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<ul class="summary-list"><li>Some US hospitals are demanding payment for non-emergency surgeries up front.</li><li>It comes as hospital systems and corporate entities buy up medical practices nationwide.</li></ul>Getting surgery is getting harder in some American hospital systems.In the past, medical centers have broadly provided procedures first and settled the bill with patients later — something they are legally required to do in emergency cases.Now, in non-emergency cases, some hospitals want to be paid up front before they operate, and customers — ahem, patients — are not thrilled, <a target="_blank" href="https://www.wsj.com/health/healthcare/hospitals-pay-before-treatment-patients-c477e2d6?mod=healthcare_news_article_pos1">The Wall Street Journal</a> reported.A surgical center in Flordia now owned by UnitedHealth, a healthcare insurance giant, told the Journal that billing patients in advance informs them of the expected cost. However, forcing patients to pay in advance also relieves companies from the cost of having to track and bill patients later on.This shift comes as insurers, hospital systems, and private equity firms are <a target="_blank" href="https://www.businessinsider.com/big-corporations-unitedhealth-optum-cvs-walgreens-taking-over-healthcare-industry-2024-4">quietly but efficiently buying up medical practices</a> across the country, Business Insider previously reported. Over three-quarters of doctors in America are now employed by a hospital or corporation and, as of January, more medical practices were owned by corporations than hospital systems, according to research from the Physicians Advocacy Institute.Some medical providers fear the corporatization of healthcare could have a detrimental impact on patients. The new "pay-first, cut-later" policies at some medical practices may be an example of that negative impact, forcing people suffering from a medical condition that's severe enough to require surgery to scramble for funds to obtain the procedure.In Tennessee, a hospital system overcharged 59-year-old Blake Young by over $2,500 for a heart scan, Young told the Journal. He had paid up front at the hospital's request and later found out he was charged too much for the service. He wrestled with the hospital for months to secure a refund check."It's not unlimited funds," Young told the Journal, noting he would use the refund for future unexpected medical bills. "They do run out."

Big corporate American hospitals now want you to pay up front for surgery

Pune, <keyword id="19897354" type="General" weightage="20" keywordseo="bajaj-auto" source="keywords">Bajaj Auto</keyword> is developing a portfolio of clean fuel CNG motorcycles, and the first such bike will hit the market in June, Bajaj Auto Managing Director Rajiv Bajaj said here on Friday. The bike will run on CNG and would hit the roads in June, he said while announcing <keyword id="20201280" type="General" weightage="20" keywordseo="bajaj-group" source="keywords">Bajaj Group</keyword>'s commitment of Rs 5,000 crore towards <keyword id="19916939" type="General" weightage="20" keywordseo="corporate-social-responsibility" source="keywords">Corporate Social Responsibility</keyword> (CSR) spent over the next 5 years. The new bike would target mileage-conscious consumers and is expected to launch under a different brand. It is expected that CNG bikes will be priced higher than their petrol counterparts due to the higher cost of manufacturing besides having a special tank to offer petrol and CNG fuel options to offer convenience to customers. Bjaja also said that <keyword id="20050188" type="General" weightage="20" keywordseo="pulsar" source="keywords">Pulsar</keyword> launched 20 years ago will hit 2 million units soon. Meanwhile, the Bajaj Group committed Rs 5,000 crore to social impact initiatives over 5 years, with a focus on skill development, under 'Bajaj Beyond'' the Group's new identity for all its CSR and charitable programmes. This will benefit over 2 crore of tomorrow's youth and enable them to take advantage of the employment and entrepreneurial opportunities offered by India's growing economy. "Social responsibility is deeply entwined in the <keyword id="21052740" type="General" weightage="20" keywordseo="bajaj-family" source="keywords">Bajaj Family</keyword>'s businesses and its philanthropic endeavours through generations. In the last 10 years alone, the Bajaj Group has contributed close to Rs 4,000 crore towards CSR initiatives largely focused on skilling and education, health, livelihood, water conservation, and several other areas of development," Bajaj Auto Chairman Niraj Bajaj said. The Bajaj Group's humanitarian efforts are channeled through several institutions. The <keyword id="21051165" type="General" weightage="20" keywordseo="jamnalal-bajaj-foundation" source="keywords">Jamnalal Bajaj Foundation</keyword>, Jankidevi Bajaj Gram Vikas Sanstha, and the <keyword id="21052739" type="General" weightage="20" keywordseo="kamalnayan-bajaj-hospital" source="keywords">Kamalnayan Bajaj Hospital</keyword>, among others, have worked unceasingly to uplift and empower communities, he said. The Group stays firmly committed to co-creating a thriving and inclusive future for all Indians, he added. Bajaj Group companies include Bajaj Auto, Bajaj Finserv, Bajaj Electricals, and Mukand Ltd. "Launching the Bajaj Engineering Skills Training (<keyword id="19925221" type="General" weightage="20" keywordseo="best" source="keywords">BEST</keyword>) last year has been a valuable learning experience for us. It gave us a very clear picture of the critical gap between theoretical education and practical skills needed in the manufacturing industry. The insights gained through BEST acted as a cornerstone in laying down the groundwork. With Bajaj Beyond, we will expand our skilling efforts across the group," Rajiv Bajaj said. "You do not change the world by sloganeering. Saying Make in India does not change the world; saying Aatmanirbhar does not change the world; saying vocal for local does not change the world; saying Viksit bharat does not change the world. "Words would not change the world, unless you have the skills to put those words into action. It would certainly not change the world by saying I will spend tens of thousand of crores of rupees on CSR or that I want to touch billions of lives," he added. Speaking at the event Sanjiv Bajaj, Chairman &amp; Managing Director, Bajaj Finserv, said, "Skilling has been at the heart of our social impact initiatives and we have seen the positive multiplier effect it has on the well-being of youth and their families. Our Certificate Programme in Banking, Finance and Insurance (CPBFI) prepares youth for employment in the fast-expanding financial services sector which is currently seeing a shortage of talent." With Bajaj Beyond, Bjajaj Finserv commits to strengthening India's skilling ecosystem, especially in the hinterland, enabling greater access to economic prosperity, he added.

