Two in-depth reports issued last year by the General Accounting Office raise numerous red flags about the proliferation of physician-owned specialty facilities and, in particular, about the threat that these facilities pose to vital healthcare services provided by full-service community hospitals.
Nevertheless, in a recent commentary ("Specialty hospital ban was premature," Jan. 12, p. 21) Sarah Swartzmeyer and Carrie Norbin Killoran give short shrift to the GAO and the conferees to the Medicare legislation, and deliberately downplay the conflict of interest inherent when physicians who refer patients to specialty facilities also have an ownership stake.
Essentially, the physician-owned specialty facility lobby wants to have it both ways. They want these facilities-which depend upon referrals by physician owners and focus almost entirely on one or two major diagnoses-to be considered the same as full-service hospitals that do not. They want these facilities to be able to continue to cherry-pick higher reimbursement patients, leaving full-service community hospitals to care for costlier and sicker patients who often have critical needs. And they gloss over other findings by the GAO that show most specialty facilities fail to meet the needs of their communities by not having fully staffed, 24-hour emergency departments and treating a significantly lower percentage of Medicaid patients than do full-service community hospitals.
Even the American Medical Association's code of ethics opposes any level of hospital ownership among physicians and acknowledges the potential for conflict of interest when physicians refer patients to facilities in which the physicians have an ownership interest.
For Swartzmeyer and Killoran to argue that an 18-month moratorium on the spread of new physician-owned specialty facilities was premature simply is disingenuous. Short of an outright ban, Congress did the right thing by, in effect, issuing an injunction against further construction, thereby recognizing the likelihood of irreparable harm to public health if physician-owned specialty hospitals continue to proliferate.
Federation of American Hospitals
Masters need funding ...
In response to your Jan. 19 cover story ("Masters of the universe," p. 6) on the efforts of the National Center for Healthcare Leadership to reform health administration education, it's comforting to know that someone out there is:
* Actually looking for the "universe" of necessary competencies for future healthcare leaders.
* Putting together the evidence-based measurement tools to launch students and educators to this far-off pedagogical space.
* Building a powerful telescope to find distant and early-stage management "stars" whom are currently opting for other professional galaxies such as consulting, investment banking, medicine and law.
Now, if only this organization had the funding of NASA, then perhaps solving the pending crises of an industry that protects human wellness and represents almost 15% of the nation's economy would be at least as important as getting back high-resolution photographs from Mars.
Advocate Health Care
Oak Brook, Ill.
... but there's more to leadership
It seems as though the intent of the National Center for Healthcare Leadership is to return to the residency approach, pioneered by my father, Richard Stull, when he started the first residency program in hospital administration at the University of California-Berkeley in the 1950s.
There is nothing like being able to experience the real environment without being held accountable. As Richard Rand once said to a participant in a seminar on the process, art and techniques of negotiations: "You won't get fired in this seminar, but there is a very good likelihood that you will when you return to your job."
I think there is more to the issue than just the lack of appropriate training, to me it seems as though our industry has lost its camaraderie, decisionmakers and risk-takers.
Richard Stull II
IPC-The Hospitalist Co.