The Health Insurance Portability and Accountability Act is nothing more than another government behemoth dumped on the overburdened backs of the healthcare providers ("The HIPAA headache," April 12, p. 6).
Although patient privacy and confidentiality are without question sacrosanct, the implementation of the law is ultimately a tremendous waste of dollars that could otherwise be spent on meaningful healthcare. I agree that the example you cite of Baylor University Medical Center's new "private area where no one else can overhear the conversations" is a better way to conduct business. However, in the millions of healthcare provider/ patient/family interactions that have taken place every day for the past 100 years, how much harm has ever been done? I am sure there are some examples of harm, but in the scheme of things and the millions upon millions of information exchanges that have taken place and are to take place, is the cost burden of HIPAA truly worth it? I say no.
HIPAA has just created more grist for the lawyer's mill, resulting in more regulations, more inspectors, more lawsuits and more cost to the entire nation. The monster is out of the box and it won't be repealed anytime soon.
Outsourcing is work ...
Having read David Burda's editorial "Over-the-top outsourcing" (April 5, p. 19), I would like to share my experience about the strength it takes for an administrator to outsource an area of his or her hospital.
You have to give credit to any hospital administrator who even explores the idea of outsourcing a key department or service. Managers have to overcome the perception that not doing everything by oneself is a sign of weakness or laziness.
Every time my company proposes an outsourcing arrangement to a hospital, the hospital's administrative team comes away with more knowledge and expertise about their current business dynamics. Taking the time to focus on a problem with experts who spend all of their time in a specialized area is a great way to learn more about key benchmarks, rules, reimbursement strategies and operational guidelines within the hospital.
There is a great deal of work that goes into selecting the expert who will bring the hospital the most value from a financial, clinical and operational perspective. The work of the hospital executive continues, as he or she must oversee the contractor's performance. Hospital executives must work hard to incorporate the expertise of the outsourcing organization into their own organizations.
The results of a proper outsourcing arrangement are that everyone wins-the patient, the community and the hospital. Patient care becomes optimal, financial systems are installed to better man- age operations, expertise is brought to bear on specific problems and the outsourced projects generally perform far better, particularly in environments where focus and specialized skills are needed.
Horizon Mental Health Management
... and shouldn't be bashed
The subtitle on David Burda's editorial ("Going outside has advantages, but overreliance is lazy management," April 5, p. 19) initially gave me some hope that the outsourcing argument was going to be addressed with some balance. Unfortunately, upon reading through the full text my hope quickly dissipated and toward the end it appeared that you made the leap to bashing of all outsourcing as an abdication of executive oversight.
I agree that outsourcing can be overdone, but I dispute your contention that any executive's job (not just in healthcare) doesn't involve an assessment of what should be done by employees or outsourced. To the contrary, services that don't directly relate to the hospital mission or constitute a core competency should be outsourced. Not to at least evaluate this option would represent the potential squandering of resources that could be deployed to areas more critical to serving the community.
One sentence of the editorial-"I'm not sure a hospital can claim to be community-based if no one in the community actually works there as an employee"-I found particularly distasteful. I must admit I am not as familiar with other forms of outsourcing, but in contract therapy outsourcing our employees live, work, pay taxes, go to school and give back to the communities just like hospital employees. We take great pride in supporting rural communities and in many cases providing a difficult-to-recruit resource and expertise that would otherwise be unavailable.
I reject your contention that healthcare services can only be performed well by a hospital employee. To make this implication denigrates the perception of quality that contracted services provide. In small departments within hospitals I contend that outsourcing is a better alternative both for the hospitals and for the employees. It broadens the employees' career opportunities, provides them with a network of other providers to address clinical issues with and adds a depth and breadth of management experience in those particular specialties that might otherwise prove insular or fall quickly out of date.
For the hospital it often provides a more dedicated recruiting effort, improved clinical protocols that have been tested across numerous organizations and benchmarking data to ensure efficiency and efficacy.
Vice president and chief financial officer
Diversity and finance
I just read your section on diversity at modernhealthcare.com. I am a black female chief executive of a home health agency. I want to tell you it is devastatingly hard to enter and stay in this business. Minorities are unable to find reasonable financing for their organizations.
Healthcare is a client-oriented industry; smaller agencies are finding it hard to grow their businesses because of lack of funds for marketing, advertising and outsourcing, and the nursing shortage. I have found that case managers and facilitators steer clients to organizations with which they are familiar (usually larger and white-owned), while the smaller agencies continue to remain stagnant and less profitable.