Bajaj Auto working on CNG bike, to hit road in June: MD

<ul class="summary-list"><li>On a trip to Melbourne, Adrian Chia envisioned a holiday home to unplug from the world.</li><li>He sold his IT business and partnered with two friends to build Big Tiny, a tiny house startup.</li></ul>How nice would it be to leave everything behind, unplug from the world, and relax abroad?This thought lingered in Adrian Chia's mind after a two-week family vacation exploring the Great Ocean Road in Melbourne in 2016.Shortly after returning home to Singapore, he floated the concept of <a target="_blank" class="" href="https://www.businessinsider.com/millennial-city-life-quits-job-build-tiny-house-wood-denmark-2024-9">living an unplugged life</a> by his friend Dave Ng, whom he'd met in his 20s during mandatory national service."We were just chitchatting, but Dave started thinking about it seriously," Chia, now 43, told Business Insider. Ng came up with the idea of creating a tiny house on wheels — a mobile house that could be easily relocated if a particular location did not attract guests.In 2017, the pair decided to sell their businesses — Chia had been working in IT and Ng in waste management — and start a <a target="_blank" class="" href="https://www.businessinsider.com/how-to-build-own-tiny-home-company-plans-2023-4">tiny house business</a> called Big Tiny. They invested 100,000 Singapore dollars, or around $77k, each, and dove into brainstorming their first prototype."I knew I was venturing into uncharted territory," said Chia, who was married with two young kids and had a newborn at the time.<h2 id="b90f8f35-563a-4d9d-9797-e15f7148fc10">An early obstacle</h2>With no experience in architecture or building, their first roadblock was figuring out how to build a tiny house."I can't even change the door knob at home," said Chia, adding that the thought of having to fit a kitchenette, a bedroom, and a living room into a 20-foot space was daunting.They hired an architect to help with the <a target="_blank" class="" href="https://www.businessinsider.com/couple-lives-in-tiny-home-on-wheels-with-office-bedroom-2023-6">design of the house</a> and agreed on a few essentials. First, the house had to be on wheels. Next, they had to ensure that the house did not feel claustrophobic.Six months of trial and error later, Chia and Ng assembled the <a target="_blank" class="" href="https://www.businessinsider.com/built-tiny-house-parents-backyard-rent-free-saved-money-2024-3">first prototype home in Chia's garden in Singapore</a>.<div type="image" title="A tiny home" height="3024" width="4032" msid="113509611" hostid="261" sizebytes="1381548"></div>They began scaling the business by sending tiny houses overseas. The first two were sent to Australia, one to Victoria and the other to New South Wales.In 2018, Chia convinced a friend from elementary school, Jeff Yeo, to join the team of founders and help with branding. Yeo had worked as an account director and manager at several marketing agencies.Together, they raised around SG$4.2 million over two funding rounds, Chia said. That includes SG$3.8 million in the second round, which took place in 2021.<h2 id="2f26daf1-a207-42de-80b6-4a8c216f56ad">Developing their tiny houses into a profit-sharing business</h2>After garnering attention from local media, the team started to receive inquiries on how to purchase tiny houses, Chia said.So, in 2017, the team started a program that allowed people to buy a tiny house for around SG$90,000. In return, they managed the hotel side of the business by renting the unit back from the buyer. They either rented the tiny house for two years and paid 8% a year or five years and paid 10% a year. Big Tiny then earns from the profit of nightly stays, Chia said.Although the headquarters is in Singapore, Big Tiny's first move was to send <a target="_blank" class="" href="https://www.businessinsider.com/live-in-a-tiny-mansion-home-so-could-afford-california-2023-10">tiny houses</a> out to the rest of the world. The homes had a modular design — flat packed "like Ikea furniture," as Chia describes.