April 2, 2007 - Profit Center

“Have you ever wondered why hospitals offer free cancer screening tests?” asks Shannon Brownlee, in an op-ed piece in yesterday’s New York Times. “Hospitals would like you to think they are doing this out of the goodness of their hearts, that free cancer screening is a public service intended solely to improve your health. But there may be another motive at work here: providing free screening brings in new cancer patients, and cancer generates profits."

Now there’s a curious thought – that I’m a potential source of profits for my local hospital. Recently, as part of my volunteer work as a member of the Community Advisory Committee of Ocean Medical Center, I’ve been part of some discussions about how to raise the public profile of a program the hospital provides, called “Oncology Navigators.” These Navigators are hospital employees who speak on the phone to cancer patients, providing them with general information about the disease and connecting them with various medical services. The one experience I had with one of the Navigators was when I was beginning my physical therapy. I called her, on Dr. Lerner’s recommendation, and she made the connection for me with Life Fitness (a hospital affiliate), where I received my therapy. I thought she was very helpful.

I have no objection to this set-up – in fact, I think it’s to be applauded – because it’s important to refer people to hospitals for auxiliary services. Hospitals, by law, must provide a lot of charity care for uninsured people, at a financial loss. So, if they can earn a little extra scratch through “profit centers,” then that’s a good thing for us all. I don’t think hospitals need to apologize for having auxiliary enterprises. It’s a matter of simple survival, in the constantly-changing, Kafkaesque world of health-care financing.

Now that I think about it, I realize that a great deal of my own cancer testing and treatment has been provided outside the hospital setting, by for-profit business concerns. Dr. Lerner’s office, where I received tens of thousands of dollars worth of chemotherapy drugs, is a for-profit operation. So is Atlantic Medical Imaging, where I’ve received my most recent scans (I would have preferred to go to the hospital for these, myself, but they don’t yet have a PET/CT fusion machine).

Of course, questions could be raised about hospitals’ non-profit status, as well. Even the smallest community hospital is a multi-million dollar concern, and is often the largest employer in its community. Some hospital staff members, particularly senior executives, are handsomely compensated. True, hospitals don’t have stockholders, and are governed by volunteer boards of trustees, but still there are ways in which the boundary line between profit and non-profit seems to have gotten a little fuzzy.

“Could it be,” wonders Ms. Brownlee, “that at least some of the $100 billion we spend each year on detecting and treating this disease is used not to improve the health of patients, but rather to prop up hospital finances?” Well, I’m not so sure I’d be as ready as she is to separate the functioning of a hospital from “improving the health of patients.” Isn’t that a hospital’s principal mission, in the first place?

Her concern, though, is that some hospitals may be too aggressive in steering patients towards costly therapies, because they bring in more money. Inasmuch as doctors have control over treatment decisions, and doctors aren’t generally hospital employees – rather, they’re independent professionals who are credentialed to serve on the hospital’s “medical staff” – I think there are adequate checks and balances. Actually, I think the temptations may be greater in the for-profit clinic setting, in which doctors are prescribing medications, then turning around and acting as a pharmacy, selling those same medications to patients.

Back when Washington Post reporters Bob Woodward and Carl Bernstein cracked open the Nixon White House, their rule of thumb was to “follow the money” – the assumption being that greed is a consistent and predictable motivator of human behavior. Is this also true in the world of medicine? Shannon Brownlee seems to think so.

I think the jury’s still out, on that one.

As for me, I’d prefer to think that my doctors, as well as the administrators of the local hospital, don’t hear “ka-ching” when I walk through the door. Medicine – that profession that connects with human beings on the most intimate level – is meant to operate from higher motives.