It'll be feast or famine for New York state hospitals if a proposal to lift hospital rate controls is adopted.
Strong competitors with a healthy proportion of commercially in sured patients may be able to raise charges, says Moody's Investors Service. But that window of opportunity will begin to close as managed care grows and pricing pressures rise, the New York-based rating agency predicted.
For academic medical centers and urban facilities with poor payer mixes, the outlook is dim. Moody's believes deregulation poses significant risks because those providers could wind up with fewer dollars to offset bad debt and charity-care costs.
Despite the positive effects of deregulation, Moody's doesn't expect widespread improvement in hospital credit ratings.
The hospitals at greatest financial risk are those that currently receive special funding from the state to stay afloat, according to the New York-based Labor Research Association.
A new 165-page report by the association, called Winners and Losers: The Future of the New York City Health Care Market, says at least four of the city's hospitals-participants in the state's distressed hospital fund since its creation in 1983-are "unlikely to remain financially viable after losing state subsidies." They are: Bronx-Lebanon Hospital Center, the Bronx; Interfaith Medical Center, Brooklyn; Jamaica Hospital Medical Center, Queens; and North General Hospital, Manhattan.
Meanwhile, New York City's large academic medical centers are leading the charge to build networks that will enhance and protect their competitive positions. Eight major networks already control 68%of the city's nonpublic hospital beds, the report notes.
Mind your own business.You hear that a close friend was rushed to the hospital to deliver her second child. You want to be there, so you drive over, follow the placards to labor and delivery, and ask a nurse how it's going with Betty Sue.
"Oh, she's nine centimeters dilated and 100% effaced. It was too late to give her an epidural. She'll have to start pushing soon."
You may think the nurse is being helpful, but in Texas she may be violating the law.
The Texas Legislature recently approved a strict law protecting patient confidentiality, and that includes release of verbal information on patients. It took effect Jan. 1. No hospital employee can give out information about a patient's medical history, treatment, diagnosis or prognosis without written authorization of the patient or his or her l awyer.
If Betty Sue didn't have time to sign that form, the nurse can only disclose that the patient has been admitted and provide one word about the patient's condition: good, fair, serious or critical.
Although some media have ques tioned the strictness of the guidelines, Texas Hospital Association spokeswoman Ann Ward said the new law is part of a larger effort to protect patients' records.
Because the state lacked such guidelines, some hospitals were more lax about what they released.
Ward also noted that federal legislation is pending on the same issue.
Litigation heaven.Malpractice insurance premiums for South Florida obstetricians are more than double the national rate at $66,200 per average physician, according to a survey by Florida Health Professionals, Hallandale, Fla.
For that reason, Dennis Beckwith, M.D., Florida Health's chief executive officer, said he rejects two of every three physicians who apply to join the 38-member obstetric group practice.
Beckwith's No. 1 reason for rejection? High malpractice records. Obstetricians and gynecologists in the survey averaged one lawsuit every 2.8 years on average, an unacceptable rate, he said. Only two malpractice suits have been filed in the past 10 years against Florida Health's physicians, he said.
Another reason the area's obstetricians pay higher malpractice premiums and are rejected by Florida Health is that so me South Florida hospitals perform C-sections at a 40% rate, while Florida Health's rate is 12%, a group spokesman said.
Mall wonder.Since Main Street moved to the mall, the hospital was bound to follow.
St. Luke's Health System in Kansas City, Mo., has installed "interactive resource stations" in four local shopping malls. They are 12-foot-wide displays of bright graphics, calendars and maps that are supposed to promote health and wellness.
They also have on hand a comprehensive directory of all the physicians and health professionals associated with the five facilities in the region operated by St. Luke's. The displays help people find a doctor's office near their home, make appointm ents with doctors, sign up for healthy cooking classes or fitness programs, get instructions about being better parents, or join a walking club.
"Shopping centers have evolved into today's town squares," says John Miller, St. Luke 's spokesman. "Families go to malls for a variety of reasons. We're going where they go."
Working partnerships.Supply firms and their hospital customers are sounding like a Rodgers and Hammerstein song with their talk of strategic partnerships. (Go ahead, sing it: "Getting to know you, getting to know all about you...")
Most relationships haven't achieved full disclosure yet, says David Jensen, a Los Angeles consultant and former hospital executive. But he has found that supplier executives say sharing information-such as exactly how much providers earn on services and suppliers net on product sales-is key to building trust and designing utilization programs from which both par ties profit.
Jensen is writing a book with the working title of Science of Selling in the Changing Healthcare Environment. From interviews with about 20 supplier executives, he culled these five principles of practical and profitable partnerships: Get the right people involved early; meet the specific needs of each partner; ensure that common goals are of strategic importance to each partner; align incentives so each partner wins; and share the information re quired to build trust and provide feedback. Easier said than done.
Quotable."Shift happens."-From a presentation by Elliot Stone, executive director of the Massachusetts Health Data Consortium, on new responses to increased demand s for information, which of course represents a worrisome and oft-described "paradigm shift" in the organization of healthcare.