Steven V. Roberts loves to talk. So much so that Roberts, who will deliver one of two keynote addresses at next week's American College of Healthcare Executives annual congress (See related stories, p. 46), has become a target of criticism in the journalism profession.
Roberts, a regular on television political talk programs, is scheduled to speak March 3 on "Politics on the Potomac" at the ACHE confab in Chicago. But the program tells only part of Roberts' personal history. It doesn't reveal that he has been featured negatively in columns by Chicago Tribune Washington Bureau Chief James Warren, the book Breaking the News by journalist James Fallows and a special program on the American press that aired on public television.
The criticism has been sparked by the vigor with which Roberts, a syndicated columnist, and his wife, Cokie Roberts, a political correspondent for ABC News and National Public Radio, have pursued paid speaking engagements, sometimes before groups with political agendas. This is in violation of the widely accepted principle of journalistic ethics that reporters shouldn't invite conflicts of interest by taking money from people they cover or might cover.
Fallows says the Robertses have declined to discuss their speaking fees since coming under press scrutiny in 1993, but Cokie has been known to require payments of more than $30,000.
A spokeswoman for the ACHE said the college was not aware of the Roberts controversy when it booked the speech. She said the college was referred to Roberts by another organization. She said she did not know how much Roberts was charging for his address.
A postscript to this story may be of interest to those attending the ACHE meeting. In a classic twist of fate, Fallows last fall became editor of U.S. News and World Report, where Roberts had his base working as a columnist. One of Fallows' first acts was to fire Roberts.
PR practitioners.Give nurse practitioners at New York's Columbia-Presbyterian Medical Center credit for tooting their own horn.
A Wall Street Journal story reporting a deal between these highly trained nurses and Norwalk, Conn.-based Oxford Health Plans prompted a flood of media coverage. The pact enables some HMO enrollees to choose a nurse practitioner as their primary-care provider. Nurse "gatekeepers" will get paid at doctor rates.
The proposal isn't exactly groundbreaking, however.
According to a study by the Washington-based American Association of Health Plans, some 64% of group- and staff-model HMOs use advanced practice nurses as primary-care providers. More than a third of the HMOs in the study included advanced practice nurses on their provider lists.
Often, care provided by a nurse practitioner is worth as much as a physician. Medicare, for instance, allows these mid-level providers to bill at physician rates if they work in a doctor's office. "The only thing that's new about this is a willingness of the managed-care organizations to reimburse (nurse practitioners) directly and to reimburse at parity (with physicians)," said Sarah Cook, a professor at the Columbia School of Nursing. "To our understanding this is the first time that this has been done this way."
Media organizations zeroed in on the nurse-as-gatekeeper concept, which is a boon for the profession, said Nancy Sharp, executive vice president of the American College of Nurse Practioners, a Washington-based nursing coalition. "What is new is the new visibility," she said.
Tracking the oryx.The Joint Commission on Accreditation of Healthcare Organizations loves space-age monikers for its activities, such as the Orion reform plan of 1995. But the latest, called Oryx, had Outliers stumped.
The new performance measurement initiative for hospitals and long-term-care homes sounds like either an obscure Greek goddess or an oral pharmaceutical from Glaxo-Wellcome.
A caller on the line during the Joint Commission's telephone conference last week assumed it was an acronym. "It's not an acronym," corrected Dennis O'Leary, M.D., president of the JCAHO. "We picked that term primarily because it was different. The obvious implication is, where we are going with the accreditation process is quite different from anything we have done before." Ah, yes, so that's what Oryx means.
O'Leary then added that an oryx is "a kind of gazelle," but added, mysteriously, "We don't wish to extend the metaphor beyond that."
Outliers did, however, and to that end, we wondered what one looks like. We were fortunate enough to find someone who could not only describe an oryx but had actually seen one.
"It looks like a deer except it's more slight and more graceful, more elegant," said Wendy Morphew, one of those smart people at the American Medical Association who can be relied upon to shed light on the arcane.
"I have seen them in the National Zoo in Washington, D.C.," she explained. "I remember them because I missed out on a trip to Africa once when I was working. So I went to the zoo and I looked at all the African animals. It was my fake safari."
Self-protection.In a blatant move to shield its members from competition, the South Dakota Association of Healthcare Organizations is sponsoring legislation that would impose a moratorium on specialty hospitals in the state.
The bill, introduced earlier this month, would prohibit any new inpatient facility that does not provide medical, surgical, obstetric and emergency care.
General hospitals are irked by three physician-owned surgical centers that have opened in the past year, each with fewer than 20 inpatient beds, said Frank Drew, president of the hospital association. The state has no certificate-of-need law to stem the tide, he said.
Loren Pankratz, a lobbyist for Sioux Falls (S.D.) Surgical Center, said the centers do the same surgery as hospitals at a lower cost. But Drew said they cherry-pick profitable services that general hospitals need to pay for indigent care. "We're being quite upfront about it," Drew said. "If you want to come to South Dakota and build a hospital, build a real hospital."
Oops.Outliers apologizes for confusing the location of a medical student group that is seeking to shed light on some of the economic changes going on in the medical community (Feb. 17, p. 156). Medical Students Organized to Create Activism and Leadership is at University of California at Los Angeles.