MedPAC head keeps mood light, `fudgey' at meetings
The Medicare Payment Advisory Commission's monthly two-day meetings in Washington can be dry affairs, with arcane points of healthcare policy and economics discussed for hours before a loyal audience that often appears to be on the verge of slumber.
That's why it's a relief when Congress appoints a commissioner who can inject some humor into those debates. In the past, Stuart Altman, the Brandeis University healthcare policy scholar who chaired the Prospective Payment Assessment Commission, a predecessor panel, was able to keep the mood light. Now comes Robert Reischauer, president of the Urban Institute. Commissioner Reischauer delivered several quips at the meeting this month.
At one point, Chairwoman Gail Wilensky, commenting on payment to Medicare HMOs, said: "It's hard to imagine a system that has more perverse incentives than this one."
Reischauer responded, "I'm sure we'll come up with one."
Later, Reischauer inquired why one figure was left out of the sometimes confusing worksheet MedPAC uses to arrive at its annual recommendation on the update to inpatient hospital payments. Vice Chairman Joseph Newhouse told Reischauer, "We collapsed two `fudgey' numbers into one `fudgey' number."
Said Reischauer, "If that's the case, we could collapse this whole (worksheet) into one line."
Speaking of MedPAC... Outliers was a bit surprised when the formerly consensus-oriented panel began holding recorded votes in January.
A measure in the Benefits Improvement and Protection Act, the Medicare payment-increase law enacted in December, requires MedPAC to record votes whenever deciding on a formal recommendation to be included in an official report to Congress.
In the past, those reports have been primarily written in a collegial setting where MedPAC staffers developed drafts and massaged the language into recommendations acceptable to all.
The handwriting was on the wall, however. MedPAC's operations have been under a microscope since last April, when the panel unexpectedly recommended an update to inpatient hospital payments that was even bigger than what the hospital industry itself had sought.
That recommendation resulted in a harshly written letter from Rep. William Thomas (R-Calif.), chairman of the House Ways and Means Committee. Thomas questioned whether the commission had become an "organized forum for self-interested lobbying."
Ironically, of the votes Outliers witnessed, none was less than unanimous.
Big leap. Tighter credit means many hospital systems are trying to beef up their financing expertise. Continuum Health Partners in New York has gone further, bringing a veteran investment banker onto its management team.
Ed Shapoff, a vice president at Goldman, Sachs & Co. and leader of the healthcare group in the firm's municipal bonds department, is leaving his job this month to become Continuum's CFO and executive vice president of corporate affairs.
Shapoff, 54, had been the investment banker for Continuum's 1,245-bed Beth Israel Medical Center since 1976. Most recently he worked elbow-to-elbow with senior management on presentations to analysts after Beth Israel's credit rating was lowered in June 2000.
Continuum President and CEO Peter Kelly says Shapoff will bring a "new dimension" to the management team, as external financing issues such as capital access become more critical. Shapoff says he likes the "collegiality" of Continuum's corporate environment, and was ready for a new challenge after 25 years in healthcare investment banking. He declined to comment on compensation, except to say it "wasn't a factor" in his decision.
"There's a need to reconfigure plants and buy new equipment, and not necessarily the resources to provide it. That's obviously an area where I'm going to concentrate my attention," Shapoff says.
A different kind of wedding gown. Weddings are kind of like gifts. It's not the setting but the thought that counts.
Gary Delaney II and Danielle Hendricks proved that last month at 82-bed Rehabilitation Hospital of Rhode Island. Delaney, 29, had proposed to Hendricks, 22, last October, and they decided to marry in a small New Year's Eve ceremony in Delaney's hometown of Warren, R.I. But Delaney had to trade in his groom's tuxedo for a hospital gown at 677-bed Rhode Island Hospital in Providence. He was paralyzed by a rare nerve disorder called Guillain-Barre syndrome, which inflames the nerves outside the brain and spinal cord.
He recovered enough by December to move to the rehabilitation hospital. The justice of the peace agreed to perform the ceremony in the hospital, and the staff provided the chairs and served coffee, punch and chocolate cheesecake.
While it may not have been a picture-perfect setting, the effort of the staff and the ordeal as a whole made the wedding even more special to the bride, a certified nurse assistant. "We went through a lot in a short amount of time," she says.
Delaney, who works for a plastics maker, could be released by the end of this month. Once he's out, the couple plans to honeymoon in Florida. Congratulations from Outliers.