality science is shit. It’s time we did better; we can, we know we can do better. We know we can do better. All right, listen, this is a call to action. Folks at Hahnemann, we’ve got your back. You will find a new slot, you will find a new job, you will find a new training path. It’s gonna be okay. You gotta keep making noise; we’re gonna keep making noise. All right? Hospital leaders, we know we can do better, we know we have to find new incentives, new ways. We have to lobby government to do this right, all right? Z-pack, you guys are the voices of the front lines. Make your voice heard, leave comments, send us messages, share this video. If you wanna go deeper, become a member of the supporter tribe, that’s like $4.99 a month, and we have the crazy conversations, just ask anyone in this comment thread who’s a supporter. You’ll see a little supporter badge. We have our own discussion group that’s closed, that’s a safe place to talk about stuff. Thank you to everybody who’s supported our show by giving stars. It’s a new Facebook thing we’re doing. So all of this stuff matters. We’re gonna keep trying to be a voice for this stuff, keep trying to make noise. If you think what we’re doing is terrible, leave your comment; we wanna hear about it. And we’re out. All right, guys, peace. Happy 4th of July. Be safe. Don’t blow your fingers off, seriously. Hold my beer.