I read with interest your article "Searching for some answers" (Jan. 27, p. 6).
Having worked for both Steven Sonen-reich at HCA-owned Cedars Medical Center and Bruce Perry at Mount Sinai Medical Center, Miami Beach, Fla., I wondered what Heidrick & Struggles would report to the current board of directors at Mount Sinai if asked to investigate Sonenreich's background prior to rehiring him in October 2001.
It might go something like this: "Worked at Mount Sinai Medical Center from November 1976 until May 1996 when terminated by (former Chief Executive Officer) Fred Hirt and the 1996 board of directors. Was COO at the time of termination. Hired by HCA as CEO of Cedars Medical Center in August 1996. Previously applied for position of CEO at Mount Sinai in December of 1998 but was refused by same board that terminated him in 1996. Now eligible for rehire after deaths of longtime senior board members in 2001. Be advised that many of the financial problems that have surfaced began on Hirt's and Sonenreich's watch."
I have no love lost for either man, but make no mistake: The board of directors has a responsibility of due diligence to the community.
Chief operating officer
Crown Sanitary Supply
Fort Lauderdale, Fla.
I read your article, "Pitching plans to the uninsured" (Feb. 24, p. 8), and am interested in any phone numbers you can provide me with for low-cost health insurance that I can share with my patients. There are indeed a large number of people who fall into the category as you described in the article. Thanks in advance.
Nurse, case management
Ellenville (N.Y.) Regional Hospital
Editor's note: The Council for Affordable Health Insurance provides information about association health plans and other low-cost insurance options on its Web site at cahi.org, and can be reached at 703-836-6200. The National Association for the Self-Employed provides free health insurance quotes via its Web site at nase.org. Or you can call 800-232-6273 to speak to an association representative.
A threat to doctor ownership
I found both your story about George Saad ("A helping hand for his family," Feb. 24, p. 30) and the one in the same issue about Jack Michel ("Doc-owned and -operated," p. 26) to be exceptionally good illustrations of what happens when a physician's interests are aligned with a hospital's. Regrettably, you neglected to mention a legal issue that could dramatically change the landscape.
Currently, the federal Stark law contains an exception to the law's self-referral prohibition for doctors who practice at a hospital and have an ownership interest in the hospital itself (not merely in a subdivision of it).
The so-called "whole hospital exemption" that now allows physicians like Saad and Michel to refer Medicare and Medicaid patients to their owned hospitals is threatened by efforts by Rep. Pete Stark (D-Calif.) in Congress to repeal it, thereby effectively putting an end to physician-owned hospitals in the U.S. States like Ohio are also attempting to do this as a matter of state law. If passed, Stark's measure could place Saad's Ohio medical license in jeopardy unless he divests himself of his interest in Cleveland's Deaconess Hospital.
The interplay of hospital and physician interests will continue to be debated as our nation considers systemic healthcare reform.
Schottenstein, Zox & Dunn
A need for oversight
It's clear that the Centers for Medicare and Medicaid Services and HHS' inspector general's office have failed to identify the problems with the Medicaid program, but I have ("Medicaid melee," March 3, p. 8).
Having been in reimbursement for a number of years, the major cause of program failure and loss is poor and incompetent administration that leads to unnecessary overpayments. In investigating reimbursement levels through most Medicaid programs, it has been my observation that reimbursement levels are excessive as compared with those of Medicare Part B, which is also for the most part incompetently administered.
Medicaid, supposedly designed to provide medically necessary healthcare to indigents, is overpaying far in excess of Medicare Part B, which is an entitlement to retirees and the disabled who pay premiums and copayments. There is no balance between these programs or any logic and common sense behind their administration.
There would be no need to reduce payments and services or delve into emergency funds if both programs were properly and directly administered. There is definitely a lack of proper training and perhaps a national indifference among personnel in both organizations. Providers are being misinformed, misdirected and reimbursed improperly. Most Medicare providers have a greater knowledge of program policy and procedures than their carriers do.
Director of reimbursement
Barriers to cost control
Your cover story "Things aren't getting better" (March 3, p. 6) quotes several industry "experts" on the failure of the healthcare system to address cost, quality and access issues. What these "experts" fail to mention is the cost and effort expended on two significant compliance issues: Y2K and the Health Insurance Portability and Accountability Act.
The time to argue the merits of the rules and regulations is long gone, but those of us at the front lines of healthcare are forced to live with the uncertainties daily, implementing systematic changes whether we agree or not. Both of these activities absorbed-in the case of HIPAA continue to absorb-a significant amount of resources.
As the manager of a small group practice, our plan is to completely overhaul our information technology systems and have an electronic medical record within two years. Now, if we could just limit the number of government mandates, we might have the time and budget to get it done.
Blair Orthopedic Associates and Sports Medicine