I refer to the new Medicare reform bill as the good, the bad and the ugly ("Winning big in reform bill," Nov. 24, p. 6).
The good part is that the bill provides some new preventive benefits, relief for rural hospitals and physicians, and a means test for beneficiaries in higher-income levels.
The bad is that the drug benefit does not go far enough. There is some relief, but if you review what you really get for your out-of-pocket payout, it is very little, especially if your annual drug costs are less than $5,000. Also, the bill does not go into effect until 2006 (interestingly, after the 2004 presidential election), but in the meantime you can get a discount card that brings you all of 10% to 15% savings on your bill.
The ugly is adverse selection; those who would buy the drug benefit for $35 per month are the ones who take lots of medicines, and the private plans offering this benefit will either need more subsidies or drop out, much like Medicare HMOs have around the country.
And privatization of basic Medicare won't work unless the private plans make a profit, and to do so they will increase premiums and reduce benefits. Hopefully before this is implemented Congress will realize the monster it has created and simplify the program for future generations.
Medicare patient advocate
Seniors' Voice for Healthcare Rights
Low volume, low quality ...
As Mark Taylor made clear in his special report on "rainmaker" physicians ("Storm warning," Nov. 17, p. 26), some physicians abuse their positions by performing a high volume of unnecessary surgeries. But what also merits consideration is that many high producing physicians have become the doctors of choice in their communities by virtue of their clinical excellence and hard work.
Indeed, often it is the low revenue-producing physicians who are the real concern. Their poor outcomes have dried up referrals from other physicians and patients have learned to avoid them.
It is to be hoped that in its quest to uncover high revenue-producing "bad apples," the government does not discourage or inhibit an elite core of specialists who are providing the highest level of care in the world.
The fact that they make money while doing so and generate revenue for their hospitals is one of the strengths of our healthcare system, not one of its weaknesses.
Chief executive officer
Merritt, Hawkins & Associates
... and governance concerns
Hats off to Mark Taylor for his timely and important special report "Storm warning" on quality oversight in hospitals.
It seems to me that in those instances in which governance is truly fulfilling its legal accountability to assure that quality services are provided, the prospects for abuse, compromise and lower standards are much less. Unfortunately, my experiences as a hospital chief executive and consultant have found too few boards up to that responsibility.
To perform well at such a responsibility, boards will have to step up their performance. Without better governance, it is unlikely that many chief executive officers or physician leaders will perform differently than has been the case to date.
Senior vice president
Magellan Management Group
One turnaround strategy you neglected to mention in your Nov. 3 special report on hospital turnarounds was a tax election ("Reaching a dead end," p. 28). In many states a hospital may form a "district" from which tax revenue can be generated. There are several ways to do this; in California, most hospital and healthcare districts attempt to pass a parcel tax to cover operational expenses or a general obligation bond to generate revenue for capital projects.
There has been an increasing level of interest in this strategy from California hospital and healthcare districts. This is because of the financial challenges all hospitals are facing, but unique to California is Senate Bill 1953, a state law mandating compliance with strict seismic-safety codes (by 2013). A large majority of hospitals do not meet these codes and will have to either retrofit or rebuild their facilities.
This past Nov. 4 we worked with Kaweah Delta Health Care District in Visalia, Calif., to pass a $51 million general obligation bond. This will fund approximately one-half of its new patient tower.
We also assisted El Camino Hospital District in Mountain View, Calif., to pass a $148 million bond that will help pay for a new hospital. Tax elections in California require a two-thirds supermajority so they are difficult to pass.
However, both communities came together with a strong volunteer effort to support a grass-roots campaign that is critical to achieve 66.7%.
We have found communities willing to approve tax increases to maintain and improve local healthcare facilities as long as the hospital's "plan" makes sense to the average voter.
Greedy teaching hospitals
Teaching hospitals and university medical centers have been exploiting their house staffs increasingly and alarmingly ("Funding fight," Oct. 6, p. 10). That is poor public policy and bad medicine. It is time to end this excursion into corporate greed.
Union of American Physicians and Dentists
John Morrissey's special report "Out to set the record" (Oct. 20, p. 28) was the best explanation I have read of the current flurry of activity surrounding electronic medical records.
