By describing the situation of Catholic hospitals in the Nov. 18 article "Special treatment" (p. 8) you have cast an important spotlight on the vast part of the healthcare safety net outside of public hospitals.
Earlier this year, my organization analyzed the finances of more than 3,600 hospitals and found that urban hospitals that derive at least 15% of their revenue from Medicaid are losing an astonishing 8 cents on every dollar of patient revenue (this report can be found at www.nauh.org).
Clearly, a system that inflicts such enormous damage on some of its most important participants cannot go on like this forever.
Like some public hospitals, private, not-for-profit urban hospitals are a critical part of the healthcare safety net, and all of us that are part of that safety net-such as the Catholic hospitals in your article-will truly require "special treatment" in future policy deliberations if we are to survive to meet tomorrow's healthcare challenges.
National Association of Urban Hospitals
Physician assistants in charge
I was very interested when someone recently sent me a copy of your article "Following nurses' orders" (Aug. 26, p. 36) about how at a New Jersey hospital doctors agree to take direction from advanced-practice nurses. At our hospital on Long Island, I developed a similar program.
The difference at our 591-bed hospital is that we use physician assistants and nurse practitioners at the heart of our teams. We have employed this method in many areas of the hospital during the past six or seven years. Our teams function on surgical as well as medical services. Our physician assistants and nurse practitioners work with voluntary and faculty physicians as well as resident physicians.
We too have measured better compliance in the use of standardized order sets, resulting in higher clinical standards. We have seen increased satisfaction from our patients, physicians and other staff members involved with the care in these areas. The financial savings also have been measurable. It has allowed us to optimize the limited number of available beds in our institution.
It is great to see that others are employing like solutions to healthcare problems. I also was happy to learn about the grants that might be available to continue work and improvements in this area.
Director, Neuroscience Institute
Winthrop University Hospital
I recently came across an issue of Modern Healthcare at my local library. I want to congratulate you on your publication. I read it with great interest. It contains excellent, informative articles and thought-provoking insights. Being in the healthcare field, I like to stay current on the latest research and findings. You do a fabulous job.
Elk Grove Village, Ill.
Who's in charge?
Thomas Galinski may have correctly stated in his commentary "Abdelhak reconsidered" (Nov. 4, p. 30) that many chief executive officers are in control of their boards.
However, for effective governance should not the board be in control of the CEO? How else can the board fulfill its key responsibility of oversight and evaluation of the CEO?
Manager, Governance Initiative
Graduate School of Public Health
University of Pittsburgh
Mathis is right
Of course former American Hospital Association Chairman Larry Mathis is correct in "Boardroom disclosure" (Dec. 2, p. 8). You can't avoid the appearance of conflict or actual conflict of interest while simultaneously serving on the boards of for-profit healthcare vendors. Personally, I'm disappointed to see that this is even a topic of debate.
Citizens Medical Center
How to read more about it
Todd Sloane's editorial on the new Institute of Medicine study on ways to fix the problems in the U.S. healthcare system "One study we shouldn't put on shelf" (Dec. 2, p. 22) was thought-provoking. We certainly need answers, and focusing on prevention is an excellent choice.
My hospital has long taken a stance that its primary role is to educate the public on lifestyle choices that will improve their health.
I would like to know more about the IOM study. Where can I find it?
Special consultant and former chief executive officer
Editor's note: The full report, Fostering Rapid Advances in Health Care: Learning from System Demonstrations, can be viewed at www.iom.edu. Click on "Recent reports" to get to the document. There is also a prompt to order a print version.
The revelation in news reports that Jeffrey Barbakow, Tenet Healthcare Corp. chairman and chief executive officer, has cashed in stock options worth hundreds of millions and will retire with an annual $1.89 million payout is different than the Enron type of corporate misconduct.
In the case of Barbakow, his deal was brokered not just on the backs of shareholders who elected to gamble a portion of their money for a possible future gain but on the backs of the elderly and in the midst of a national healthcare crisis. How clever for Barbakow to admit after his windfall that Tenet's recent actions aren't of the highest ethical standards.
