When the bipartisan "mainstream coalition" released its reform plan recently, it was the culmination of months of work by one of the Senate's most moderate Republicans, Rhode Island's John Chafee.
The mainstream group's plan was hailed by its creators as the last great hope for healthcare reform this year, and given that Mr. Chafee's coalition represents the largest bipartisan group working in the Senate, that may be true.
But the triumph has not been without its costs. Other Senate Republicans, who would just as soon see healthcare reform wait until after the November elections, have been critical of Mr. Chafee behind closed doors for continuing to work with the Democrats. Staff members say the attacks have grown increasingly harsh and personal as Congress works through its usual August recess.
In public, hard-line conservatives such as Sen. Phil Gramm (R-Texas) and Sen. Dan Coats (R-Ind.) have criticized not only the mainstream group's plan but also its authors, clearly breaking the old code that "Thou shall not speak ill of a fellow Republican."
Less is more.Healthcare consolidation is an industry hot button these days, so here's a similar trend that providers are likely to cheer-consolidation of meetings.
The National Association of Psychiatric Health Systems and the American Hospital Association's Section for Psychiatric and Substance Abuse Services will likely combine their annual meetings, beginning in 1995.
The Washington-based NAPHS usually meets in January, the AHA group in June. Next year's combined meeting is planned for June in New Orleans.
"The potential is to build the attendance at the meetings," said Robert Trachtenberg, NAPHS executive director. This year, each group drew about 250 attendees, he said.
Blending the meetings seems to be a logical move. At NAPHS' meeting in January, the group-which has been dominated by for-profit hospitals-voted to broaden its membership to medical/surgical hospitals with psychiatric units (Feb. 7, p. 16). Since then, NAPHS has added 83 members, 12 of which are medical/surgical hospitals. The group now has 312 members.
When asked about taking the next step to merge the two organizations, Mr. Trachtenberg said that while they have no such plans, "We're always talking to each other."
Foreign aid.Speaking of consolidations, here's a positive outcome from hospital mergers: Late last month, Columbia/HCA Healthcare Corp.'s Plaza Medical Center merged with Saint Joseph Hospitalin Fort Worth. Last week, hospital officials gathered equipment and supplies no longer needed because of the consolidation and shipped them off to a place where the need is great-war-ravaged Rwanda.
The surplus equipment included 20 beds, 40 mattresses and 144 IV sets, plus lots of syringes, microsurgical knives, thermal blankets, catheters and drainage tubes.
The equipment and supplies were collected and will be shipped to Rwanda by World Medical Mission, an effort headed by Franklin Graham, son of evangelist Billy Graham.
A hell of a bill.What's the cost of expelling a few demons? Nearly $13,000, according to the bill that Kingsboro Psychiatric Center got socked with.
The state mental facility in Brooklyn, N.Y., allowed Alphonso Pecou, a 43-year-old patient, to receive spiritual counseling outside the hospital. Mr. Pecou was committed to the facility after being tried on charges that he slashed his wife to death with a machete and set her on fire in 1982.
The ritual performed by the Rev. Alpha O. Bundu involved mineral-water baths and oil anointments. When hospital personnel learned of the type of "spiritual" care he was receiving, the state ordered it stopped and mailed Rev. Bundu a check for $500. That's the standard rate of payment for several sessions of more conventional counseling.
"We recognize that people have different religious beliefs," said Robert Spoor, a spokesman for the New York Mental Health Office. "The issue is about charging us nearly $13,000 to perform a ritual that we felt went beyond spiritual counseling and into the realm of psychiatric treatment."
To avoid devilish payment snafus in the future, the state has created a board of consultants to review nontraditional treatments. If the state should have a change of heart on paying for exorcism, Outliers would suggest assigning it to DRG 666.
What about a test drive?Anybody want to buy a used hospital in Texarkana, Ark.?
It's a tough sell, as Administrator Tom Byrne of St. Michael Hospitalcan testify. In late November, the hospital will move about three miles away into a new $128 million, 318-bed replacement campus. Texarkana straddles the state line between Arkansas and Texas, and St. Michael's new campus is on the Texas side. That also happens to be where the city's other two acute-care hospitals are located.
One of the reasons St. Michael is moving is that hospital officials fear the Arkansas Legislature some day may repeal the personal income tax exemption enjoyed by Texarkana's 54,000 residents. "It's fought every single legislative year," Mr. Byrne said.
Texarkana residents are exempted from income taxes because the city has to compete for labor with Texarkana, Texas, where no such tax exists. Only two of the hospital's 200 physicians live on the Arkansas side now, but if the exemption were lifted, those physicians would have to start paying taxes on income they generated in Arkansas. Adding such a burden might prompt physicians to refer patients instead to the Texas-side hospitals.
While construction has been under way, Mr. Byrne has tried to sell the hospital's current eight-acre campus to the federal Bureau of Prisons and the Department of Veterans Affairs. No luck.
So, two weeks ago St. Michael took out advertisements in about 25 newspapers and journals asking for bids.
Although St. Michael's owner, the Sisters of Charity of the Incarnate Word, is anxious to unload the hospital, Mr. Byrne isn't anxious to see another hospital chain buy it. "We don't need another hospital in Texarkana," he noted.