<h2 id="86541299-29a2-4f07-931a-d1593e686640">In 2023, they set up tiny houses in Singapore</h2><a target="_blank" class="" href="https://www.businessinsider.com/tiny-home-village-atlanta-south-park-cottages-photos-booker-washington-2024-3">The tiny house movement</a> encourages <a target="_blank" class="" href="https://www.businessinsider.com/tiny-house-new-yorker-first-time-experience-2022-7">minimalistic and sustainable living</a>. Although the movement has taken off in <a target="_blank" class="" href="https://www.businessinsider.com/tiny-house-movement-future-2021-1">countries like the US</a> and <a target="_blank" class="" href="https://www.businessinsider.com/tiny-home-tube-shape-surprising-things-europe-slube-photos-2023-2">Germany</a>, it has been less popular in Singapore.In 2021, an opportunity arose for Big Tiny to set up houses in Singapore under a government initiative promoting innovative business ideas.The government awarded Big Tiny state land, for which the company pays rent, to build their <a target="_blank" class="" href="https://www.businessinsider.com/stay-tiny-home-remote-lazarus-island-singapore-2024-8">tiny houses on Lazarus Island</a> — one of the eight Southern Islands in Singapore."We jumped on it," Chia said.In an email response to BI, a representative from the Sentosa Development Corporation, an organization under Singapore's Ministry of Trade and Industry, said the initiative aimed to complement the existing environment of Lazarus Island by introducing "light-touch" recreational uses.Additionally, the response noted that Big Tiny's houses were equipped with sustainable features, which were in line with their goal of reducing vacationers' carbon footprint on the island.The government also awarded another company a chance to <a target="_blank" class="" href="https://www.businessinsider.com/luxury-tent-glamping-into-the-woods-lazarus-island-singapore-2024-9">build nine tents nearby.</a>Since opening the tiny house resort in April 2023, Chia said, it has been running on an average of about 90% occupancy. Guests have to book a few months in advance to secure their stay. He added that they have been cash-flow positive since their inception.In August, BI was able to book a stay for SG$380 a night, less than three weeks in advance, although only a few tiny houses remained available at the time. All of the houses were full during BI's stay.<h2 id="4f271ca1-9272-4f7b-83ed-2c77ec2a4d51">Each tiny house is placed in nature</h2><div type="image" title="An accommodation in Lake Stella, New Zealand" height="3459" width="5189" msid="113509618" hostid="261" sizebytes="2539654"></div>Seven years on, Big Tiny has placed more than 400 tiny houses in more than 10 countries worldwide, from Taiwan to Europe and Australia.On Singapore's Lazarus Island, guests are surrounded by lush greenery and can swim in the sea. At Lake Stella in New Zealand, two hours north of central Christchurch, guests can hike the surrounding mountains or take a dip in the lake. In Yilan, Taiwan, guests can sleep in a tiny forest cottage and gaze at the stars when night falls.<div type="image" title="The cofounders of Big Tiny take a selfie" height="2736" width="3648" msid="113509620" hostid="261" sizebytes="240580"></div><h2 id="a0ebf152-35eb-4037-bc31-9862591a586e">Working with friends can be challenging</h2>Looking back on the journey, Chia said he learned that ideas never come fully formed. "When I was speaking with Dave, it was just an idea of putting tiny houses in rural areas so that people can recharge themselves in nature," he said.He said they never thought they could build tiny houses in his own garden — let alone transport them worldwide.And although <a target="_blank" class="" href="https://www.businessinsider.com/business-partnership-ended-friendship-partners-friends-2024-1">working with close friends</a> can be tricky, Chia credits their successful collaboration to clearly defining their roles.While Chia oversees revenue and strategic development, Ng heads operations and production, and Yeo focuses on branding."Whenever we face problems, we will call for a discussion. Everyone will have ideas on how to get things resolved," he said."But at the end of the day, the person leading the aspect of the business will take ownership and decide on what is the best course ahead."

