Regarding your cover story "Going with the (patient) flow" (Feb. 9, p. 6): Emergency room overcrowding is a national issue and is of significant concern for patient safety. ER visits are one of the fastest growing areas of healthcare delivery. The reasons for this increased demand on ERs are multifaceted. Having the Joint Commission on Accreditation of Healthcare Organizations establish standards to deal with this problem, however, would not address the causes and put further stress on a system facing peril.
In Georgia, approximately 65% of hospitals lost money last year. Many hospitals recognize the problem but do not have the financial and staffing resources to correct the deficiencies in the system. Many of the low-technology, low-risk procedures are being done in ambulatory surgery centers, which are taking this profitable business from local hospitals. This further compromises hospitals to fund areas that traditionally have not covered their costs.
Ensuring that communities have adequate on-call physician coverage for the emergency room is another issue many hospitals are facing throughout the country. Much of the care delivered in emergency departments is provided with little or no compensation to the hospitals or physicians. Physicians are exposed to increased liability potential, poor reimbursement and quality-of-life issues related to providing on-call services to emergency departments.
ER overcrowding, quality of patient care and patient safety are issues that need attention. Addressing these issues will require support from our legislative branch and the healthcare industry. One option that has been discussed is a national or state sales tax that would be used to reimburse hospital for indigent care.
Vice president of professional services
Colquitt Regional Medical Center
... ER docs are to blame ...
I have to disagree with your story on emergency room patient-management standards. Although I do agree with the overcrowding issue, I feel that the ER physicians are to blame. The countless visits with consultants, monitoring turnaround times with radiology and laboratory departments, and purchasing newer technology have improved the processes within the ER in the last two facilities where I have worked.
It is time to look at the process with the ER physicians and why it takes so long to make decisions on patient care. One radiologist here said it perfectly: ER doctors like to spin the "wheel of misdiagnosis."
Hardin Memorial Hospital
... goals must be realistic ...
Although I agree with the new initiative of the JCAHO, there is another side to this story.
There are so many rules and changes coming at the hospitals that no hospital could address all of them at once unless they are a very rich hospital, and there are not too many of those.
No matter how you slice it these initiatives require new resources that someone has to pay for.
While acute-care hospitals are being bombarded with "must dos," we have to expend many resources to simply get paid for the care we have already rendered. Cash flow can become a very serious issue. Every time a hospital closes, it puts a greater burden on the rest of the hospitals and it only becomes harder for people to access healthcare.
The majority of acute-care hospitals are doing a good job but may not survive if they are forced to meet unrealistic goals. Someone needs to step up to the plate and pay for this high-quality care that everyone wants, but they need to realize it is not free.
So instead of whining about "watered down" standards, these people should be helping us find ways to manage and pay for this great influx of change.
Assistant administrator, nursing services
Natchez (Miss.) Regional Medical Center
... gaps in coverage key
Your article on ER standards is right on the money. As a hospital administrator for more than 33 years, I have never seen it as bad as it is right now. Among the biggest deficiencies in our community is the lack of neurosurgery coverage at the nontrauma center ERs.
Regardless of whether you have insurance coverage or not, you take your life in your hands if you go to an ER and need neurosurgery intervention. There are other specialty gaps with respect to on-call docs at ERs, but the neurosurgery gap seems to be the most serious.
Dennis E. Coleman & Associates
Stark consistency needed
I am writing regarding the Jan. 12 commentary by Sarah Swartzmeyer and Carrie Norbin Killoran ("Specialty hospital ban was premature," p. 21). Unfortunately, the authors missed the most important part in commenting on the temporary ban on physician investment in specialty hospitals as part of the Medicare reform legislation. They contend that there is not enough information to conclude that physician investment in specialty hospitals affects behavior or referrals.
I will suggest that statement indicates an absolutely naive approach to what is happening in the real world. The most salient feature for me, and the principal reason to extend the temporary ban, is to bring into play consistency of the Stark law with the rest of the industry. If hospital administrators can go to the federal penitentiary for doing what physicians can do with impunity (give financial incentives to physicians), it seems to me that we have a disjointed, unfair and absurd legal inconsistency.
Before we can argue whether or not niche hospitals negatively affect general acute-care margins and/or the Medicare and Medicaid programs, let's at least satisfy ourselves that we can explain this apparent contradiction.
President and chief executive officer
Our hospital is no threat
We are responding to the recently released report by the advocacy group Community Catalyst about Triad Hospitals being a threat to community hospitals ("Verbal assault," Feb. 2, p. 14).
