> I've been pressured into unnecessary procedures and even given (multiple!) sales pitches for surgeries that I haven't needed or wanted, because the hospital makes huge amounts of money from it, and consumers aren't savvy enough to know when their doctor is just trying to pad his profitability figures.
That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Providers still get paid for individual services but the rate depends on quality metrics of their overall population. (Source: worked in software for Population Health)
The inefficiencies you describe are less from the clinical side and more from the administrative side. Many of these admin-level people are doing what they can in an incredibly complex maze of processes, most of which started for a good reason. But they are process bees, and unable to make any changes: there's a huge barrier to change as of course nobody wants to be responsible for worse outcomes / deaths due to failure to respect process—yet they are immune from repercussions if poor outcomes are cause by said process.
More to the point, clinicians live in a constant grey zone: everything is a risk tradeoff and they do what they can to get the best outcome. The adminstrative folk see things in black and white. Here's a real example: outpatient office has slightly expired meds that are life-saving if a procedure goes bad, but new meds are not available because factory got damaged by hurricane. Common-sense is that a med does go from perfect to useless overnight and a few weeks is no big deal, especially when there is no alternative. Administrative view is the meds can't be used and must immediately be discarded because having them around the office will expose them to liability during audits... yet of course doesn't understand why that means all procedures of that type would get cancelled.
I'm a retired neurosurgical anesthesiologist with 37 years of experience. Medications one day after their so-called expiration dates are just as effective as they were 24 hours earlier. Loss of potency and therapeutic efficacy over time varies tremendously depending on storage conditions: drugs kept refrigerated and in the dark will likely work just fine for YEARS after their expiration date. Pharmaceutical companies have noted that they are extremely conservative when it comes to expiration dates, much preferring to err on the side of caution. Dept. of eating your own dogfood: I had an anaphylactic/allergic reaction of unknown etiology in late 2015, my first ever; I had to go to the ER for IV steroids and Benadryl for treatment. No recurrence since. I immediately bought two Epi-Pens, one for my house and one for my car. Their expiration date was March 2017. I am completely comfortable not having purchased new ones, especially considering their now inflated prices even after all the bad publicity that focused on their markup. So I have bet my life on my belief that these "expired" epinephrine injectors will save my life should I ever have another anaphylactic/allergic reaction. However — if someone asked me for advice, I would tell them to get up-to-date ones; as a former practicing physician, this is one of those cases where what you advise is quite different from what you yourself would do.
That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Providers still get paid for individual services but the rate depends on quality metrics of their overall population. (Source: worked in software for Population Health)
The inefficiencies you describe are less from the clinical side and more from the administrative side. Many of these admin-level people are doing what they can in an incredibly complex maze of processes, most of which started for a good reason. But they are process bees, and unable to make any changes: there's a huge barrier to change as of course nobody wants to be responsible for worse outcomes / deaths due to failure to respect process—yet they are immune from repercussions if poor outcomes are cause by said process.
More to the point, clinicians live in a constant grey zone: everything is a risk tradeoff and they do what they can to get the best outcome. The adminstrative folk see things in black and white. Here's a real example: outpatient office has slightly expired meds that are life-saving if a procedure goes bad, but new meds are not available because factory got damaged by hurricane. Common-sense is that a med does go from perfect to useless overnight and a few weeks is no big deal, especially when there is no alternative. Administrative view is the meds can't be used and must immediately be discarded because having them around the office will expose them to liability during audits... yet of course doesn't understand why that means all procedures of that type would get cancelled.