Fed up with growing Medicare regulations, staff at the Mayo Clinic endeavored last year to count them all-one sheet at a time.
They came up with 111,088 pages of HCFA documents and 21,632 pages produced by other agencies, including (non-HCFA) HHS, the Civilian Health and Medical Program of the Uniformed Services, the Department of Veterans Affairs and Medicaid, for a total of 132,720. The biggest tree-eaters were HCFA rules published in the Federal Register from 1994 to 1998, 30,000 pages; Provider Reimbursement Review Board decisions, 24,000; and HCFA fraud-and-abuse regulations, 14,500.
Various provider advocates have used the numbers as evidence of governmental micromanagement. Among them is American Medical Association President Nancy Dickey, M.D., who cited the "more than 100,000 pages" of Medicare regs in a Feb. 23 statement attacking the government's attempt to fight fraud by encouraging patients to squeal on their doctors.
"We've had people at HCFA tell us we're wrong" about the numbers, acknowledges Bruce Kelly, the Mayo Clinic's director of government relations. He says the numbers are only estimates and include supporting documents as well as published rules. "I guess our answer is, we're not going to argue with you over the number of pages. The point is, the program has become horrendously complex."
Uncovered lives. Is employer-paid healthcare coverage on the way out? One of the strongest signals to emerge from a March 3 Health 2000 Forum in Seattle was that large employers may be unwilling to cope much longer with the frustrations of the healthcare system.
"Most employers would rather not be in the business of providing healthcare," said Steven Hill, senior vice president of human relations at Weyerhauser Corp., a 36,000-employee forest products company based in Federal Way, Wash. He said his company paid more for health insurance last year than it made in profits.
The session was the second in a series co-sponsored by MODERN HEALTHCARE*and the American Association of Health Plans to identify challenges facing the industry in the new millennium. Other participants included Gail Wilensky, chairman of the Medicare Payment Advisory Commission, and AAHP Chairman Philip Nudelman.
Hill, who represented healthcare customers on the panel, suggested that one of the main obstacles to creating a "sustainable" healthcare system is that "the people who use healthcare are not paying for healthcare."
Many companies are already heading for the exits, he warned. "Look at the data. It's happening."
The real world. Paul Keckley, who's been a ubiquitous speaker at healthcare conferences as vice president for strategic development at PhyCor, has left the company.
Keckley, 49, says his job at the Nashville-based physician practice management company became obsolete when PhyCor shifted focus from acquisitions to operations. He says his departure in December was a "mutual decision" between him and the company.
Keckley, who assumed an operating role at PhyCor in 1994, gripes that the economics of most physician practices "can't satisfy" Wall Street expectations. "I'm going into the real world," he says, which includes seeking capital for an Internet medical records venture.
Kicked upstairs, without pay. Physician managers must make full-time commitments in order to master their jobs. But doing so comes at a price, according to a recent survey.
Medical directors who devote most of their time to clinical duties enjoy median total cash compensation of $215,000, 14% more than those who spend most of their time on management duties, according to the Ernst & Young 1998 Physicians Benchmarking Survey.
According to the study, physicians often start with part-time management roles that actually boost their total pay. But when they become full-time managers, the loss of lucrative clinical income deflates their compensation.
According to Ernst & Young, "Without giving physicians the opportunity to maintain-and increase-their earnings in these new roles, it will be increasingly difficult to attract and develop the talent necessary to provide the professional leadership and technical management needed within the medical profession."
Quotable. "Only inside the Beltway could elected politicians honestly believe that substituting private health insurance will solve Medicare's problems. And only inside the Beltway could they seriously advance that without fear of being killed."-Bruce Vladek, former HCFA administrator, speaking last week on "The Future of Medicare" at the American College of Healthcare Executives' Congress on Healthcare Management in Chicago.
We love our CEO. Employees at Arkansas Heart Hospital in Little Rock sent an unusual valentine to their president, David Blackburn, and vice president for clinical services, Chris Dent. On March 3, the second anniversary of the MedCath-backed, 84-bed hospital's opening, they purchased a half-page ad in the Arkansas Democrat-Gazette.
"We are proud to serve with leaders who have taught us an approach to care unparalleled in focus and devotion to our patients," the text said. "Thank you, David and Chris, for working so hard to provide a facility which empowers all of us to utilize our clinical, business, housekeeping, dietary and technical skills. Your example motivates us to 'think outside the box' to achieve excellence in patient care."
The response from the community was surprising. "We had a couple of different hospitals call our (human resources) director and say, 'What are you guys trying to do to us over there?' " says the hospital's marketing vice-president, Vickie Wingfield. Nurses also called seeking work, she says.