While consumer groups and the Catholic Church are waging an ideological war against for-profit healthcare, analysts at New York's Bear, Stearns & Co. see no immediate threat. Here's a sampling of their evidence:
On quality. Columbia/HCA Healthcare Corp.'s decision to "aggressively pursue" accreditation with commendation from the Joint Commission on Accreditation of Healthcare Organizations is "a very good long-term strategy," said A.J. Rice, a Bear, Stearns managing director and healthcare services analyst. Some 21% of Columbia's 340 hospitals have achieved this distinction, compared with 12% of total U.S. hospitals.
On efficiency. In a study of the top 100 hospitals by HCIA, a Baltimore-based healthcare information company, and William M. Mercer, a New York-based management consulting firm (Dec. 4, 1995, p. 54), for-profit hospitals claimed 33 spots. Columbia hospitals accounted for 26 of the 33 for-profits in the top 100.
On negotiating acquisitions or joint ventures. Rice said a recent report by the Washington State Hospital Association notes a number of the "positives" of doing business with Columbia (Jan. 1, p. 8).
On pricing. The conversion of Blue Cross and Blue Shield plans to for-profit status means more insurers will be answering to shareholders instead of pursuing market share at any price. That could result in more disciplined pricing, predicted Gary Frazier, a Bear, Stearns managing director and managed-care analyst.
What sort of impression are patients and visitors forming as they pass through your hospital? Judging from a study published in the American Journal of Medicine in August 1995, they may be getting an earful.
Ethics researchers from the University of Pennsylvania and the University of Pittsburgh wanted to find out what kind of remarks employees were making in hospital elevators. They rode elevators in five hospitals a total of 259 times. Inappropriate remarks were heard on 14% of the trips, half of them violations of patient confidentiality. The worst offenders were doctors, followed by nurses.
Typical unprofessional remark: "I worked 16 hours yesterday, went home, had some beer, and before I knew it, I was back here. I don't think I can make it all night." Or this, said by one nurse to another nurse in a wheelchair: "You just can't assist on those procedures this morning if you're this sick."
On two occasions, the study reports, "physicians riding elevators made it clear that they were biding their time until they could make large amounts of money."
The clincher: Two administrators talked about calling the coroner in to look at a deceased patient because "his death was the hospital's fault." That comment was made on a packed elevator, at which point all conversation ceased.
Tension between physicians and hospital administrators is so rife it's acquired a catchy moniker: Docs vs. hocs (healthcare organization chiefs).
"Ten Key Differences Between Docs and Hocs" appeared in the January/February issue of Group Practice Journal, published by the American Group Practice Association.
It was written by Charles Musfeldt, M.D., a part-time family physician and president of a Naperville, Ill.-based consulting company. Among the observed differences:
Meetings. "Hocs crave communications and orchestrate frequent briefings and debriefings followed by endless analysis and interpretation. Docs consider meetings a senseless waste of time."
Lawsuits. "Hocs seek protection through maximum documentation and frequently discuss medico-legal risk. Docs seek protection through only essential documentation and cringe through time-consuming legal discussions. A doc would rather hug a boa constrictor than be deposed."
The Joint Commission on Accreditation of Healthcare Organizations. "Hocs truly care about JCAHO reviews, reports and accreditation. Docs couldn't care less. Nothing irritates a doc more than hearing a hoc say, `You must do such-and-such because the JCAHO says so."'
The Greater New York Hospital Association took exception to a report in Crain's New York Business about the truths behind hospital layoffs in New York City, but it doesn't mean the issue has been clarified.
As Outliers reported (March 11, p. 68), hospital lobbyists have bemoaned the loss of 10,000 jobs last year because of Medicaid cuts, while the New York State Labor Department reported that hospital employment actually increased by 1,900 in 1995. Crain's, a sister publication to MODERN HEALTHCARE, said the data proved "hospitals are hiring virtually the same number of workers they are firing as they open clinics and start other units to deliver healthcare outside the hospital setting."
GNYHA President Kenneth Raske said the report was inaccurate, noting it did not include public hospital employment. The public hospital data are not yet available, but when they are, Raske said it will reveal a net job loss for the entire hospital sector in 1995.
While acknowledging it should have noted its data came from private hospitals only, Crain's disputed another contention of the GNYHA. That was that if attrition, or the elimination of vacant, budgeted positions, is counted, job losses were even greater. Crain's noted that employment data should compare jobs, not budgeted positions.
It sounded plausible: The chairman-elect of the American Hospital Association telling registrants at a major national health conference that the trade group would soon be changing its name to the Association of Integrated Delivery Systems.
Reginald M. Ballantyne III, president and chief executive officer of PMH Health Resources, Phoenix, discussed industry changes during a keynote speech at the Federation of American Health Systems annual conference last month in Washington. Naturally, reporters wanted to find out when a new name would become official.
Not so fast, said Richard Wade, AHA senior vice president of communications. At this point, "there's nothing formal," Wade said. In 1995, the AHA adopted mission and vision statements reflecting the changing nature of the industry and its membership. About 21% of hospitals belonged to integrated networks in 1994, and the number continues to grow.
Ballantyne later explained the issue of a new name is on the agenda for the AHA's strategic planning committee meeting this week in Chicago and could be unveiled as part of the organization's 100th anniversary in 1998.
