CON has its place
Your April 21 cover story ("Pros and cons of certificates," p. 4) appears to give too much credence to the tired old belief that the only value of a certificate-of-need program is its number of disapprovals. In fact, during the heyday of federal involvement in health planning, there actually was a short-lived proposal to pay review agencies based on the number of projects denied.
Several of the arguments put forth in the article about CON also would argue that speed limits are unnecessary if traffic cops are visible on their beat and cars don't exceed the speed limit (at least while the cops are in sight). After all, aren't speeding tickets the purpose of speed-limit laws?
CON has a valid role in keeping some aspects of health spending in check. A good CON program should function much like an open-book test. If standards are well-defined, there should be no surprises to anyone. Frivolous or unneeded proposals can be avoided because potential applicants know the outcome in advance.
Alliance for Health
Grand Rapids, Mich.
I read with no small interest your articles and editorials on the revelations of HealthSouth Corp. and its founder, Richard Scrushy. For four years immediately prior to HealthSouth's founding, I was a co-worker of Scrushy's at Lifemark Corp. For the next 19 years I watched with mixed emotions the performance of his company and its influence on the practice of physical rehabilitation services.
As a physical therapist and manager of rehabilitation services for competitor public corporations, it was impossible not to envy HealthSouth's consistent ability to meet strong growth and earnings expectations. The achievement of this financial success appeared from the outside to come through the implementation of clinical and business practice innovations that drove productivity and profitability-often with questionable regard for the value of the clinical services rendered.
Now we learn of outrageous financial practices. Everyone committed for the long term to providing high quality, cost-effective rehabilitation services will benefit from a clarification of the HealthSouth record.
Payers and privacy
I read with interest your editorial about the recently enforced medical records privacy regulations of the Health Insurance Portability and Accountability Act ("A HIPAA has its day," April 14, p. 21). HIPAA has cost my hospital thousands of dollars to implement and we are not through yet. Managers have spent countless hours poring over policies and educating everyone, yet we are still anxious that perhaps we have forgotten something that will result in fines or lawsuits. This has been distressing for us all and for what? All we are doing is putting into writing practices that we have been following for years.
The one area where there is little change in practices under HIPAA but where the most abuse of patient information is in dealing with third-party payers. The law says we must give them any and all information they ask for, but then what happens to it? I have a friend who used to work for an insurance company. She was appalled that patient charts were scattered about her company, lying open on desks and being discarded in a trash can or worse, put in a recycling bin.
I believe that the public has no idea how insurance companies use their information. In addition, I would like to know what these companies are required to do with this information when they no longer need it, and I am including both Medicare and Medicaid in this.
Clinical coordinator, nursing administration
St. Mary's Hospital
Editor's note: HIPAA privacy regulations apply to insurance companies, Medicare and Medicaid, all of which must get patient consent prior to sending information to third parties. The law also specifies safeguards for discarding medical records, such as the shredding of paper documents.