I enjoyed your coverage of the American Hospital Association lobbyist and the fund-raiser for President Bush ("Mixing politics with pleasure," Oct. 6, p. 6).
Being the only person outside the Beltway quoted in the piece, it turns out I am the only one who really sees impropriety in this type of lobbying/private affairs. I was shocked that Common Cause didn't have stronger comments. John Gardner, Common Cause founder, whom I knew fairly well in my days in Washington back in the 1960s and '70s, would be rolling over in his grave if someone read him those comments.
What you have shown in this piece is that the whole town plays the "business as usual" game when it comes to conflict of interest. The "advocacy" groups have become organizations whose main goals are to self-sustain and they are not much different than the trade groups (which we expect to act that way). They are afraid to criticize because their leaders do the very same thing.
People's Medical Society
Neil McLaughlin's recent ranting about alleged AHA involvement in a Bush fund-raiser ("A different kind of pioneer," Oct. 13, p. 24) appears to have been scripted by Democratic Central Committee operatives. And his allegation that the Bush administration opposes domestic programs like Medicare and Medicaid were ill-disguised hyperbole.
As one who was involved in this recent effort, I can assure you that AHA leaders took great pains to not link the association to this private event. And since when do private citizens lose the right to support candidates of their choice just because their "day job" is a senior-level position with a prominent national trade association?
I can only deduce that Mr. McLaughlin's blather relates to his partisan political leanings. How else can one explain this exaggerated attempt to pummel an invented issue?
Wisconsin Hospital Association
Antibiotic savings overestimated
Regarding your Oct. 13 Daily Dose item, "Reduced use of antibiotics could save $1 billion": I found this report-about a VHA study-unrealistic. I don't know what hospitals were targeted by the VHA and I haven't seen a full print of the study. But the statement that an average 250-bed hospital could save more than $100,000 annually by improving antibiotic usage is an overstatement.
We are an acute-care, 250-plus-bed hospital; we are not using ceftriaxone (or similar third-generation cephalosporin) or fluoroquinolones for routine pre- or post-surgical prophylaxis. Vancomycin is reserved only for special cases. But we don't see savings such as these.
Pharmacy clinical coordinator
Providence Everett (Wash.) Medical Center
Left off recruiter ranking
Modern Healthcare is usually very accurate and is a terrific publication to keep track of news and trends in the healthcare industry. In your Sept. 15 By the Numbers chart on the "Top 15 executive recruitment firms" (p. 32), you left out my company, Solomon-Page Group.
Solomon-Page is a 10-year-old retained search group that focuses on healthcare and life sciences on a global basis from its three offices in New York, San Diego and Pleasanton, Calif. Although we are privately held and do not have publicly available financial information, based on your criteria of 2002 revenue we would be the eighth largest firm on your list. Our revenue is more than $4 million annually and is growing rapidly in a difficult environment.
Thanks for your continued good work.
Group president, healthcare and life sciences
DRGs for docs
I think it is a great idea to cut costs and regulate money for healthcare, but the one thing that I think could also make a difference is placing a cap or a DRG on physicians ("It was 20 years ago today ..." (Sept. 29, p. 6). Physicians are the only providers who can admit and discharge a patient from the hospital, and this puts the hospitals at the mercy of the physicians. Physicians know that they get paid regardless of how many days or what cost is incurred. I think that is a little unfair. If hospitals are forced to take care of patients for allotted amounts, why aren't physicians?
With the cuts that Medicare is making, it is forcing hospitals to cut back workforce and even shut needed services. Without caps or DRGs for physicians, before long we will have plenty of physicians but no hospitals. Hospitals are not able to continue losing money for care provided to patients while the physicians continue to receive payment with no limits.
Assistant risk manager
Baptist Healthcare System
CMS hits roadblocks
The article in your Oct. 13 issue, "Volunteer or else" (p. 8), concerning the public quality reporting initiative, demonstrates the limitations of the CMS in leading change within the healthcare industry. The threats of forced participation in the hospital quality measurement project as a result of low voluntary responses, without evaluation of the cause, may be best described as a "tantrum."
The reality is, a significant portion of the 4,100-plus hospitals do not have sufficient discharge volumes in the areas designated by the CMS to participate with statistically significant data. My hospital, for example, while subscribing to the sharing of quality information with the public does not have the AHA-suggested 25 discharges per quarter in any of the designated categories. We have participated in public reporting through the Michigan Hospital Association. While not as provocative as many of the new CMS measures, the public was at least made aware of some basic length-of-stay and mortality data for the facilities. Lack of response to the voluntary reporting should not be automatically construed as a lack of willingness to participate.
The CMS continues to compare the hospital initiative with the nursing home quality initiative. This demonstrates the lack of understanding of the roles different providers have in the healthcare industry. The consistency in types of services and patients among skilled-nursing facilities is far greater than can be found among hospitals. Scope of services, intensity and responsibility within the broad continuum of care is significantly different for acute-care hospitals.
Unfortunately, the CMS is likely to mandate participation in the system if they don't get what they want, which will result in the development of a meaningless set of measured outcomes that may impress some beneficiaries, a few businesses and congressional leaders but lead to few healthcare delivery performance improvements.
Administrator and chief executive officer
Deckerville (Mich.) Community Hospital