NBC recently agreed to fork over $13 million per episode to Warner Brothers for the popular television drama "ER." Seeing as much of the plot centers on the budget problems of a public hospital emergency department, maybe someone should figure out a way to use a part of that record amount to ease the department's financial woes.
On the show, the emergency department of fictional Chicago-based County General Hospital is facing funding cutbacks, and, recently, characters wrestled with whether they should bring in an outside management company.
After much hemming and hawing (and a brief affair -- it is television), the attending physicians balked at the company's unnamed "cost-containment strategies." Executives at practice management companies around the country likely were cringing as attending physician Carrie Weaver declared, "I'm willing to make hard choices; I'm not willing to endanger patients."
Not that scandal. While the fate of onetime White House intern Monica Lewinsky is captivating the nation, the real Washington scandal -- at least in the minds of some of the nation's physicians -- is finally drawing to a close. In December, a federal district judge in Washington ordered the government to pay nearly $300,000 in legal fees to the Association of American Physicians and Surgeons. The AAPS is a conservative Washington-based group that represents about 4,300 mostly private-practice physicians from all specialties.
The association sued Hillary Clinton in 1993, seeking access to the documents of the Clinton administration's healthcare task force. It charged that the task force operated illegally, relying on private advisers and meeting in secret.
The administration and the Department of Justice claimed that task-force working groups consisted only of full-time government employees, but the released documents proved otherwise.
Now, nearly five years after the suit was filed, U.S. District Judge Royce Lamberth has found that attorneys for the administration and the Justice Department knew all along that the task force was not made up solely of government employees.
According to AAPS spokeswoman Kathryn Serkes, the House last month passed a nonbinding resolution stating that taxpayer funds should not be used to pay the $285,000 sanctions, that the individuals involved should be personally responsible for payment.
"It is clear that the decisions here were made at the highest levels of government and the government itself is -- and should -- be accountable when its officials run amok," Lamberth wrote. "It seems that some government officials never learn that the cover-up can be worse than the underlying conduct."
Any questions? Every year Deloitte & Touche publishes a cheat sheet of thorny questions stockholders might ask executives and board members at annual meetings. Almost no stone, no matter how tiny, is left unturned.
For example, Deloitte & Touche suggests healthcare executives in 1998 might hear a mouthful like, "What impact, if any, will EITF Issue No. 97-2, 'Application of FASB Statement No. 94 and APB Opinion No. 16 to Physician Practice Management Entries,' have on the company's financial statements?"
That got us here at Modern Physician thinking, and we came up with a couple of curveballs of our own.
To MedPartners: "Is new chairman Richard Scrushy cutting costs by trading in his Harley for a moped?"
To Oxford Health Plans: "That software system you installed wasn't 'Doom,' was it?"
To Columbia/HCA Healthcare Corp.: "So would the $1 billion you lost in the fourth quarter, if laid end-to-end in dollar bills, really get you to Saturn?"
Speaking out. The Feb. 15 issue of Annals of Internal Medicine, the journal of the American College of Physicians, featured the premiere of a new section, Physicians as Leaders in Improving Healthcare. The section will be edited by pediatrician Donald Berwick, M.D., a longtime quality advocate in his post as president of Boston's Institute for Healthcare Improvement.
Berwick's introductory piece is critical of the current "rhetoric of siege and battle," of efforts like Massachusetts' Ad Hoc Committee to Defend Health Care, which he says fogs any "honest appraisal" of whether patients can get good care at less cost.
"Achievement of these improvements will require of physicians not handwringing and resistance to change but concerted, positive, capable leadership," Berwick writes. That leadership, he says, "will help physicians better deploy their clinical expertise and professional purpose in a debate that has heretofore been informed primarily by economics."
The piece isn't pro- or anti-managed care; instead, it simply assumes that managed care exists and probably will for some time.