Director of public relations
American Health Information
Where the profits go
Providence St. Vincent Medical Center, Portland Ore., recently took honors for the seventh time as a top 100 U.S. hospital, as determined by Solucient ("100 Top Hospitals" supplement, Sept. 29). This determination was based on data provided by the hospital and is comprised of eight categories, including profitability. What Modern Healthcare isn't aware of is the story behind the story.
At about the same time that your supplement was being printed, parent Providence Health System was sending an e-mail to employees of its Portland service area, including those at Providence St. Vincent. This communique announced the results of an annual market analysis regarding pay ranges. Providence Health stated that this analysis supported a 3% increase to the pay ranges of these employees, but Providence Health said that only the employees at the bottom of the existing pay range would see a 3% adjustment. There was no mention of how this would affect the vast majority of other employees.
Since the e-mail, these employees have not seen any adjustment upward on the newly revised pay range. So, while their market study says they are worth more, Providence Health has undervalued them by leaving them at their previous position within their respective ranges.
And now for the really bad news. Besides the loss of 3%, as most employees view this (lack of) action, Providence Health has decreased the merit increase range from last year's 0%-6% to 0%-5%, taking away another 1% of potential pay. This was attributed to "financial pressures on the economy," with reference to "difficult economic times."
Meanwhile, Providence Health has begun building a new Providence Newberg Medical Center (estimated to cost $58 million); completed a new neurovascular biplane procedure room in the furtherance of its stroke program; and completed a general surgery expansion, adding 27 new operating suites with additional preoperative and postoperative beds, totaling more than 60,000 square feet of new space.
The "difficult economic times" haven't seemed to curb Providence Health's desire to build a new Hillsboro, Ore., medical campus, said to support some 1,400 jobs with an average annual salary and benefit package of $63,000 ($88.2 million annual budget) with the addition of a regional school of technology, estimated to cost $6 million; an enlarged parking structure for the hospital in 2004; and a new patient tower, targeted for completion in 2008.
In the meantime, Providence Health Chief Executive Officer Henry Walker will continue to surpass his 110% pay increase, attributed to a new incentive pay system, according to spokeswoman Cheryl Sjoblom, as quoted in the Oregonian.
Borrowing from Peter to pay Paul, Providence St. Vincent will undoubtedly remain profitable in the year(s) to come based on its recent history of innovative revenue collection and major improvements.
Providence St. Vincent Medical Center
Editor's note: Hospital officials declined an offer to respond to this letter.
A ranking suggestion
I read with interest the supplement to your Sept. 29 issue listing Solucient's "100 Top Hospitals." Given the number of excellent healthcare institutions across the country, I am sure the process of choosing the best was not an easy one.
This information surely will be helpful to many as they choose their best option in selecting a hospital or specialist.
Perhaps the next ranking could be of long-term-care facilities. Traditionally, media outlets publish stories about long-term-care facilities that are below par for a variety of reasons. The fact is the nursing home of today is vastly different from those of the past, many of which were riddled with scandal and simply warehouses for the elderly.
Many nursing homes are providing state-of-the-art care in beautiful, homelike environments with high-level staffing. Not only would such a list help those who are searching for a nursing home for a loved one, but also it may in some way alter the negative perception many have about nursing homes.
Executive vice president
Rosalind and Joseph Gurwin
Jewish Geriatric Center of Long Island
Collect and help moms
Great article on self-paying patients and bad debts ("Balance past due," Sept. 22, p. 32).
One method we are using to improve collections while enhancing patient service is to assist single moms in processing medical child-support claims.
There are more than 5 million children in the U.S. without insurance of any kind, government or private. There also are more with high copayments or coverage gaps. Single moms are the biggest portion of this number.
Since 1994, all children subject to child-support agreements are required to be covered with medical insurance, but until recently there were no standard laws for processing claims.
Standard laws, along with Internet and other high-tech tools, now allow for the orderly processing of child support nationwide, including medical bill reimbursements (the only third-party claim covered by child-support statutes).
Simple modifications to intake questionnaires, namely identifying children covered by child-support agreements, allow healthcare providers to assist moms in the collection of their claims.
Outsourcing this niche to child-support collection experts keeps costs down and compliance high. Transfer of sums collected directly to providers closes the loop.
Noncustodial parents are a legitimate third-party collection source that is mostly untapped in America today. Billions of dollars are available to providers, offering stress relief for the most needy of patient families, those led by single moms. Implementation of this process should be a high priority for all industry participants.
Family Support Assurance Corp.
What do you think?
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