How 3 friends without any hospitality experience started renting out over 400 tiny homes in remote locations around the world

<ul class="summary-list"><li>An Australian hospital is asking snakebite victims to stop bringing the snakes to the ER.</li><li>The hospital's director said that having a live snake in the ER puts staff and patients at risk.</li></ul>A hospital in Australia is asking snakebite victims not to bring the reptiles with them to the emergency room, the <a target="_blank" href="https://www.abc.net.au/news/2024-04-22/bite-victims-warned-stop-bringing-snakes-to-emergency-department/103752506">Australian Broadcasting Corporation reported.</a>In one instance earlier this month, staff at Bundaberg Hospital in Queensland were handed a plastic container with a small Eastern Brown snake inside, according to the news outlet.The snake species is common across much of eastern Australia, and its deadly venom is the <a target="_blank" href="https://www.theguardian.com/australia-news/2024/mar/20/north-queensland-snake-bite-death-deeragun-townsville-hospital#:~:text=About%203%2C000%20snake%20bites%20are,according%20to%20a%20nationwide%20review.">country's most common cause of fatal snake bites.</a><a target="_blank" href="https://www.theguardian.com/australia-news/2024/mar/20/north-queensland-snake-bite-death-deeragun-townsville-hospital#:~:text=About%203%2C000%20snake%20bites%20are,according%20to%20a%20nationwide%20review.">According to The Guardian</a>, about 3,000 snakebites are reported in Australia each year, with 41% coming from Eastern Brown snakes.Last month, the newspaper reported that one of these snakes caused a man's death after he was bitten multiple times.According to Bundaberg Hospital's director of emergency medicine, Adam Michael, the snake at his hospital this month was "not very well secured."It was also trying to escape the plastic container, ABC reported."The staff got a fright and the serious consequence of that is it delays people's time to treatment," Michael told the news outlet.He added: "We want people to be able to get seen and assessed quickly, and having a live snake in the department slows up that process."A snake catcher told the news outlet that he had removed several snakes bought into the hospital, many arriving in plastic containers or bags.According to the Australian Medical Association, wait times in Australia for emergency rooms are at their longest in a decade, <a target="_blank" href="https://www.9news.com.au/national/australian-surgery-wait-times-longest-ever-emergency-rooms-strangled-ama-report-finds/648102d5-0c6a-437b-adcf-5fa6a387c780">9 News reported last week.</a>While people bringing in snakes may think it will help doctors with identification and speed up getting the right treatment, Michael told ABC that all it does is endanger lives.He said doctors aren't trained to identify snakes, so it only "puts the staff at risk as well as yourself," according to ABC.Bringing in the snakes, he added, risks becoming a "huge" disaster with no upside."We can determine if you need anti-venom and, if so, what anti-venom you need based on clinical signs, blood tests, and also the snake venom detection kits that we keep here at the hospital," Michael said.

A hospital in Australia is begging snakebite victims to stop bringing the snakes in with them

<ul class="summary-list"><li>Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.</li><li>Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.</li></ul>Independent doctors are almost a thing of the past.UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. The same month, the powerful healthcare conglomerate, which owns the nation's largest <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">health insurer</a>, got the green light to take over a decades-old independent Oregon <a target="_blank" href="https://www.oregonlive.com/business/2024/03/oregon-health-officials-give-emergency-ok-to-corvallis-clinics-acquisition-by-insurance-giant-unitedhealth-group.html">medical practice</a>, adding another 100 healthcare providers to its roster. It picked up a 400-doctor <a target="_blank" href="https://www.fiercehealthcare.com/payers/unitedhealth-quietly-scoops-new-york-physician-group-crystal-run">group</a> in New York about a year before.These are just the purchases we know about; there could be many more. Physician practice deals often go unannounced and get little attention from regulators, but they add up. Near the end of 2023, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth's Optum</a>, the business unit housing its clinics and surgery centers, said it employed or was affiliated with 90,000 doctors. That's a whopping 10% of all doctors in the US.Though it's the hungriest, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth</a> is just one buyer in the market for physicians. Little by little, big businesses have taken over healthcare in the US. Hospitals have been scooping up medical practices for decades to create giant health systems. Insurance companies fought back with their own clinic purchases. Private equity firms increasingly staked claims to nursing homes and groups of specialists such as emergency physicians and dermatologists.And in the last few years, tech companies and retailers like Amazon, CVS Health, and Walgreens added thousands of doctors to their payrolls when they bought <a target="_blank" href="https://www.businessinsider.com/cvs-walgreens-amazon-primary-care-acquisition-strategy-2024-3">primary-care chains</a>.Nearly 78% of US doctors are employed by hospitals or other corporate entities, such as insurers and PE firms, according to <a target="_blank" href="https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Study-on-Physician-Employment-Practice-Ownership-Trends-2019-2023">research</a> from consultancy Avalere and the Physicians Advocacy Institute. For the first time, more medical practices were owned by corporate entities (30%) than hospitals (28%) as of January 2024, the research found.There's mounting evidence that this trend toward corporatization could harm patients. Research has found that prices go up when hospitals and private-equity firms buy medical groups. Sometimes, care gets <a target="_blank" href="https://www.nber.org/papers/w30928">worse</a>, but there's still much unknown about how corporate ownership affects medical care, especially when it's a giant like UnitedHealth or CVS doing the buying.Some doctors and experts in the industry fear corporate owners could prioritize their investors and profits ahead of patients, and doctors could lose the ability to make their own decisions about what's best for a patient."The big guys aren't cheaper. They don't deliver better customer service, they aren't more timely, none of that. They're just able to negotiate higher prices," said Farzad Mostashari, the CEO of Aledade, a company that aims to help primary care practices stay independent.The federal government is starting to pay attention. In March, it <a target="_blank" href="https://www.ftc.gov/news-events/news/press-releases/2024/03/federal-trade-commission-department-justice-department-health-human-services-launch-cross-government">launched</a> an inquiry into PE firms and other corporate owners' "increasing control over healthcare" and how this might threaten patients' access to affordable and quality care.The feds also zeroed in on UnitedHealth, <a target="_blank" href="https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2">reportedly</a> facing an antitrust investigation by the US Justice Department into how its medical group acquisitions affect consumers and competitors. News of the probe surfaced before a <a target="_blank" href="https://www.businessinsider.com/change-healthcare-cyberattack-small-mental-health-practices-payments-money-2024-3">cyberattack on UnitedHealth's</a> technology business, Change Healthcare, caused hospitals and clinics nationwide to forgo billions in payments — raising more questions about UnitedHealth's chokehold on the healthcare industry.