Healthcare an urgent crisis
Building a better healthcare system requires engineeringlike processes that start with a general concept and then build the details. All elements of healthcare should be considered, and all stakeholders should weigh in with ideas. We need to look at problems and come up with conceptual solutions, making sure flexibility gets built in. There can be no "one size fits all" mentality with healthcare. There are too many variables and a great deal is at risk for that kind of static approach. In order to re-engineer healthcare, concepts and ideas must be adaptable and flexible.
And where do we get these concepts? First, determine what consumers want and what they are willing to pay for. Physicians, nurses, hospital administrators, insurance firms, pharmaceutical companies, finance experts, technologists and medical ethics experts all should be engaged. People in and outside of government, and those who understand the legal and emotional issues in healthcare should be involved. In other words, we must understand the entire breadth and depth of the healthcare landscape and consider as many different factors as possible.
As we examine the larger issues, we should remember that there will be enormous progress in technology-both medical inventions and business process changes. Consider the area of claims processing. Historically, payers considered a 60-day "float" to be a good thing. Now we are using technology to automate and analyze claims, so that 90% of claims are paid on receipt. This results in savings for the hospitals, the insurers and consumers, which is something we would not have thought possible at one time.
Also consider medical technology. Nearly 50 years ago few would have believed the advances that were ahead in both diagnostic and treatment alternatives. Who could have seen the advent of CT scans and MRIs or believed that surgeons would use lasers instead of scalpels? The day when molecular circuits will be used to perform real-time physicals is not far off. We must be prepared for that day. Today, we have an opportunity to impact healthcare 50 years from now.
That's why I'm pleased to see the federal government looking at various ways to improve healthcare for all Americans. One piece of proposed legislation that has great potential is a bill sponsored by Sens. Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah). The bill, "Healthcare That Works for All Americans Act of 2003," advocates a logical approach much like the old carpenter's adage, "Measure twice, cut once."
The legislation ("First aid for the uninsured," March 17, p. 14) proposes to first "measure" by engaging the American public in an informed national public debate about our healthcare system. This kind of input is needed if healthcare reform is to succeed.
The act proposes to establish a citizens' Healthcare Working Group to facilitate this debate. The debate is envisioned as a two-year process that will review all facets of healthcare in America. The Healthcare Working Group would include diverse consumer, provider, payer, supply chain, employer, academic, economic, technology and government representatives who would examine all aspects of healthcare and provide a report to the American people. The second stage of the discussion would involve local community meetings where individuals throughout the country would be given a chance to voice their opinions. Ultimately, Americans would decide which services they want covered, what healthcare coverage they want, and how much they are willing to pay for coverage. The bill would provide for a vote by Congress on the recommendations that come from the discussion.
There are many ways that we can approach the issue of healthcare, but none will be successful if we do not take into account as many variables as possible and try to address the issues head-on. Lasting, workable solutions will come from thoughtful discussion, open dialogue and logic.
The journey to a successful healthcare model is bound to be a long one, but like all great adventures, it begins with a single step. This proposed bill, and similar initiatives, should help us take that first giant step in the right direction. The future of healthcare in America depends on us starting the journey now.
Ross Perot Jr.
President and chief executive officer
Perot Systems Corp.
Barbakow's exit no loss
I am a nurse working in a Tenet hospital and I would not characterize Jeffrey Barbakow's resignation and departure as anything other than fortuitous for the company as well as for patients who come to receive care at its facilities ("The other shoe drops," June 2, p. 4).
Barbakow's shenanigans, including the outlier payment debacle and the labor union farce, have led to mistrust of the corporation from employees as well as stockholders.
What I will never understand is that after his disastrous reign, we send him away with millions of dollars in severance pay. If I had done so poorly with my responsibilities, I'd probably be facing neglect charges.
Sue Spencer Cannon
Western Medical Center
Santa Ana, Calif.
The `treatment gap'
The American Heart Association agrees that the U.S. needs prospective healthcare as outlined in Ralph Snyderman and R. Sanders Williams' commentary, "The new prevention," (May 26, p. 19).
Over the past few years, the American Heart Association has been attacking cardiovascular disease with new vigor and speed. Our prevention and treatment guidelines are being revised more quickly to incorporate the latest research findings. Our scientific journals disseminate new studies via our Web-based "rapid access" process. And we are working even harder to help the medical community identify individuals at high risk for cardiovascular disease, and proactively treat (patients) to avoid a stroke or cardiac event.
