Just five hours apart on Aug. 18, two Phoenix surgeons became the first in the city to perform a cutting-edge cardiac procedure. That's about the only thing they shared, as the surgery's debut became fodder for the fierce competition in the local healthcare marketplace.
Columbia Medical Center Phoenix invited the media to observe the procedure, known as a percutaneous myocardial revascularization, or PMR. Richard Heuser, M.D., used a laser to create small perforations in the heart, stimulating blood flows to areas of the organ that had been oxygen-deprived.
A few hours earlier, Robert Strumpf, M.D., of the Arizona Heart Institute quietly performed the city's first PMR at St. Luke's Medical Center.
Nevertheless, the Arizona Republic and Arizona Business Gazette gave credit to Heuser as the local pioneer. According to the Phoenix Business Journal, the heart institute responded by demanding a retraction from the Republic, which also owns the Business Gazette. A spokesman for the institute admits contacting the paper but says no retraction was sought.
Why such a fuss? AHI and Columbia are locked in a fierce marketing battle over the city's cardiac patients. It was prompted by the heart institute's decision to team with Charlotte, N.C.-based MedCath to build the Arizona Heart Hospital, a 60-bed, $30 million facility devoted entirely to cardiac patients. The hospital will open next to Columbia Medical Center in the middle of 1998.
We hardly knew ye.The American Medical Association, perhaps hoping for a public relations break after its sponsorship debacle involving Sunbeam Corp., hopped quickly on the Princess Diana story. Unfortunately, the association's press release lacked, as we say in the journalism biz, a proper "news peg."
Under the headline "American Physicians Mourn Death of Princess Diana," AMA President Percy Wootton, M.D., said: "The physicians of the American Medical Association are saddened at the tragic death of Diana, Princess of Wales. We express our deep remorse and heartfelt sympathy to her family and the British royal family, as well as the families of the others lost in this horrible accident."
The trouble is, the AMA never had any formal connection with the princess, other than sharing a general interest in AIDS, cancer research and a "mutual commitment to the campaign for a worldwide ban on anti-personnel land mines." Same could be said for a lot of people who didn't issue a press release.
Better late than early.Another axiom of public relations is that if you've got bad news, make it public as late as possible on a Friday, so it's too late for most newsweeklies or buried in a little-read Saturday newspaper. And if it's a long holiday weekend, when newspapers are read even less, all the better.
That point was driven home by two subjects of federal subpoenas Aug. 29.
At 5: 26 p.m. Eastern Standard Time, Wellcare Management Group of Kingston, N.Y., announced it had been subpoenaed by a federal grand jury in New York, which is requesting extensive documents from the company about its business activities.
Eight minutes later, Hospital Staffing Services, a Fort Lauderdale, Fla.-based home-care company, said some of the company's current and former employees and officers were subpoenaed by a federal grand jury in Florida. The subpoenas are part of an ongoing Medicare fraud investigation of the company, it acknowledged.
Wellcare, which runs an 81,400-enrollee HMO primarily serving upstate New York, said it doesn't know the target of the grand jury investigation but "has reason to believe" current officers and directors of the company aren't being investigated.
Having not been invited to any barbecues, MODERN HEALTHCARE reported on the subpoenas last week (Sept. 1, p. 4).
Outside reformer.It turns out that Jamie Court, the California activist whose latest cause is getting more HMO enrollees on a California committee investigating managed care, isn't enrolled in an HMO.
Court became famous for dumping dried beans in front of what he called HMO "bean counters." As director of Los Angeles-based Consumers For Quality Care, he stumped unsuccessfully-along with the California Nurses Association-for a ballot initiative to restrict HMO practices and penalize downsizing hospitals.
Because there are only six HMO enrollees on the 30-member state task force, Court says it's "like cats reforming the ecosystem for field mice."
The law creating the task force called for equal representation among six categories of players, including employers, health plans, providers, and consumer groups.
Says Court: "In the context of managed care, only patients can represent patients."
But while Court was a Kaiser Permanente enrollee for 10 years-"because it was cheaper," he says-he and his wife dropped out three years ago for several reasons, one of them being that Kaiser wouldn't send his wife for what he terms a necessary test.
Hear no evil.One of the clinical underpinnings of managed care takes a beating in a new study. It turns out that relying on primary-care physicians for early diagnoses-thus saving money through fewer tests and specialist referrals-many not work out so well.
Specifically, the study of 453 residents and 88 medical students showed they weren't able to use a stethoscope effectively; after listening to audiotapes of 12 common cardiac abnormalities, they correctly identified just 20% of the conditions. The researchers, Salvatiore Mangione, M.D., and Linda Z. Nieman, postulated that their findings may be just the tip of the iceberg. "Deficiencies similar to those we found for (use of stethoscope in diagnosis) might exist in other important areas," they write in the Sept. 3 issue of the Journal of the American Medical Association.
"This study underscores the medical and economic relevance of bedside diagnostic skills; it also refutes the current managed-care policy of entrusting primary-care physicians with the responsibility of assessing conditions where refined bedside diagnostic skills may play an important role," they say.
The authors say neither the American Board of Family Practice nor the American Board of Internal Medicine requires any structured assessment of stethoscope skills at the time of board certification. Such testing could improve stethoscope skills, they say.