<h2>Doctors are hot commodities</h2>It's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. But, in essence, they're all hiring doctors for their relationships with patients, who bring opportunities for more profits. <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">US healthcare spending</a> reached $4.5 trillion in 2022, representing almost a fifth of the national GDP.Hospitals rely on doctors — especially those who provide primary care — to refer patients for lucrative procedures or surgeries. <a target="_blank" href="https://www.businessinsider.com/unitedhealth-stock-exec-medical-costs-rising-2023-6">Insurers like UnitedHealthcare</a> and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Still, they can pocket more of those premiums by sending patients to clinics they own.Pharmacies hope that buying medical practices will give more prescriptions to fill and get more customers to buy over-the-counter products at the front of the store."They all realize that patients will follow what their doctors tell them to do or where their doctors tell them to go," said Chas Roades, a longtime healthcare consultant. "So it allows them to both drive traffic to a downstream profit model that they're interested in growing, and I think it also is a way to get consumers to trust them."Meanwhile, independent doctors have a tough time going it alone. Reimbursement is shrinking, and small practices don't have the ability to <a target="_blank" href="https://www.ama-assn.org/system/files/2022-prp-practice-arrangement.pdf">negotiate higher rates</a> as big hospital systems do. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. <a target="_blank" href="https://www.businessinsider.com/ai-chatbots-tech-doctors-medicine-healthcare-system-empathy-quality-email-2023-6">The pandemic</a> made things even more challenging, spurring many doctors to sell their private practices.<h2>The quiet takeover of physician practices</h2>Much of the takeover of physician practices has slid under the radar. That's because acquisitions valued below <a target="_blank" href="https://www.ftc.gov/enforcement/competition-matters/2024/02/new-hsr-thresholds-filing-fees-2024">$119.5 million</a> don't have to be reported to federal regulators, and many practice purchases don't meet that threshold. Publicly traded UnitedHealth, for instance, rarely announces its purchases of medical groups and surgery centers."We're really flying blind here with respect to understanding how many acquisitions by which entities and what geographies and what specialties," said Yashaswini Singh, an assistant professor at Brown University who studies healthcare consolidation.This lack of disclosure has made consolidating doctor practices difficult to study. Research into private equity's effects on healthcare is just emerging, and there's little to no academic, peer-reviewed research on how other corporate owners' acquisitions affect healthcare prices and quality, Singh said.Studies, including Singh's <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946">research</a>, have shown, however, that PE ownership leads to steeper prices and more utilization, meaning patients may have more frequent doctor's appointments. Together, that drives healthcare costs higher. Research also suggests that PE ownership of nursing homes and hospitals <a target="_blank" href="https://jamanetwork.com/journals/jama/article-abstract/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=122623">worsens the quality</a> of care. One <a target="_blank" href="https://www.nber.org/system/files/working_papers/w28474/w28474.pdf">paper</a> found that patients who went to nursing homes owned by private equity firms had a 10% greater chance of dying.And yet, private equity companies are rapidly expanding their presence in healthcare. A 2023 <a target="_blank" href="https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf">study</a> found that one private equity firm owned 30% of the market share for physician practices in over a quarter of metropolitan areas across the US. A single PE firm owned over half the market share in some areas.<h2>'An unsatisfying way of practicing medicine'</h2>Acquisitions by other corporate giants might not produce the same outcomes as PE firms, said Zirui Song, an associate professor of healthcare policy and medicine at Harvard Medical School who studies private equity in healthcare. PE firms are unique in holding on to their acquisitions for only a few years and saddling their acquired companies with debt and fees. Owners who hang on to their medical groups might be more motivated to improve services, he said.Anecdotally, though, many doctors don't like working for corporate overlords, Roades said. Older physicians who own equity in their medical practice get a nice payday when they sell, but the younger ones left behind are closely managed and measured in terms of cost and productivity, he added.It's "an unsatisfying way of practicing medicine. We're seeing a growing number of disgruntled early and mid-career physicians in these groups who find themselves suddenly working for large corporations, and this is not what they wanted to do with their lives," he said.After a few years working at Optum-owned Oregon Medical Group, Dr. Nick Jones opened a <a target="_blank" href="https://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3">direct primary care practice</a>, a type of clinic that charges a monthly fee instead of billing insurance. He said there's a sense of powerlessness for primary-care doctors in the traditional healthcare system — whether they're employed by Optum, a large hospital system, a private-equity firm, or a nonprofit clinic.With thousands of patients to treat, they face a mountain of administrative paperwork and have no control over their schedules. These problems stem from the fact that primary-care doctors are <a target="_blank" href="https://kffhealthnews.org/news/article/compensation-pay-primary-care-shortage-solution/">underpaid</a> in the traditional "<a target="_blank" href="https://www.commonwealthfund.org/publications/newsletter-article/moving-health-care-system-away-fee-service">fee-for-service</a>" healthcare system, in which doctors are paid for every visit, he said.While he felt supported at his previous Optum-owned clinic because of his office manager, "the financial underpinnings and the economics of medicine" made it unsustainable and stressful, Jones said. "There was a three or four month wait for patients to see me. There was still too much on our plate to do, and [during the pandemic] there weren't enough medical assistants or case managers or nutritionists or other support to make 20 patients a day feel like the right thing to do."