I find the government's statements about Tenet Healthcare Corp. shocking ("A question of integrity," Jan. 13, p. 6). I was the director of the health information and patient accounting departments in a Tenet hospital from 2000 to 2002. My responsibilities included managing the hospital coding function as well as billing and receivables management. During my time there Tenet's culture always emphasized the importance of ethics and compliance and this was reflected in operational policies and practices.
The company spends a great deal of time and money ensuring that employees understand and practice compliance in their work, particularly in the area of coding and billing. Never did I sense any pressure directly or indirectly to maximize revenue at the expense of an ethical and compliant operation.
If such a culture of fraud as depicted by the government existed within Tenet, I'm certain I would have sensed something of it during my time there.
Health information management
Jackson Purchase Medical Center
The real smallpox danger
Thanks for setting the record straight in your editorial, "No clear and present danger" (Jan. 13, p. 20). I have long opposed the use of smallpox vaccination for any of our medics, unless someone somewhere comes down with the disease.
You can rest assured that the first case of smallpox will not be in the Texas counties of Bexar, Blanco, Comal or Travis. We would have ample time to get our crews vaccinated if the threat actually materialized. In the meantime, I view the smallpox threat like the bogeyman we use to scare children.
The real danger is the massive side effects of the vaccination. We could easily kill someone by using it. Therefore, I am not going to authorize the use of smallpox vaccination for all our emergency response staff, at least for now. We have the same wait-and-see policy in the emergency department at Baptist.
Emergency Medicine Department
Baptist Health System
The wrong threat
Before any health system board or chief executive makes the decision to begin vaccinating employees or medical staff against smallpox ("Smallpox, big worries," Jan. 6, p. 6), they would be well-advised to read Richard Preston's book The Demon in the Freezer: A True Story. Our rush to action about a possible threat of smallpox used as a terrorist weapon may be real, but what the terrorists send our way may not be what we are vaccinating our employees and staff against.
This national vaccination program may be more a public relations move than a real safety precaution for our healthcare workers.
Morgan Executive Development Institute
Ponte Vedra Beach, Fla.
Thank you for your "Outlook '03" article (Jan. 6, p. 26). I appreciated your pointing out the malpractice premium issue; it's a very real crisis.
Just as important, however, are the problems arising from health plans that don't pay on time, deny legitimate claims and/or underpay. The resources necessary for eligibility verification, authorization, billing, rebilling, appealing decisions, etc., are too high for most practices and hospitals to accommodate. Most do not perform the steps well, and therefore many claims go unpaid and providers find themselves in a desperate financial position.
In California, we are facing Medicaid cuts that will bring rates so low that we would rank 50th in the nation for lowest rates of reimbursement. Physicians and hospitals cannot accommodate a combination of a malpractice crisis, growth of uncompensated care, delay in payments, underpayments and cuts in government funding.
Med Direct Executives
The other side of Tenet story
As someone who has worked in for-profit and not-for-profit healthcare for more than 20 years, I feel the need to comment on your coverage of the Tenet Healthcare Corp. scandal (Jan. 13, p. 6).
I'm not condoning what Tenet may have done in using "revenue optimizing" methods to increase reimbursement. However, there are two sides to every story, and in this case only one side is being widely and destructively publicized. It must be noted that in today's economy hospitals also are struggling to stay alive with the increases in costs, dwindling resources, nursing shortages and the bureaucratic red tape required to gain reimbursement.
Unfortunately, the government has consistently worked to decrease revenue to hospitals and providers, leaving providers no choice but to find the best way to gain reimbursement to keep providing quality care and keep what staff they still have.
Medical staff, continuing medical education
Placentia Linda Hospital
Editor's note: Placentia Linda Hospital is a Tenet-owned facility.
Don't blame the providers
Who's going to clean house?" ( Jan. 20, p. 30) is the right question with the wrong answer. Provider-side compliance efforts have gone as far as possible in the Byzantine world of federal healthcare reimbursement. The Columbia/HCA Healthcare Corp. defendants got off for one simple reason: The reimbursement rules are too confusing. The Bush administration has changed the acronyms (HCFA is now CMS and PROs are now QIOs) but not the substance of federal healthcare reimbursement.
It's time to stop blaming providers. The government should simplify the rules and give fair notice of problem areas before vilifying providers for technical documentation and coding errors.
Withrow, McQuade & Olsen