This Buzzfeed post asks why admission rates to this country’s NICUs have rapidly increased since 2007, particularly with full-grown healthy babies. The obvious answer is the correct one: so the hospital can make more money. Even at the expense of newborn babies.
Medicine is strictly a business, and patients are strictly sources of revenue. The old days of nonprofit or Church-sponsored medicine, with healing as the first priority, are as outdated as bell-bottoms. The Boomerist cynics now in charge of medicine have the same priorities as the ones in charge of our universities: It’s all about the benjamins.
And one of the basics of any service-industry business is to maximize utilization. This means an airline has to minimize empty seats on its flights, and a restaurant needs to minimize empty tables on Saturday night. And so today’s hospital administrator (generally an MBA with no medical training) seeks to minimize empty beds in order to enhance revenue, because there is literally no other purpose to his life.
It’s the same with any medical facility. If a hospital opens an endoscopy suite, they will want that suite performing endoscopies at all times. If a clinic buys a CT machine, then they want that machine being used 24/7. The medical necessity is wholly irrelevant. For instance, a man who ran a clinic I briefly worked for insisted that any and all patients should be sent for a CT for any reason we could think of, or none at all. And he would get increasingly agitated if I got just a regular X-ray for a routine pneumonia instead of a chest CT; never mind that the CT represents a 100-fold increase in radiation. Hospitals have the exact same policy to their own CT and MRI machines.
But back to the beds: A pediatric ER doctor at UMC in Las Vegas once told me flat-out that he strove to admit any patient he possibly could because the hospital administrators wanted him to, in order to make more money. He did not sugar-coat it the way most doctors do. He acknowledged the fact that he was just managing a revenue stream, because that is what the Boomerists who run everything see children as. Revenue streams. And so he did their bidding by keeping the pediatric floors packed with minor asthma attacks and stomach viruses, stuff that should have been treated as an outpatient.
UMC’s NICU was kept full for the same reasons. Admittedly, the NICU did not have to try as hard to scrounge up questionable admits, thanks to Vegas’s generous complement of pregnant meth-heads and junkies, as well as illegal immigrant mothers with zero prenatal care. (I actually saw a case of hydrops fetalis while in Vegas.) But I have zero doubt the hospital’s MBAs would insist on packing the NICU with perfectly healthy babies if necessary… and I have zero doubt the neonatologists would play ball.
You will note that none of this has to do with what’s best for the patient.
A woman who works for a local neurosurgery group recently told me about how the group was quietly moving away from low-income patients to only accepting patients with good, private insurance. And then she told me to pretend like she never said that. But what she said had as much shock value as if she told me Meek Mill did not fare very well in his beef with Drake. Show me a medical practice that does NOT prioritize money over patients — THAT is what will have me reaching for the smelling salts.
Perhaps that’s why urgent care is best for me. We are independent of any hospital, so I am not obliged to funnel patients to any ER for cash. We don’t have anything more fancy than an X-ray machine, so I am not obliged to pad superbills with questionable or even harmful procedures. Sheer volume of patients drive our revenue stream, and 100% of them come here of their own volition. It’s as close to medicine as it should be practiced as possible in this country. And if I send you to the ER, you can take it to the bank that I am doing it for a damn good reason.
As a patient or caregiver, question everything any time some ER doc or NICU nurse is pushing for an admit. Why? Is the illness really that bad? Could it not be handled at home or with outpatient visits? If they are not able to convince you, then call for a second opinion or patient advocate. After all, the doc or nurse might not be even seeing a patient. She might just be seeing a cash pinata.