<h2>Doctors worry corporate giants put profits over patients</h2>The insurers and retailers say care is better and cheaper when integrated under one roof, connected to the health plan, pharmacy, or other provider organizations.For its part, Optum says it wants to improve the health and well-being of people and lower the cost of care with integrated care teams and better technology. It says it's helping clinics transition to providing <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">"value-based"</a> or "accountable" care, which means that its doctors get paid fixed fees upfront that, in theory, encourages them to keep patients healthy and order fewer unnecessary tests.Optum said in a statement it continues "to focus on supporting physicians, advance practice clinicians, and nurses in closing gaps in care and helping the health system perform better for everyone."A spokesperson pointed to a <a target="_blank" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376">study</a> by Optum published in JAMA Network Open in December 2022 that found seniors in value-based care arrangements were less likely than seniors in traditional payment models to visit the emergency room, or be admitted at the hospital for COPD, asthma, stroke, or heart attack.But there are potential dangers. Patients may end up with fewer choices as bigger companies edge out competitors.California health system Emanate Health sued Optum in 2023 for anticompetitive behavior. It alleged that Optum canceled its contracts with Emanate hospitals and steered patients away after Emanate refused to agree to certain terms. Among the terms: Emanate primary-care doctors would serve only Optum patients, and Optum would get first dibs if Emanate decided to sell its primary-care practices.Care might also feel less personal. Some <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">One Medical patients</a> complained that since the chain folded into Amazon, their appointments were shortened, and certain features for seniors, like having health coaches available during patient visits, went away, according to a report from <a target="_blank" href="https://www.washingtonpost.com/technology/2024/02/28/amazon-health-one-medical/">The Washington Post</a>.<h2>Patients could end up spending less time with doctors and face higher costs</h2>Dr. Mitch Li, an emergency physician who started Take Medicine Back, a group that opposes corporate owners pushing into healthcare, said patients will spend less time with their doctors and potentially face higher costs from predatory billing practices."The corporate practice of medicine is the reason why <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">healthcare costs</a> are out of control," Li said.Above all, some doctors fear having to make decisions that benefit the owner's bottom line, even though they may not be the best option for a patient.Dr. Michelle Cooke, a primary-care physician, previously practiced at an Atlanta clinic owned by a hospital system. Though the system was not-for-profit, it didn't operate like that, and over time, the job became unbearable, she said.She had more than 3,000 patients assigned to her care — <a target="_blank" href="https://www.jabfm.org/content/jabfp/29/4/496.full.pdf">far more</a> than typical — and appointments were too short, especially for the chronically ill, she said. The hospital system would prioritize lucrative physicals for <a target="_blank" href="https://www.businessinsider.com/cigna-selling-medicare-advantage-business-insurers-higher-costs-slower-growth-2024-2">Medicare patients</a> rather than seeing patients with an urgent need."It really got to the point where I feel like I was working to feed the corporation," Cooke said. "It really wasn't incentivizing what the patients needed."Cooke has since opened a direct primary care practice, where she sees just a few hundred patients and can spend more time with them. She said she's found that she prescribes less medication now because she has time to educate patients on lifestyle habits and nutrition.<h2>The federal government and states are dialing up the scrutiny</h2>The Federal Trade Commission, the US Department of Justice, and the Department of Health and Human Services are <a target="_blank" href="https://www.wsj.com/articles/federal-agencies-probe-private-equity-profiteering-in-healthcare-2ba4c23a">stepping up scrutiny</a> of healthcare deals, particularly those backed by private-equity firms. The agencies also signaled that they want to look at smaller deals that typically wouldn't trigger an antitrust review.Several states have also increased their oversight of local healthcare consolidation. Some state lawmakers are also trying to strengthen <a target="_blank" href="https://www.nejm.org/doi/full/10.1056/NEJMp2306904#f1">laws prohibiting</a> corporations from practicing medicine. Most states have these bans on the books, but companies have found various ways around them.It's unclear if any of these efforts will meaningfully slow the corporatization of healthcare. And, to be sure, some physician practices may not have survived without an infusion of capital from a corporate buyer.A bill introduced by Oregon State Rep. Ben Bowman would have closed certain <a target="_blank" href="https://www.opb.org/article/2024/02/22/oregon-lawmakers-could-limit-corporate-ownership-of-medical-practices/">loopholes</a> and put more distance between corporate entities and their medical practices. Bowman told Business Insider he wanted to prevent big businesses from eroding doctors' autonomy."A physician who went to medical school who took an oath — their highest ethical duty is to care for their patients. Whether it's a private equity firm or a large corporation, their highest ethical duty is to generate a return on investment for their shareholders. Those two incentives are fundamentally at odds," Bowman said.The bill, opposed by Amazon and CVS, died in March, but Bowman said he plans to reintroduce it in 2025.Around the same time the bill died, UnitedHealth's Optum and The Corvallis Clinic — the small Oregon medical practice that Optum struck a deal to buy — requested that their tie-up receive an emergency exemption from state review because of the Oregon clinic's deteriorating finances.The proposed acquisition, first announced in December, had received plenty of pushback from state residents. The request also came as hospitals and clinics nationwide faced cash shortfalls because of the cyberattack on UnitedHealth's Change Healthcare.A week later, Oregon's health authority approved the request.

