June 30 marks the end of the road for New York's hospital rate-setting system. Not surprisingly, hospitals are at odds over how to proceed. Much like Doctor Dolittle's Pushmi-pullyu, the industry is moving in opposite directions on a handful of payment issues.
Recently, a coalition of more than 30 hospitals retained Albany, N.Y.-based lobbyists Weingarten & Reid Associates to work on its behalf. The "Hospitals for Fair Funding" coalition opposes special treatment of financially "distressed" hospitals and other hospitals that serve a large percentage of Medicaid and self-pay patients.
Under the expiring rate-setting system, 36 of the state's 250 hospitals qualify for tens of millions of dollars in subsidies and special capital assistance, but Hospitals for Fair Funding said it's time to level the playing field. Says lobbyist Steve Weingarten, the objective is to end a system "that many times awards the inefficient."
Despite the infighting, hospital groups insist they're unified on larger reform issues. For example, New York hospitals unilaterally oppose the governor's proposal to fund "public goods" through a 9% surcharge on non-Medicare payers.
The eye is watching.An old joke has it that one way you can tell you're having a bad day is when your secretary says a "60 Minutes" crew is in the waiting room.
Well, that may be happening to Columbia/HCA Healthcare Corp., the nation's largest for-profit healthcare provider. A number of sources told Outliers that the CBS news program is working on a segment on the Nashville, Tenn.-based company.
Columbia executives declined to comment, and so did a spokesman for "60 Minutes," who added that the network does not comment on segments before they are aired.
However, a source at the network confirmed a segment is in process, looking at consolidation and "corporatization" of the healthcare industry. The source said the story might air in the next few months, but added, "If some news broke, it could go this weekend."
Managed greenbacks.More interesting news about HMOs was published recently in the Tampa Bay (Fla.) Business Journal. The Journal listed the salaries of some top HMO executives in Florida.
One warning: The amounts could make hospital CEOs jealous, especially when their average salaries are about $200,000.
Here are the annual salaries of some of the top execs: William Griffin, Riscorp, $6.4 million (including bonus and stock options); William Flaherty, Blue Cross and Blue Shield of Florida, $1.9 million; Stefon Fritz Brueckner, Anthem Health Plan, $859,000; Luis Lamela, CAC-United HealthCare Plans of Florida, $522,500; Phillip Garmon, Humana Medical Plan, $511,000; Neil Natkow, PCA Health Plan, $502,000; Betty Kimmel, Cigna HealthCare Florida, $460,000; Mitch Goodstein, PacifiCare, $451,000; and Michael Fernandez, Physicians Healthcare Plans, $269,000.
Not bad for jobs designed to save consumers money on healthcare costs.
Condemning suicide chic."Physician-assisted suicide is an oxymoron," said Rex Greene, M.D., an oncologist who has treated more than 2,000 terminally ill cancer patients.
Speaking to reporters at a press luncheon hosted by the Los Angeles County Medical Association, Greene attacked social activists, the media and the judiciary for pushing the right-to-die movement. A recent Los Angeles Times editorial "assured us that even though the Nazis gave euthanasia a bad name, American physicians could do it right," he said.
"But I'm on the other side of the stethoscope, and I find it chilling how this idea is overwhelming the public discussion," said Greene, who's treasurer of the medical association.
This "suicide chic" and "necrophiliac cult" distract from issues of caring for the terminally ill, he said. There's no evidence that Jack Kevorkian, M.D.-who believes "carbon monoxide is the treatment of choice for depression"-ever considered how to best care for the terminally ill, he said.
Of the more than 2,000 terminally ill patients Greene treated, only one committed suicide, he said. Ten others spoke of suicide, but it turned out they had "transient depressive episodes based on family conflicts and fear of being dependent," and the conflicts were "easily resolved."
Assisted suicide "will put tremendous pressure on burdensome human beings-the old, the poor and those with stigmatized diseases like AIDS," he said.
And "in this crazy world of managed care," where physicians are at financial risk for their patients' care, doctors will feel financial pressure to help the terminally ill die, Greene said.
Greene advocates giving the terminally ill adequate drug dosages to relieve pain and caring for them in a hospice.
Wacky docs.While a new calendar distributed by Hays (Kan.) Medical Center may appear a bit goofy, the 147-bed rural hospital is just trying to show it's got physician unity and a staff with a sense of humor.
With pictures of nurses and doctors in costumes, horsing around with needles, the "Doctor's Tongue In Cheek" calendar is designed to tout cooperation between physicians and the hospital. "We wanted to use it to show the cohesiveness of the physicians in the community," said Stan Unruh, director of communications at Hays. "These physicians work together, and it's good for the staff to see the doctors in this light. A lot of people might think physicians might not want to be a part of something as laid back as this endeavor was."
The hospital, which has been nationally recognized for its physician recruitment efforts, is using the calendar as a fund-raiser and also sending it to residency programs and the area's hospital administrators.
The hospital has recruited more than 40 physicians to Hays, population 19,000, in the past five years, nearly doubling the area's physician pool to 70. For those efforts, the hospital's physician recruitment strategies were recognized two years ago by the American College of Medical Staff Development and the National Institute of Physician Recruitment and Retention.
Quotable."If you were for-profit, you'd get a better room."
Harold Iselin, counsel to the New York State HMO Conference, joking about the awkward layout and inept sound system at the site of a recent public meeting on Empire Blue Cross and Blue Shield's charitable assets.