When the new Republican-led Congress convenes next year, healthcare may not be at the top of its agenda but it won't be for lack of people who come from the healthcare industry, all of whom are Republicans.
Freshman member-physicians include Greg Ganske of Iowa, Dave Weldon of Florida and Tom Coburn of Oklahoma, all internists who will serve in the House. Besides the physicians, there will be Barbara Cubin of Wyoming, who worked as a medical office manager, and Charlie Norwood of Georgia, a retired dentist.
Bill Frist, M.D., a heart surgeon from the Hospital Corporation of America family, will be the only physician in the Senate. The Tennessee Republican unseated Sen. Jim Sasser.
Two members with medical backgrounds will not be returning next year. J. Roy Rowland, M.D., a Georgia Democrat, retired from his House seat, and Washington optometrist Mike Kreidler, a Democrat, lost his bid for re-election to a House seat.
Software paradox.If you can't decide which type of managed-care information system to buy for a hospital in transition, some consultants have an answer: Buy both-it's cheaper.
Sounds paradoxical, and it is. Versions of software are very different depending on where a provider is on the road that leads from fee-for-service discounting to capitated, predetermined payment. But unless a region is expecting a very rapid change to capitation, it's well worth the investment to put a basic contract-management system in place to help capture underpayments and provide information for new-contract negotiations, said Sandra Smith, a Walnut Creek, Calif.-based consultant with Superior Consultant Co.
When capitation becomes predominant, "If they have to throw it away then, it's paid for itself a couple times over," she said. These systems can be acquired for under $400,000, and they've shown the ability to recover that much in underpayments from managed-care contracts in a year or two (Nov. 7, p. 60).
Providers that wait until they're ready to manage costs rather than contracts could hemorrhage cash in the meantime. The healthcare-delivery market will be easing into the new rules of business, Ms. Smith said. "In virtually all communities, there's a lot more talk about capitation than is actually occurring," she said.
Contract-management software can be the first of a two-step approach, said David Engert, vice president of sales for the managed-care group of HBO & Co. "The first helps stop the bleeding and the second helps you get into re-engineering the business," he said.
Risky business.Picture this: A surgeon, surrounded by nurses, assistants and hospital staff, drops a patient's heart on the floor during an operation. The hospital representatives say, that's OK, because "the floor is clean."
That scene was depicted in a popular cartoon passed around at the 16th annual American Society for Healthcare Risk Management meeting earlier this month in Seattle. But risk managers, who made up the majority of the 1,200 people attending the meeting, weren't chuckling. As healthcare systems become more integrated they'll also become more liable. Risk managers will be taking on expanded roles with greater responsibilities for physicians' actions.
Quality together.Quality initiatives come and go, but at Methodist Medical Center in Oak Ridge, Tenn., the commitment and fervor remain strong. For the second year in a row, MMC has received the Tennessee Quality Achievement Award.
One interesting approach used by the hospital is the Quality Together Fellowship, which grants an MMC manager a three-month sabbatical from regular duties to hone leadership skills and learn about quality improvement techniques. Sheila Borges, the first executive to complete the fellowship, has resumed her regular duties managing a 95-person telemetry unit. "I've gone back with a new eagerness and a renewed commitment to continuous improvement," she said.
MMC President Marshall Whisnant said fellows are expected to concentrate on "developing plans to accelerate the culture of empowerment." Linda Sullivan, the hospital's director of information systems, recently embarked on her QT fellowship.
Mousy procedure.A University of Washington surgeon has performed two operations using genetically altered mouse cells to treat brain cancer. Mitchel Berger, M.D., an associate professor of neurological surgery, performed the operations on Robert E. Eichler, 37, a Yakima carpenter, and a 24-year-old man from Saudi Arabia. Both are recovering at the University of Washington Medical Center in Seattle.
"This is, we think, the basis for a cure," Dr. Berger said.
The technique, developed over the past three years, uses a combination of viruses, mouse cells and an anti-herpes drug, and eliminates the need for harsh chemotherapy and radiation that has been largely ineffective anyway.
"This clearly could redefine the way we treat brain cancer," Dr. Berger said.
All patients being treated with the new therapy have glioblastoma, the most aggressive form of brain cancer. The rapid enlargement of the tumor destroys normal brain cells, debilitating the patient and causing headaches, vomiting and drowsiness.
The UW is one of three medical centers in the nation performing the gene-therapy surgery. Iowa Methodist Hospital in Des Moines and the University of California San Francisco Medical Center have each performed two of the operations since July.
Genetic Therapy, a Gaithersburg, Md., biotechnology company that owns the rights to the retrovirus, is financing the current research.
Chilly welcome.When HCFA Administrator Bruce Vladeck greeted reporters gathered recently in the frigid eighth-floor conference room at HHS headquarters in Washington for an announcement on new nursing-home regulations, he announced a change in the program.
"We may have to do a briefing on treatment of hypothermia," Mr. Vladeck said to two dozen shivering, goose-pimpled reporters. "But if all of you keep breathing, maybe it will warm up."
Quotable."Harry and Louise are still under contract."-Health Insurance Association of America President Bill Gradison, discussing healthcare reform in the coming 104th Congress during a post-election press conference.