Low Reimbursements Force Major Hospital Closure

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Doctors With Disabilities Paid Less Than Non-Disabled Doctors

It’s common knowledge that workers with disabilities earn less than workers without disabilities across the vast majority of industries. We’re also learning that disabled patients often have trouble getting their needs accommodated by physicians, many of whom hold misconceptions about these disabilities. But what about the experiences of physicians who are disabled? According to a new study in JAMA Health Forum, which assessed the income of physicians with disabilities against those of physicians without disabilities, the payment disparities are stark. Disabled doctors make 20% less than nondisabled doctors annually and 13% less per hour, even when accounting for differences such as race, gender, and whether they are a surgeon or not.

The researchers looked at survey data from 2005 to 2019 that included more than 92,000 physicians, of which roughly 1,900 had disabilities. They wrote that employer discrimination may be a key factor in the income disparities, making it critical to collect such data. They also believe the study should encourage more research on the nature of the pay disparities related to the degree of a person’s disability, the longitudinal earning trajectories, and more.

My Two Cents

This is a fascinating study, and because medicine is often considered a demanding profession, it would make sense that practitioners with disabilities would struggle more. I dug a little deeper into the study methods to determine what the researchers considered a disability. For the sake of this study, physicians were identified as having a disability if they answered “yes” to any of the following standard six disability questions in the American Community Survey:

• Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?
• Does this person have serious difficulty walking or climbing stairs?
• Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone, such as visiting a doctor's office or shopping?
• Does this person have difficulty dressing or bathing?
• Is this person blind or does he or she have serious difficulty seeing even when wearing glasses?
• Is this person deaf or does he or she have serious difficulty hearing?

With our society’s growing demand for diversity, inclusion, and equity, and our awareness of where these areas are lacking in so many different facets of life, we need to do better. We need to make more noise, shine a brighter light, and call more attention to these deficits until we start to see real change.

OUTSIDE THE LANE

Under-Reimbursements Take Out Another Successful Hospital

The largest physician-led health care network in the United States, Steward Health Care company, recently announced plans to close the New England Sinai Acute Long-Term Care and Rehabilitation Hospital (NESH) in Stoughton, Massachusetts, by early April 2024.

Why are they closing this seemingly successful facility? Steward Health Care cites “chronic low reimbursement rates” for the services provided to Medicare and Medicaid patients. Management states, “Nearly 75% of Steward hospital patients are public pay, which chronically underpays, sometimes at rates less than the cost of delivering services. Unlike ‘non-profit’ systems, Steward does not have a multibillion-dollar investment portfolio to fall back on.”

They also said, “Unfortunately, NESH's planned closure continues a troubling trend for the health care system in Massachusetts, where access to community-based care continues to decay because of sustained under-reimbursements.”

My Two Cents

As optometrists, we are aware of chronic underpayment. Many vision plans either have not updated their reimbursements in years or have only increased their reimbursement levels by borderline comedically small amounts. When the doctor’s age is higher than the reimbursement amount, there’s something seriously wrong with the current system. Our friends in other areas of health care are fighting the same battles. Interestingly, the reimbursements have hit such a rock bottom in some places, that they’ve forced the closure of hospitals!

CAN YOU RELATE

Over the past week, I’ve been reading Creating Magic by Lee Cockerell. This is another book about leadership strategies and business ideas from the brains behind Disney Parks and Resorts. If you know me, I have a borderline obsession with how Disney runs their in-person experiences. The level of attention to detail paid to even the most minor areas and how they train their people is something every company in the service or health care sector should seriously take into consideration.

Creating Magic details Mr. Cockerell’s life, from his younger years as a Midwestern farm boy to reaching the highest level of Disney leadership. He doesn’t shy away from his early failures as a manager and man. He gets deep into specifics to hopefully help his readers avoid the same mistakes he made (not to mention the many injuries and stitches he endured).

Below are key takeaways from Mr. Cockerell that can be immediately implemented into your life/practice.

• Everyone is important. All your employees, coworkers, colleagues—everyone—should know that their opinions matter and will be listened to. We must communicate clearly and directly so that all team members understand boundaries and responsibilities. The most successful cultures in business are established by thoughtful design—not by chance or luck.
• Explore all areas of your business regularly. Don’t sit in your office far away from the action or get stuck in the exam lanes. Get out and see how the entire office is flowing and functioning. Spend time talking to your patients/customers in the optical and get their thoughts about the experience (ie, what they’re looking for, what they like, and what they don’t like). Be visible, but not overbearing. You’re a member of a team. Don’t micromanage and breathe down other team members' necks, but by being visible, you can gain trust and hopefully allow people to open up and share what they think you need to know.
• Master the idea of ARE: appreciation, recognition, encouragement. This is the fuel that can allow your practice to reach the next level and build the confidence and self-esteem of all team members. It’ll also help you create a fantastic culture while helping you to attract and keep the best team members.

QUOTE OF THE WEEK

“Remember to practice the four employee expectations: 1) make me feel special, 2) treat me as an individual, 3) respect me, 4) make me knowledgeable, educate me, and understand me."

— Lee Cockerell, former executive vice president of Walt Disney World Resort