Why so long?
I read and liked your article on healthcare chief executive turnover ("Staying put," April 28, p. 6).
I have worked at the same West Virginia hospital for 39 years. A colleague, Robert Harmon, has been at Grant Memorial Hospital in Petersburg, W.Va., for 39 years. West Virginia has other long-serving administrators, many who have been at their facilities for more than 20 years.
I think it would really be interesting to find out the reason so many of us have stayed on at our jobs.
Boone Memorial Hospital
Focus on the uninsured
I found the special report by Laura Benko on health plans marketing to the uninsured ("Universal appeal," April 14, p. 26) to be both informative and well-researched. I would add two comments:
One is that the problem is the 41 million uninsured, not those who have some coverage. Why not focus on solving the problem for the uninsured and let the insured continue with their existing coverage?
Two, why tax hospitals for the uninsured? We are providing millions in free care now so what have we done to deserve an additional tax burden? Support for covering the uninsured should come from general revenues.
Behavioral Health and
Regional Healthcare Services
Regarding "Looking into the future"
(April 21, p. 28), I want to know where to get additional information on the outcome of the conference titled "The American Hospital: What Does the Future Hold?"
Senior vice president, marketing and strategy
Editor's note: A transcript of the conference can be found at kaisernetwork.org or by calling the Henry J. Kaiser Family Foundation at 202-347-5270. Papers presented at the conference also will be published in the September/October edition of Health Affairs.
Other views of CON ...
As the person who supplied the primary documentation for your exclusive cover story, "Pros and cons of certificates" (April 21, p. 4), I am forwarding to you a representative sample of comments I received about the story in hopes of further balancing the coverage.
Your coverage of certificate-of-need law trends and impact was timely and specific, but the headline and conclusions created a definite slant against CON effectiveness which deserves significant follow-up.
Here are some comments I received:
* From a major hospital chain executive: "Just saw (the article). One thing we might want to point out is that in states with tough CON, the reason for high approval percentages is that providers don't waste their time on a service that isn't needed or that doesn't meet criteria. Thus, CON is a great investment."
* From a CON program executive: "(Modern Healthcare) is a pro-business newsletter, after all. I think they projected a pretty bleak and one-sided version of the program. Some bad projects are discouraged before they get to the CON application stage and even the good projects are required to go through a process that makes their planning better."
* Another CON official: "The authors overlook the other function of most CON agencies, which is to provide technical assistance to applicants and communities as part of community health planning."
* From a state department of health official: "It could also be said that if most CON projects get approved, it must be because the CON guidelines and the record of prior CON program actions are in most cases effectively communicating to applicants what are and are not desirable projects. ... That is exactly what was intended 30 years ago."
My business friends were disappointed that studies by the Big Three automakers and others recognizing CON successes weren't mentioned in your story.
If readers would like a copy of the latest American Health Planning Association National Directory referenced in the article, use the following contact information: American Health Planning Association, 7245 Arlington Blvd., Suite 300, Falls Church, Va. 22042; by e-mail, [email protected]; call 703-573-3103; or access it online at ahpanet.org/directory.html.
Missouri Certificate of Need Program
American Health Planning Association
Falls Church, Va.
... and another
I found the article "Pros and cons of certificates" to be interesting. Although the majority of projects seeking a CON are approved, how many are never submitted because potential applicants know that they cannot justify the project based on CON standards?
Without CON, duplication could be even greater and healthcare costs even higher. Finally, CONs also set standards for the number of procedures needed to ensure the probability of higher-quality care. This is consistent with the Leapfrog Group quality initiatives.
CONs also provide a mechanism to evaluate the overall public benefit of a project vs. investors' judging just the potential financial returns.
J. Thomas Jones
West Virginia United Health System
Avoid the courts
P hysicians and other health professionals have been complaining that payment levels from managed-care organizations and insurers are inadequate. If this is correct, any-willing-provider laws are basically giving professionals the right to be inadequately compensated for their services ("Willing and able," April 7, p. 6). I leave it to the medical professional to explain why it views such laws as a great triumph.
From a legal perspective, the decision by the U.S. Supreme Court to refuse to apply the Employee Retirement Income Security Act pre-emption to any-willing-provider laws echoed another decision of that body in striking down ERISA pre-emption of state independent review laws. I think the court is giving all of us a message: It is within Congress and the state legislatures--and not courts--that businesses, insurers, consumers and providers need to hash out the shape of healthcare and reimbursement.
Maxicare Health Plans
What do you think?
Write us with your comments. Via e-mail, it's [email protected]; through the Web, use modernhealthcare.com; by fax, 312-280-3183; or through the mail, Modern Healthcare, Letters to the Editor, 360 N. Michigan Ave., Chicago, Ill. 60601.