David Burda's defense of specialty hospitals "Embrace the challenge" (July 29, p. 18) misses two fundamental points.
First, in the U.S. different patients requiring the same treatment can represent vastly different revenue yields to the hospital, depending on their health insurance status. If the physician owners of specialty hospitals steer to them the high-revenue patients and steer the low-revenue patients (especially the uninsured) to the full-service community hospital that is then expected or required by law to accept them, how can one call that fair competition?
Second, if we do believe in "free competition," then why shouldn't a full-service community hospital competing with a specialty hospital have the right to dictate, purely on the basis of self-interested economics, which physicians may or may not have admitting privileges at the hospital? That should be part of the competitive game. Since when is a privilege a right?
If Mr. Burda sincerely believes the market for inpatient care in America is or can be a model of "competition in a free-market economy," I would like to invite him to sit through my next Economics 102 class. He would be surprised to learn what stringent conditions a freely competitive market must meet to warrant that label. The U.S. market for inpatient services certainly does not meet those conditions. Just for starters, gas stations can let you sit there with an empty gas tank when you can't pay for gasoline. Can community hospitals do likewise?
Professor, economics and public affairs
Princeton (N.J.) University
I could barely get to your July 29 editorial "Out with a whimper" (p. 34) after shaking my head over your editorial cartoon. My experience with Thomas Scully as administrator of the Centers for Medicare and Medicaid Services has been that he is accessible and reasonable, but certainly not a shill for the healthcare industry, let alone someone who would obstruct justice.
I think your cartoon was inaccurate, unfair and a disservice to all.
Tennessee Hospital Association
Don't indict everyone
Your article on Neodyme "In need of repairs" (Aug. 19, p. 30) should not be taken as a general indictment of technology or asset-management firms. The overwhelming majority of those companies, from the regional players to the nationals, employ sound accounting practices and practice strong client service.
It is also important to recognize that, as with any other product or service, "If it looks too good to be true, it probably is." Firms that sell on a heavily discounted basis will be managing cost, not care. Real savings in asset management are the result of proper service to the equipment and proper support to the user. This approach reduces operation errors, increases "uptime" and extends the life of the equipment. Companies that apply this hands-on, on-site approach to service are those that provide consistent long-term value.
Raymond Peter Zambuto
Technology in Medicine
Nurses deserve better
Your article on the national nursing shortage in hospitals "Too little, too late or enough?" (Aug. 5, p. 6) was on target. I worked in a hospital setting right after graduating from nursing school. I enjoyed the learning experience, but I felt the treatment of the nurses was abysmal.
Nurses work very hard to provide the best possible care for our patients. We are their advocates. It just seems that hospital administrators are not looking at the acuity of each patient and how to provide care for them.
Nurses have been overworked, underpaid and underappreciated. Hospitals need to look at the way they treat their nurses. Treat us right and we will give 110%. Hospitals should provide the proper acuity ratio per nurse, flexible hours, extra compensation for extra duties and, of course, good base pay and benefits.
I now work in community health and I love it. It beats putting up with all the politics and mistreatment in the hospital setting.
Los Barrios Unidos Community Health Clinic
Todd Sloane's concise, hard-hitting, data-driven editorial on fiscal irresponsibility in Washington "A trillion here, a trillion there" (Aug. 12, p. 26) made my day. Modern Healthcare would miss you, but your piece is as good and better written than many editorials in the Washington Post, the New York Times or the three newsweeklies. Well done.
John Schowalter, M.D.
Professor of Child Psychiatry and Pediatrics
Yale University Child Study Center
New Haven, Conn.
Regarding the commentary by Michigan Gov. John Engler "The Medicaid bind" (July 29, p. 35), you might find it interesting that the governor recently vetoed a bill he had proposed that would have given Michigan hospitals an additional $148 million in federal money, boosted the state's general fund by $35 million and helped pay for medical treatment for Medicaid patients.
The reason for the governor's veto was that he was annoyed that Michigan hospitals supported a ballot initiative to reallocate the proceeds from the tobacco settlement to healthcare.
You might want to find a better advocate for Medicaid and for healthcare when you look for reasonable commentary.
Suttons Bay, Mich.