Each person who reads those words knows someone who has had to choose between retirement and health insurance or fears for themselves or their parents because care is less and less available to our elderly.
Did Barbakow, his associates and his board put their gains to public good? Did they create hospitals with exemplary care and continually improved outcomes?
It is time to hear from the staff of those facilities and from the patients who were served there. The truth is there, Mr. Barbakow, for everyone to see.
Supervisor, oncology nursing
Northwestern Medical Faculty Foundation
An old battle
Regarding your article on the Blue Cross and Blue Shield Association study "Battle of the cost reports" (Oct. 28, p. 6), the healthcare cost problems identified in the article might be summarized in the following quote: "What are these problems? Many of them are related to the cost of care. Indeed, one close observer of the Washington scene has argued that the medical `crisis' ... is purely and simply a crisis of cost. The inflationary `crisis' ... is purely and simply a crisis of cost. The inflationary rise in medical costs is the key concern of congressmen and consumers, a fundamental political and economic fact of life for both."
While sounding profound and appropriate for the topic, the quote is taken from Victor Fuchs' 1974 book Who Shall Live? Reading the book, one can clearly see the problems have not changed during the past 30 years and will not change unless new approaches are developed. The Blues' effort to identify the drivers of healthcare cost increases offers nothing new and is probably very similar to one initiated by the same organization in the late 1970s. Change the statistics, change the types of care affecting cost and you have the same conclusions to present to the public.
For what purpose was the Blues' effort undertaken? One must consider the source. Much like the property and casualty insurance companies that have used Sept. 11, 2001, to explain higher premiums, the Blues association must be able to explain its members' 15% average increase in premiums, nothing more.
The Blues' study lends nothing to the solution of healthcare problems; it only exacerbates and dilutes an already cloudy argument. If this were not true, the Blues would be the first in line on Capitol Hill asking for better Medicare and Medicaid reimbursements for hospitals to stop the cost shifting we see in healthcare today.
Unfortunately, the defensive posture of the hospital industry will not help either. We need to take the leadership role in redefining the issues and developing effective solutions. The good news for the hospital industry is that the Blues do not have a clue and there is still time for us to take control of real reform.
Deckerville (Mich.) Community Hospital
The other cost factors
The Blue Cross and Blue Shield Association's recent study did not include two of the largest drivers of healthcare costs-the legal system and regulatory agencies. The cost of maintaining a risk-management program to protect against an increasingly litigious society armed with increasingly aggressive lawyers, plus the cost of compliance with a growing nightmare of overly restrictive, conflicting and sometimes useless regulations would cause any industry to experience a surge in operational costs, which then would increase consumer costs.
Devenney Group Architects
SSM Health Care, St. Louis, is deserving of major coverage by Modern Healthcare as the first healthcare provider to win the Malcolm Baldrige National Quality Award. I encourage your publication to go far beyond the brief Nov. 25 announcement (p. 4) and devote major stories both to SSM Health Care and the Baldrige program.
Among the seemingly endless "top 100" lists and awards given by professional societies, consulting companies and other organizations, there is only one program that is as competitive and comprehensive as the Baldrige award. It is the gold-standard recognition of performance excellence and the one that truly sets an organization apart as world-class. Congratulations to SSM Health Care!
Vice president of regional development
Salina (Kan.) Regional Health Center
Hope and trust
Neil McLaughin's editorial "Trust, that valuable, fragile asset" (Nov. 25, p. 16) struck a major chord with me. So often we hear that the worst thing we can lose is hope. However, I agree with McLaughlin that a greater loss is experienced when we lose trust.
When someone remarks, "I sure hope that the hospitals, nurses, doctors, insurance companies, etc., get their act together and improve our healthcare system," that individual is reacting out of the fear that it won't happen.
But when someone says, "I don't trust that the people involved have the integrity or capability to improve the system," that's something entirely different.
There will always be hope because there will always be fear, be it real or imagined. We can't say the same about trust. Trust is faith-based and can disappear entirely, and if that happens healthcare professionals and society as a whole will have truly suffered a great loss.
Chief information officer
St. Luke's Hospital
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