It is unfortunate that white people do not see any problem with keeping the status quo and forgetting about the importance of diversity, not only in regard to patients, but with owners of businesses as well. As a result, low-income, inner-city patients are not receiving the healthcare to which they are entitled.
My agency hires and provides services for all races, nationalities, religions and creeds. We are in the business of helping people who cannot help themselves; therefore, nothing matters to us (including profit) but improving the quality of life for our communities.
Chief executive officer
Trusted Home Healthcare
CMS, JCAHO and quality
I welcome Todd Sloane's comments encouraging managed-care plans to find a way to engineer improved quality while lowering health system costs ("The health plan challenge," April 12, p. 20). He was right on the mark in saying that "payment is the only reliable incentive" to improve quality, cost and access to care.
The CMS has already taken the initiative in partnering with the Joint Commission on Accreditation of Healthcare Organi- zations in an extraordinary process to encourage/compel most hospitals to provide quarterly data on outcomes in heart failure and acute myocardial infarction (with a pending addition of surgical infections).
The CMS 10 measure starter set of quality measures is linked to hospitals' marketbasket adjustment-a message of play or lose. The CMS has even taken the unprecedented step of aligning itself with the already proven and established approach pioneered by the JCAHO in its Oryx core measures program for collecting and pooling hospital performance improvement/quality data.
The open challenge now is, how can this bold step by the CMS and the JCAHO be best linked to a program that can actually achieve demonstrable and sustainable improvements in care, cost and access? Perhaps your newfound friends at America's Health Insurance Plans can find a constructive way to join with CMS/JCAHO in some form of complementary collaboration to help achieve this common objective.
Beacon Health Informatics
Cantor & Co.
Beverly Hills, Calif.
In Sen. John Kerry's campaign for president, he makes a point that healthcare insurance costs have risen 11% under the Bush administration. Now is our opportunity as healthcare providers to remind Mr. Kerry (and the voters) that medical malpractice liability costs have made up most, if not all, of that extra cost. And that's because Sen. Kerry and his good friend Sen. Edward Kennedy, both in the hip pockets of trial lawyers, have steadfastly blocked administration-backed tort reform in the past two sessions of Congress.
C. William Spencer
I think you have one of the most forward-thinking, up-to-date and informative health magazines in the country. I especially enjoy your special reports.
I would like to see you do an article on how well hospitals are keeping tabs on their equipment and medical supplies. What systems do hospitals have in place to allow them to pinpoint not only where equipment is stored but how to keep a handle on its use and availability? I believe that there are many war stories out there about duplication of equipment and supplies, about outdated/underused medical supplies or equipment and materials that are lost within vast hospital systems.
South Broward Hospital District
Memorial Healthcare System
Editor's note: Readers who are interested in this topic should search the archived articles at modernhealthcare.com and be on the lookout for a special report on supply-chain management coming in our Nov. 22 issue.
Another nurse CEO
Your special report on nurses becoming top executives was excellent ("Front lines to front office," April 19, p. 24). This was an excellent article. You missed an outstanding example, however. Jeanette Clough is chief executive officer of a Harvard teaching hospital-Mount Auburn Hospital in Cambridge, Mass. She has an outstanding record of bringing clinical staff, management and trustees together. Under her leadership the hospital has had consistent financial success, as well.
Jeanette is also the chairwoman-elect of the Massachusetts Hospital Association.
James Roosevelt Jr.
Senior vice president and general counsel
Tufts Health Plan
Board of overseers
Mount Auburn Hospital
The high costs of selling drugs
Todd Sloane's editorial on prescription drug reimportation and U.S. drug costs mentioned the higher prices we pay also covered the costs of research and development of new life-saving drugs. What the editorial failed to mention, however, is the ratio of advertising costs to those R&D costs ("It's time to look at Rx pricing," March 15, p. 18).
More than 50% of the cost of a new drug can be attributed to advertising. Look at any nationally published magazine. Watch the national news on both network and cable television channels. Stand outside any hospital and watch the flow of pharmaceutical company sales representatives in and out on a daily basis.
Visit any physician's office and notice how many items you see with drug names on them. Yes, as the editorial states, the real issue is U.S. prices, but these prices could be cut drastically if the advertising/marketing costs were cut.
Instead of governmental price controls, how about advertising price controls?
Corpus Christi, Texas
What do you think?
Write us with your comments. Via e-mail, it's [email protected]; by fax, 312-280-3183.