Those healthy boomers
I loved your article on the supposed baby boomer onslaught ("Boomer bust?" July 28, p. 24). Speaking as a boomer myself, I certainly see the validity of the content among my friends and peers.
As the manager of a busy ambulatory surgery, catheterization and gastrointestinal laboratory department in a large city hospital serving an amazing cross section of people, I can state without reservation that I am seeing a tremendous proactive shift in the general health consciousness of people. It makes me, for one, very happy.
Nurse manager of ambulatory surgery
St. Mary of Nazareth Hospital
URAC and HIPAA
I read with great interest your article "Proof of privacy" (July 14, p. 20), which highlighted the business associate privacy certification program offered by the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. URAC strongly supports the mitigation of risk through independent third-party review.
I was disappointed, however, to find that URAC's work in information technology, and particularly our Health Insurance Portability and Accountability Act compliance efforts, were overlooked. URAC already has put into operation a set of HIPAA privacy and security accreditations for covered organizations and business associates alike. Importantly, URAC's accreditation programs are the only options that result in the accreditation of an organization's HIPAA compliance programs.
Some 250 healthcare organizations have registered with an information security work group we formed with the National Institute of Standards and Technology to facilitate communication and consensus on best practices. Another 21 organizations have been accredited through our privacy program. In March, we launched a HIPAA security accreditation program.
Ultimately, the decision to implement and validate HIPAA compliance programs resides with the individual healthcare organization. I believe that all relevant information regarding accreditation options must be presented in order for an organization to make an informed decision. I hope that in the future we can count on Modern Healthcare to report the news on all HIPAA accreditation programs.
President and chief executive officer
The AMA replies
We are very concerned about inaccuracies in your July 28 issue.
Both "Breaking away" (p. 12) and "Some free advice for the AMA" (p. 20) refer to the American Medical Association "steadfastly" clinging to a "strict $250,000 limit on noneconomic damages" in liability reform. The truth is that the bill the AMA supports in both the House and the Senate contains a provision giving states the right to pass their own liability reform caps as long as they have a cap. And the $250,000 figure wasn't chosen on a whim; it's a proven performer that has successfully stabilized premiums and allowed patients full access to the courts in California for more than 25 years.
A $500,000 cap was never "proposed in the Senate." Sen. Diane Feinstein (D-Calif.) discussed but never introduced a $500,000 cap with a $2 million exception in some cases. The AMA is always open to negotiation to find a liability reform proposal that will stabilize skyrocketing liability reform premiums and give patients access to the physicians they need. So far, we have seen absolutely no evidence that a $500,000 cap with a $2 million exception clause would stabilize premiums. In fact, actuaries have determined it would not.
It is also incorrect that it was AMA leadership (as opposed to delegates) that made liability reform our No. 1 legislative priority. That was a decision made in public by the full House of Delegates at last year's annual meeting. We've had tremendous support from both physicians and patients for our effort.
In his editorial, Todd Sloane opines of the AMA: "On issues of medicine it makes all the right noises but does little to push those agendas. ... " What bigger issue of medicine is there than ensuring that patients have access to doctors?
As for "public health" issues, the AMA has launched two new initiatives in the last two months alone: a 226-page guide to help older patients continue driving safely (See Outliers, p. 40) and our new disaster preparedness training program to help us better prepare for mass casualty events. In just the last few weeks, the AMA has lobbied and testified on patient-safety concerns associated with reimportation of prescription drugs and direct-to-consumer advertising, as well as the need to cover the uninsured.
As for the tired, old charge that the AMA is being "led by the same generation of older men," AMA membership is increasingly younger and has the benefit of more women than ever, a trend we encourage and expect will continue. In 1983 the median age of an AMA member was 58; in 2002 it was 49. In 1983, only 8% of AMA members were female; in 2002 it was 24%, very similar to the percentage of women in medicine overall. The AMA's board and other leadership are increasingly younger and more diverse as well. We're pleased to have two exceptional women physicians on our current board, including the current speaker of the House of Delegates.
American Medical Association
Your article on Medicare outlier payments ("It's more than just Tenet," July 14, p. 4) includes some misleading information about Summerlin Hospital Medical Center, an affiliate of Universal Health Services.
In fiscal 2001, Summerlin was a newly constructed, newly Medicare-certified hospital, which had an initial Medicare cost report period of just 75 days. As you might expect, a newly opened hospital would typically operate at a high cost-to-charge ratio because of a high percentage of fixed costs, first-year startup operational costs and low startup occupancy levels.
Because of normal delays in fiscal intermediary cost report settlements, that first year 75-day cost report was used for Summerlin's federal fiscal 2001 outlier payment calculation. And, therefore, by properly following all of the detailed Medicare laws, Summerlin was credited with a high outlier payment percentage.
This was not part of some data manipulation to "boost (its) bottom line." Instead, it was simply a one-year aberration. A review of subsequent Medicare outlier payment data for Summerlin shows a sharply reduced payment percentage, reflecting the use of subsequent full year Medicare cost report cost-to-charge ratios.
Director of reimbursement/decision support
Universal Health Services
King of Prussia, Pa.