This group dedicated a large portion of its so-called research on our hometown, Las Cruces, N.M., and the effect that our hospital, MountainView Regional Medical Center, a Triad facility, had on the local not-for-profit hospital, Memorial Medical Center.
It is our understanding that not a single representative of Community Catalyst visited our community but rather chose to base their research on the former chief executive of Memorial, MaryAnn Aelmans-Digman.
Two examples of Aelmans-Digman's inaccurate or misleading assertions stand out. The first example is her claim that if an uninsured patient comes to MountainView, they would not stay long because they are typically stabilized and shipped to Memorial.
The facts reveal otherwise. In 2003, MountainView's first year of operation, we treated approximately 2,700 uninsured patients both in our ER and electively. Only 24 uninsured patients were transferred out of MountainView's ER because our hospital doesn't provide trauma, pediatrics and inpatient psychiatric services.
Based on local ambulance records, MountainView accepted approximately 40 patient transfers from Memorial in 2003.
The second example is her assertion that we deliberately located our hospital in an "upscale" neighborhood without bus service. We believe that this assertion is misleading because Aelmans-Digman failed to disclose that under her leadership as CEO of Memorial, MountainView was forced to abandon its original site (right off Highway 70) because of Memorial using a land covenant technicality and preventing us from locating in a high-visibility location with bus service. MountainView has requested bus service from the city.
The sad reality is that Aelmans-Digman chooses to misrepresent the facts surrounding our community based on her experience and tenure as CEO of Memorial.
The theme of her campaign is that the arrival of our new hospital, MountainView, and Triad's tactics were the main factors leading to the decline and eventual sale of Memorial.
She is wrong. In fact, as extensively documented in various articles in our local newspaper, Memorial experienced financial and management problems well before the arrival of MountainView.
Chairman of the board of trustees
Chief of staff
MountainView Regional Medical Center
Las Cruces, N.M.
Seeking better value
Every Monday, I look forward to receiving my copy of Modern Healthcare and reading about the events of the previous week that are of interest to hospitals and other healthcare providers. Accordingly, I am extremely disappointed to discover that the just-released Value Group coalition study was mentioned only briefly in your Feb. 2 cover story ("An ounce of prevention," p. 6), and then only as subtext for another story.
This unprecedented study opens a new chapter in the national discussion about healthcare spending and deserves to be in the spotlight, not the shadows. In addition to determining the overall return on investment in healthcare, the Value Group study quantifies several specific gains associated with tremendous advances in treatment for four of the nation's most serious health conditions: heart attack, stroke, breast cancer and type 2 diabetes.
For example, the Value Group study reveals that over the past 20 years, mortality from heart attacks has been cut by more than half and that five-year survival rates for people with breast cancer have risen from nearly 77% to more than 86%. Unfortunately, Modern Healthcare did not publish even one chart from the Value Group study's findings. I believe that your readers would be better served by more attention to this groundbreaking research.
Federation of American Hospitals
Midcareer education is key
As an experienced healthcare executive who has moved on to the academic world, I tend to agree with Gary Filerman, the past president of the Association of University Programs in Health Administration, when he states that the cause of the shortage of high-quality candidates for executive-level positions can be addressed through a formalized continuing or midcareer education by healthcare organizations themselves ("Masters of the universe," Jan. 19, p. 6).
Most graduate programs, with the exception of executive graduate programs, do not train students to assume senior-level positions within large healthcare organizations. The goal of most graduate programs is to give students a sound foundation of skills and knowledge necessary to add value to an organization upon graduation. Those students who continue to develop their skills through a rigorous continuing education program and who assume positions of increasing responsibility are then ready to assume senior-level executive positions in healthcare. Professional organizations such as the American College of Healthcare Executives also serve the purpose of helping young healthcare executives refine their administrative and leadership skills through continuing education and professional development.
The best way to prepare a young healthcare executive to fill executive-level positions in healthcare is through a combination of education, experience and professional affiliation. The absence of any one of these severely weakens a young executive's ability to perform as a senior executive.
Graduate programs in healthcare administration can take the young executive only so far. Healthcare organizations must develop active mentoring programs to identify, monitor and develop advanced administrative and leadership skills in those young executives who demonstrate the ability and desire to become senior healthcare executives.
Organizations also must ensure that they develop a rigorous continuing education program and/or strongly encourage promising executives to affiliate with a professional organization that will require continuing education as a requirement for membership. The primary reason that a shortage of high-quality candidates for executive-level positions exists is because these same organizations have failed to identify and develop young executives who show potential to fill these executive positions.
Visiting associate professor
Department of Health Care Administration
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