Eat What You Kill: A hospital helped a doctor’s practice flourish even as it suspected he was hurting patients
Eat What You Kill: A hospital helped a doctor’s practice flourish even as it suspected he was hurting patients
Hailed as a savior upon his arrival in Helena, Dr. Thomas C. Weiner became a favorite of patients and his hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did the trail of patient harm and suspicious deaths.
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Adding to a six-figure base salary, his pay was calculated by the number of relative value units, or RVUs, he billed on behalf of the hospital. The system compensates doctors using weighted values for certain types of visits or treatment. It works like this: A doctor might be paid $100 per RVU. A routine physical might be equal to 1 RVU, or $100; a more complicated and time-consuming procedure like radiation therapy might equal 8 RVUs, or $800. In other words, the more patient visits and treatments a doctor bills to insurance, the more that doctor and the hospital earn. Weiner described this system, which is common in American medicine, as “eat what you kill.”
Jesus Christ.
I learned this a few years ago. Because my condition is lifelong and degenerative, my RVH is quite high, and so my value to insurers and doctors/hospitals has a very low ROI. My care has degraded quite obviously as my condition has deteriorated, to the point I’ve decided I’d rather die at home than bother with healthcare at this point. And I can’t afford it anyhow. That sucks, but I’ve got medical PTSD now, and I don’t want to put myself through the indignity anymore. (eta: I don’t think I deserve the indignity anymore.)
I’m by far not alone in this. I used to be a very productive member of society, and I still could be if I could get even passable healthcare, but I can’t because the system has broken me. I have very in-demand skills that I can’t use, and instead , I’m staring down homelessness now. I cannot afford food.
This system is wasting people’s potential and lives. I will not survive this administration. I likely won’t make it another year.
The US medical system wants me to die, and I feel my compatriots have now voted to accelerate that. I honestly don’t know why I’m still fighting. I feel like I shouldn’t.
I get why the shooter did this. Our lives mean less than nothing. These executives can’t even imagine what it’s like to be using washcloths because you can’t even afford toilet paper.
Eat what you kill indeed. I have a nice recipe for a pork sauce. Humans have been called ‘long pork’.
That's... horrifying. I'm in and out of hospitals, but when my disease kills me, if it kills me, it'll be a quick, "Your body fucked up extra hard for a few days out of the year, and we couldn't get to you in time" rather than a progressive degeneration. I'm at risk, but I also have an okay chance of surviving the fuckery of the next few years, even if not as okay a chance as I'd like. Or as I'd've had if my countrymen weren't a bunch of cretins.
Don't rightly know what to say, other than that you - and I suppose, all of us - deserve better. Our shitty for-profit healthcare benefits neither the sick nor society as a whole. It's a parasitic malady in its own right to make a few ticks fat on our blood. And the death toll just keeps increasing.
Thanks, I just have to make peace with it, honestly. I’m still in the denial/ anger stage, unfortunately. It feels unfair.
I’m glad you can make it through. Hang in there, and I hope you can enjoy the time you have.
None of us should have to deal with this in the most affluent country in the world, especially when we have more to contribute, and especially when a few greedy cunts are siphoning our resources into a dragon hoard they couldn’t possibly spend in a thousand lifetimes. It’s obscene.
I will die at the altar of their greed. I had much more to do, much more to invent and write and think, but a few dollars they can’t even spend was worth more than my life. So be it.
It is unfair. Fuck every one of these people for doing this to you, and double-fuck every one of those doctors for breaking their oaths. They owed you better.
I'm probably stating the obvious, but is it not possible to immigrate and get healthcare in a decent country?
It would be difficult to pass immigration checks.
Pretty much every country you’d think of will refuse to accept immigration applicants who aren’t in essentially perfect health.
Yeah fair enough. I was kinda hoping the "very in-demand skills" part would help but apparently not.
Not with zero money or assets, and without the ability to get a work visa when you’re unable to work, no.
Pretty much nobody wants that kind of immigrant, no matter where you’re from. (I’ve looked.)
e: ‘if I could get proper healthcare, I’d be able to work’ doesn’t fly.
In 2019, two nurses and a pharmacist questioned a Weiner order to apply a fentanyl patch on a 93-year-old woman who was already on opioids and bobbing in and out of consciousness. A nurse texted Weiner to ask whether he was sure. Weiner responded, “Tell them put it on or I will rip their lips off.” Weiner told me this was “an inside joke.”
What an article.
Federal regulators also failed to address alarming trends. An analysis of Medicare drug data shows that, from 2013 to 2020, Weiner’s volume of opioid prescriptions ranked ninth among all cancer doctors who bill the program. When it came to morphine, Weiner consistently ranked among the top five. In 2017, he prescribed more morphine than any other cancer doctor. The Centers for Medicare and Medicaid Services did not respond to questions.
[...]
If a patient wants CPR or a machine to keep them breathing, they elect to be a “full code.” Weiner, the hospital said, had a pattern of altering, without consent, a patient’s status from full code to a DNR/DNI, do not resuscitate and do not intubate.
[...]
If the residents of Helena had seen those files, they would know how Weiner built a high-volume business that billed as much as possible to public and private insurance, all the while sending numerous patients through a carousel of unnecessary and life-threatening treatments. They would have learned that the hospital had financial incentives to look away.
[...]
When I asked Weiner why the hospital would publicly accuse him of various types of malpractice but withhold its concerns about his end-of-life care, he said it’s because administrators knew what he was doing and even encouraged it.
Yeah, this dude is the worst kind of scum.
RVUs are supposed to measure how much work something takes, so it's literally just paying someone based on how much work they do. If you're not actually doing the work, or are doing work that shouldn't be done, that's certainly a problem, but I don't think RVUs existing is a problem in and of itself.
Generally the hospital has checks and balances to prevent fraudulent billing (well not in this case, apparently).
My bigger issue with the RVU system is how it promotes sub sub specialization into procedure based specialties which are the antithesis of preventative medicine. The system valuee family medicine doctors the least despite the massive shortage in their services (especially in rural communities).
So, the surgeon that fixes the broken hip gets paid more than the doctor that gets the bone density scan done and starts meds that support bone health. The cardiologist that opens up the blocked vessel gets more than the PCP who takes the time to counsel on athersclerotic cardiovascular disease and controls risk factors medically and with lifestyle.
I'm not saying the surgeon / proceduralist shouldn't get paid more. I'm just saying that when your system incentivizes 'wait for the problem to happen and then fix it' you're going to have some bad health outcomes.