Are academic health centers crying wolf? HHS doesn't think so. A massive federal initiative is under way to measure the changing healthcare environment's effect on academic health centers' survival.
The goal is to establish policies that will help preserve the production of "public goods," namely medical research, education and care for the poor.
Not since the Clinton administration's failed healthcare reform initiative has there been such a coordinated effort to address issues affecting the nation's 128 centers of research, teaching and patient care.
A 62-member intra-agency task force of HHS, including four separate working groups, is collecting data and producing analyses in the areas of education, research infrastructure, service and access to capital. The government wants to know, for instance, whether managed care and competitive pressures are compromising academic health centers' viability and if centers will need capital assistance to maintain their missions.
The task force will review existing federal policy, suggest revisions and offer new recommendations in a report to HHS Secretary Donna Shalala due by the end of September. "We want to see that public-good production remains robust," says Ciro V. Sumaya, M.D., task force chairman and deputy assistant secretary for health.
In some cases, academic health centers' grumbling may not warrant federal intervention, Sumaya says. Urban public teaching institutions, he says, may be much more vulnerable than others. "We're trying to see how real this is . . . and what consequences that has to populations that need free care."
MS zero.The latest strategy to link with doctors, the management services organization, appears to be burning yet another hole in hospital wallets already riddled by previous physician ventures.
Only one in nine hospital-sponsored MSOs has achieved the break-even point, according to a survey by Cleveland-based Medimetrix, a healthcare marketing and consulting firm, which received responses from 140 of 346 MSOs it identified nationally.
Most commonly, MSO startup budgets ranged from $300,000 to $1 million.
MSOs reported problems with balancing physician and hospital interests, inadequate medical information systems and too many prior bad deals.
Few assist physicians with managed care. Most don't track benchmark data to measure overall performance and aren't capable of spreading clinical data among physicians. Five in eight aren't electronically linked with their hospital sponsors.
Of course, 80% of MSOs are less than 4 years old. Struggling organizations might take a hint from the fact that MSOs that offer physicians an ownership stake appeared more likely to make money.
Smokin' mad.The second-hand smoke battle apparently has moved from hospital office suites to operating rooms-although it's a different type of smoke.
A coalition representing nurses and other personnel who work in operating rooms wants the federal government to protect workers from the hazards of surgical "plume," or smoke, generated by the use of electrical or laser devices in surgery.
"At the moment, it's up to the individual hospital whether they want to evacuate the smoke," says James Albertine, a Washington lobbyist hired to represent the Coalition for the Protection of Operating Room Personnel.
Coalition members have asked members of Congress to pressure the Occupational Safety and Health Administration into publishing guidelines on controlling surgical smoke. OSHA is working on such guidelines.
Coalition members worry about whether the gases in surgical smoke are toxic, whether the particulates contained in the smoke can penetrate surgical masks and enter respiratory systems, and whether the particulates contain infectious matter that could make operating room workers sick.
Nurses and other operating room personnel say they are at greater risk than surgeons because they spend more hours per day exposed to the surgical plume.
The coalition includes the American Nurses Association, the Association of Operating Room Nurses and the American Association of Nurse Anesthetists.
Managed music.Samuel R. Bierstock, M.D., has long cast a wary eye on the rise of managed care. Now the former eye surgeon and current healthcare information systems consultant is having his revenge through, of all things, music.
He has formed Dr. Sam and the Managed Care Blues Band, a group of medical people who play standard tunes with substitute lyrics reflecting the problems of managed care. The players constitute what Bierstock calls an "integrated music delivery system."
They have arranged such tunes as "You're One Hip Man (Cause They Won't Pay for Two)," "If You Want Good Coverage Don't Get the Blues," and "My HMO Done Me Wrong."
Bierstock, in a sarcastic vein, says he wants to emulate HMOs' strategy: "Frankly, our music isn't that great. But once we have our listeners locked into paying for it, we can pretty much deliver any level of music we want."
The group does play some standard music at its venues, which are healthcare conferences and hospital system gatherings. "We are, after all, booked as the entertainment, and people do want to get up and dance," says Bierstock, 50, who plays the blues harmonica.
The group recently performed at two functions in Florida for the International Foundation for Alternative Research on AIDS. If you want to have the band perform at your healthcare conference, call Louise Milone at 305-861-2647. However, the band notes the "contracting organization assumes 100% of risk."
Quotable."The AHA is doing the same thing they always do when we want something from them, they whine. They want the six-month moratorium so (the teaching hospitals) can steal more money to pay dues to the AHA."-Rep. Fortney "Pete" Stark (D-Calif.), on the American Hospital Association's request that HHS Inspector General June Gibbs Brown put a six-month moratorium on investigations of hospital Medicare billing.