For example, our organization has developed a comprehensive program to ensure that patients with coronary artery disease who are discharged from the hospital are taking appropriate medications and have referrals for follow-up nutrition counseling, exercise programs or cardiac rehabilitation and smoking cessation counseling. The Get With the Guidelines-Coronary Artery Disease program leverages the "teachable moment" immediately after a patient has had an acute event-when patients are most likely to listen and follow health guidance. The program helps hospitals develop care teams and quality-improvement measures such as care maps, discharge protocols and standing orders to ensure that cardiac patients are treated according to guidelines.
In a 1999 Journal of the American Medical Association article, researchers documented a "treatment gap." Doctors and hospitals were not following the treatment guidelines published by the American Heart Association and the American College of Cardiology. Only half of the ideal candidates received beta-blockers, little more than half received ACE inhibitors and only two-thirds were treated with clot-busters. This treatment gap may be a contributing factor in many recurrent cardiovascular events. Within six years of a recognized heart attack, 18% of men and 35% of women will have another heart attack, and about 22% of men and 46% of women will be disabled by heart failure.
We're also using technology to push the latest research into practice and into the hands of the public. The Heart Profilers program helps patients and doctors sift through the latest published medical research to find the studies that are most relevant to a specific condition and an individual patient's health. Developed with technology partner NexCura, the program creates customized reports including treatment options for high blood pressure, heart failure, coronary artery disease, cholesterol conditions or atrial fibrillation.
Our nutrition and exercise guidelines provide information for physicians that helps their patients make healthy lifestyle choices, and our community programs, such as Search Your Heart and The Heart of Diabetes provide tools to help implement these changes. These are just a few of the many ways the American Heart Association is driving the rapid application of scientific discoveries and promoting quality improvement. Under the leadership of our incoming volunteer president, Augustus Grant, a physician and professor of medicine at Duke University, we look forward to continuing to lead the charge in fighting cardiovascular disease in new and innovative ways. Our goal is to help all Americans live longer, stronger lives.
Senior communications manager
American Heart Association
Wake up to frivolous lawsuits ...
It was interesting to read yet another perspective on the medical malpractice crisis (Letters to the editor, June 2, p. 23). Richard Torpey opines that it is the fault of the physicians. Let's all move to Philadelphia-apparently there are no frivolous lawsuits filed there. Every malpractice lawsuit filed there must be legitimate and the fault of the physician.
Wake up, Mr. Torpey. As long as people (plaintiffs, juries and attorneys alike) think every medical procedure must be perfect, that healthcare providers must be infallible and that every injury (real or imagined) is worth millions, nothing will change except the face of healthcare.
Corporate director of risk management
East Texas Medical Center Regional Healthcare System
... root out plaintiffs' bar
I have heard the statistic that 20% of the plaintiffs win their cases against physicians in medical liability cases.
I will agree with Mr. Torpey that the physicians who are "most responsible for medical malpractice in the first place" should be rooted out. However, will Mr. Torpey agree that the plaintiffs' attorneys in the other 80% of the claims also should be rooted out for filing frivolous lawsuits?
Chief executive officer
Regarding your coverage of certificate-of-need legislation ("Pros and cons of certificates," April 21, p. 4): Like so many ideas within the governmental structure, this was, at the time of its inception, thought to be a worthy piece of regulation that was meant to assist with controlling costs. However, what it did was drive up the cost of healthcare by establishing a body of people that had no clue in most cases what the applicant was discussing and they took a very negative view of any projects being developed for a long time.
In many states it was business as usual in that hospital projects were automatically approved, but any competitive project to the hospital was automatically disapproved rather than evaluating the merits of the project with regard to cost efficiency, satisfaction to both the consumer and the provider and the quality-of-care issue.
The CON process has added tremendous cost to given projects throughout the U.S., thus driving up the overall cost of any project that must be recouped at some point in time, resulting in an increase in cost for the consumer.
It seems to me we were doing a better job without the CON process and would do a better job if we let the competitive forces prevail.
Myers and Stauffer
For more information
We are planning a new 650-bed acute-care facility to replace our existing 60 year-old hospital.
I would like some information on what U.S. hospitals have done to make their facilities bioterrorism-ready so that we could provide similar assistance to our new hospital. I would appreciate your kind assistance in providing us with a list of such hospitals. We then will write to the hospitals for permission to visit, as we are planning a trip to the U.S. sometime in July or August.
Director of hospital planning
Editor's note: For further information on federal bioterrorism funding, go to www.hhs.gov/news/presspres0320.html. Once federal funds reach the state level, each state is in charge of deciding how much of the money will go to the hospitals within the state. A good contact for large public hospitals is Skip Moskey, assistant vice president of communications for the National Association of Public Hospitals and Health Systems in Washington, 202-585-0102.
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