Rebecca Anderson had a good heart, and now it beats for someone else.
Anderson, 37, a nurse, was one of those medical personnel who rushed to the Alfred P. Murrah Federal Building in Oklahoma City April 19 to help victims of the bomb attack.
Unfortunately, Anderson, an employee of a local nursing home, became another victim. While helping rescuers she was struck on the head by a slab of concrete that fell from the crumbling nine-story building. She died five days later at University Hospital.
Her tragedy had a silver lining, though. Surgeons at University Hospital transplanted her heart into a 55-year-old Oklahoma man who had been hospitalized awaiting an organ.
Recarey redux.Miguel Recarey, the head of a failed HMO who fled the United States in 1987 to avoid prosecution, told ABC-TV's "20/20" news program that he spent thousands of dollars-but not enough-to buy influence in Washington from Jeb Bush and other prominent political figures.
Interviewed in Spain, where he is immune from U.S. prosecution, Recarey denied being at the center of a multimillion-dollar healthcare scandal in the mid-1980s, but supported allegations that Bush acted improperly while his father, George Bush, was vice president. Recarey said he paid $75,000 to Jeb Bush for helping to persuade HHS Secretary Margaret Heckler to preserve Medicare funding for his Miami-based company, International Medical Centers.
Jeb Bush wrote ABC to deny acting as a lobbyist for Recarey and said the money was a real estate commission on a new corporate headquarters for IMC, a deal that was never completed.
Recarey was charged with diverting Medicare funds to his criminal defense, paying off a union to get a contract and wiretapping his own employees.
In the mid-1980s, IMC, the nation's largest Medicare-certified HMO, faced enforcement of a federal rule limiting an HMO's Medicare patient load to 50%.
IMC received $360 million from Medicare in the year before regulators declared the firm insolvent in 1987. Six months later, Recarey vanished. More than $200 million was never accounted for, but Recarey told ABC the books were straight when he fled to Venezuela. IMC was later sold to Humana.
Variable costs.In Medicare jargon, it's "Procedure 8411." Colloquially speaking, it's a toe amputation.
Have a toe removed in the "low managed-care" market area of Charlotte-Gastonia-Rock Hill, N.C., and you'll be charged an average of $17,599 and stay in the hospital an average of 15.8 days. The average cost to the hospital is $8,848.
In the "high managed-care" market of Rochester, N.Y., you'll be laid up an average of 9.2 days and billed an average of $9,504 for a procedure that costs an average of $5,677.
The variations may seem severe, but "amputation of toe" actually represents a below-average opportunity for hospitals to save money because it's a relatively low-volume procedure.
These conclusions come to us courtesy of the Columbus, Ohio-based Center for Healthcare Industry Performance Studies. The center has just published a 245-page book on the 50 most-frequently performed inpatient Medicare surgical procedures. The Procedures Resource Book provides national and local benchmarks to help hospitals identify areas for improvement. The data reflect more than 11 million Medicare discharges at more than 6,000 hospitals.
The surgery with the greatest potential for industrywide cost savings is Procedure 8622, "excisional debridement of wound, infection or burn," also known as cutting away of dead tissue. If hospitals outside of the "best practices" group reduced their costs for that treatment to the average for national "benchmark" hospitals, the industry could save $274.2 million, the book says.
Lifeline.When an avalanche blocked the only road to rural Renovo, Pa., last winter, nine-bed Bucktail Medical Center was cut off from "just about everything," said Lennea Brown, the facility's assistant administrator.
That's why Bucktail will be among the first sites to benefit from a $200,000 telemedicine grant given by Bell Atlantic of Pennsylvania to Geisinger Health Care System, Danville, Pa.
Bucktail's emergency room, which is staffed by a Geisinger physician, will be equipped with a computer workstation, enabling the tiny hospital to consult with specialists at Geisinger Medical Center in Danville 80 miles away.
A Renovo physician's office, part of Geisinger's Clinton County multispecialty group practice, and Jersey Shore (Pa.) Hospital in neighboring Lycoming County, which serves Geisinger Health Plan patients, also will be rigged with the new teleconferencing equipment.
Expanding early detection.To fight breast cancer mortality in California, the state is launching a campaign to target women of various backgrounds for whom mammography is an unfamiliar, even frightening, procedure.
On May 3, a breast cancer early detection program called "Every Woman Counts" will provide free screenings and diagnostic services to low-income, underinsured and uninsured women. The program was created by legislation in 1993 and funded by a tax on tobacco.
Liana Lianov, M.D., chief of the state Department of Health Services' cancer detection section, counsels physicians: "If you do not routinely see `poor' patients, or if you are not a Medi-Cal (Medicaid) provider, do not assume that your patients don't qualify. We know that women from a variety of backgrounds can be embarrassed to admit that they can't afford healthcare services or that their insurance will not cover certain procedures."
Since the program removes the cost barrier, state health services Director Kim Belshe is asking doctors of all specialties to routinely perform clinical breast exams and refer female patients for mammograms, under certain guidelines.
The program gives doctors eligibility criteria based on women's age and medical history. Household income must be at or below 200% of the federal poverty level, and the program accepts patients who are uninsured or underinsured.