Big corporations are quietly taking over your medical practice. Some doctors and experts say it's ruining healthcare.

<ul class="summary-list"><li>Salaha Ashraf spent her last few years of medical school feeling stressed and anxious.</li><li>She said hospital wards were under-resourced and busy, and she knew she wanted to quit. </li></ul>This as-told-to essay is based on a transcribed conversation with Salaha Ashraf, 28, from Bolton, a town in the northwest of England. Ashraf went to medical school in 2014 but pivoted into a corporate career after deciding she didn't want to be a doctor. The following has been edited for length and clarity.There wasn't a defining moment when I decided to <a target="_blank" href="https://www.businessinsider.com/what-parents-did-right-to-help-get-into-med-school-2021-1">go into medicine</a>. I sort of fell into it. In my South Asian culture, medical professions are highly regarded. Plus, my siblings worked in the medical field, and I could see them doing well.During my time working in hospitals for my medical degree, I experienced a lot of anxiety and stress. I was working long shifts and felt like I was being thrown into the deep end.I decided to <a target="_blank" href="https://www.businessinsider.com/nurses-are-considering-leaving-the-profession-after-covid-19-pandemic-2021-5">leave the medical field</a> in 2020 after finishing my degree. I got on a corporate graduate scheme at 25 and now have a 9-to-5 in HR. I've never looked back.<h2>I struggled with the UK's understaffed hospital environment during my studies</h2>I started my five-year medical degree in 2014 at a university in northwest England.The first two years of my course were focused on learning theory about anatomy and physiology and the last few years were spent in hospitals, learning the skills and techniques I'd need to be a doctor.I enjoyed the first few years, but I began to struggle in my third year when it became more hospital-based. In a lecture theatre, I was shielded from the realities of being a doctor.<a target="_blank" href="https://www.businessinsider.com/covid-uk-hospitals-nhs-collapsei-doctors-nurses-2021-1">The NHS</a> has been under increasing pressure. When I worked in hospitals, the wards were understaffed, under-resourced, and extremely busy because of a <a target="_blank" href="https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/health-funding-data-analysis">lack of government funding</a>. It was a tough environment to learn and practice skills. Doctors were being pulled in all directions. Finding one with the time to watch me practice and teach me was hard.I also had reservations about junior doctors' salaries. <a target="_blank" href="https://www.businessinsider.com/junior-doctors-strike-reasons-and-interview-2016-1">Junior doctors</a> in the UK have been striking for years over low pay. My peers had such a passion for medicine that they were willing to be doctors no matter what. I didn't feel I had enough passion to compensate for the lack of fair pay.<h2>I found a new passion for business management but decided to finish my medical degree before switching career path</h2>I dreaded going into my fifth year of medicine and decided to take a year out and do a master's in business management. I wanted to explore areas outside the medical field.I felt more passionate about business management after one year compared to four years of medical school. I attended lectures because I wanted to, not because I had to.I knew I wanted to <a target="_blank" href="https://www.businessinsider.com/productivity-youtubers-creator-business-channel-hacks-tips-ali-abdaal-2021-11">quit medicine</a>, but I was so close to the finishing line after passing my fourth-year finals before taking a year out. Logically, it made sense to finish my medical degree. I was meant to graduate in the summer of 2020, but it was brought forward to April because the pandemic hit.<h2>In the UK, we have graduate schemes that help you get your foot in the door at an industry</h2>During my fifth year, I started applying to graduate schemes. I'd heard about <a target="_blank" href="https://www.top100graduateemployers.com/">The Times newspaper's</a> book of top 100 graduate employers. I looked through it and applied to a range of companies. My choices were mainly based on location, as I wanted to stay in the north of England, close to my parents.The application process was harder than I expected. I didn't realize there were various stages, like personality and situational judgment tests. I messed up the first video interview I did. But my technique improved after a few other interviews.I made it to a final interview with an aerospace company and got offered a remote job as a graduate commercial officer, managing contracts for the company. I started in January 2021.There was a cohort of around 30 of us on the grad scheme.I was 25 at the time, and many of the other grads were younger than me. I felt behind and like I should be further in my career at this stage, but I had to remind myself I had the maturity and professionalism that the 21-year-olds didn't have.I learned a lot about communication while training to speak with patients as a doctor.<h2>The perks of a 9-to-5 job are great</h2>The scheme officially ended after 18 months, and I was given a permanent role in contracts. The company let me pivot into HR six months later because I wanted to do something that would incorporate my people skills.I felt my medical background made me suitable for <a target="_blank" href="https://www.businessinsider.com/amazon-hr-performance-improvement-plans-pip-pivot-had-to-quit-2023-11">HR work</a>. Doctors improve patient's lives, and in HR, I'm improving employee's lives. I left that company in September 2023 and now work in HR at a pharmaceutical company.In a corporate role, I get my weekends off and have more control over my annual leave. I take an hour lunch break, whereas when I worked in a hospital, I would skip meals to keep up with the workload. I also <a target="_blank" href="https://www.businessinsider.com/dream-job-in-office-work-full-time-flexibility-benefits-2024-3">work from home</a> at my current job, which allows me to spend time with my family.I feel I'm in the right career for me.<h2>I don't wish I was a doctor</h2>I try to look back at <a target="_blank" href="https://www.businessinsider.com/personal-finance/medical-school-cost">medical school</a> in a positive light. I'm glad I did it because it taught me useful skills, like how to communicate clearly.If I truly asked myself at 18, "What do I actually want to do?" I probably wouldn't have enrolled in medicine. If I felt empowered to follow my passion, maybe I would have studied psychology, which I found interesting at school. I'm glad I'm thinking about what I want now — better late than never.I don't for one-second wish I was a doctor. I greatly respect people who are, but I strongly believe it's the passion that drives them — and that's something I ultimately never had. In response to a request for comment from Business Insider, an NHS spokesperson said: "There are more doctors working in the NHS than ever before, with more than twice as many people joining the medical register as leavers, but we know there is more work to do to retain our hardworking staff. As part of delivering our NHS Long Term Workforce Plan we've taken action to improve working conditions and improve retention, including increasing choice and flexibility in rotas and reducing duplicative inductions and training so clinicians can spend less time on admin and more time treating patients. At the same we are continuing to expand education, training and recruitment, including a 25% increase in medical places and an expansion of specialty training places, to ensure we have the staff we need to meet the changing needs of the population."

I quit medicine for a corporate grad job. I felt behind but didn't have the passion to become a low-paid doctor. 

Mumbai, Feb 23 (PTI) Former <keyword id="19895394" type="General" weightage="20" keywordseo="lok-sabha" source="keywords">Lok Sabha</keyword> Speaker Manohar <keyword id="19952829" type="General" weightage="20" keywordseo="joshi" source="keywords">Joshi</keyword> passed away at a Mumbai hospital on Friday, where he was admitted after suffering a cardiac arrest. Joshi (86) was admitted to <keyword id="20694838" type="General" weightage="20" keywordseo="hinduja-hospital" source="keywords">Hinduja Hospital</keyword> in the Intensive Care Unit (ICU) on February 21 and passed away early Friday, the private medical facility said. Joshi Sir, as he was popularly known, was the first chief minister of the undivided Shiv Sena and held the post during 1995-1999. He was admitted to the hospital in May last year after suffering a brain haemorrhage. He was also elected as a member of Parliament and was the Lok Sabha Speaker from 2002 to 2004 when the Vajpayee government was in power. Born on December 2, 1937 in coastal Konkan region of Maharashtra, Joshi obtained his Bachelor's degree in Civil Engineering from the prestigious Veermata Jijabai Technological Institute (VJTI) in Mumbai. His political career began with his involvement in the Rashtriya Swayamsevak Sangh and he later became a member of the Shiv Sena. In the 1980s, Joshi emerged as a key leader within the Shiv Sena, and was known for his organisational skills. He was the Lok Sabha Speaker from 2002 to 2004 when the Vajpayee government was in power. The former Union minister was married to Anagha Joshi, who died in 2020 at the age of 75. He is survived by a son and two daughters. Joshi began his career as a teacher and entered politics in 1967. He was associated with the Shiv Sena for more than four decades. He was a municipal councilor in Mumbai during 1968-70 and Chairman, Standing Committee of the Mumbai municipal corporation in 1970. He was the Mayor of Mumbai during 1976-1977. He was then elected to the Maharashtra Legislative Council in 1972. After serving three terms in the Legislative Council, Joshi was elected to the Maharashtra Legislative Assembly in 1990 and was the Leader of the Opposition in the assembly during 1990-91. In the 1999 general elections, Joshi won from the Mumbai North-Central Lok Sabha Constituency as a Shiv Sena candidate, and was later Union minister of Heavy Industries and Public Enterprises. Condoling Joshi's demise, Union minister Nitin Gadkari, who was a member of the Maharashtra ministry when the former was the CM, said the state had lost a "cultured face" of politics. Joshi's family said his last rites will be performed at Shivaji Park crematorium in Dadar area.

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