I am always skeptical of "top" lists, such as the 100 Top Hospitals, top graduate schools, etc. It occurs to me the tools used to measure success often miss the point. Recently, Solucient released its inaugural list of the 100 Most-Improved Hospitals ("Leading the way," March 15, p. 26). Included in the list, under teaching hospitals with 200 or more acute-care beds, is Maryland General Hospital in Baltimore. People outside the Baltimore area may have been unaware of Maryland General's recent troubles, but locals have been inundated with news coverage of just how bad the lab at Maryland General is.
As Modern Healthcare reported last week, the president and CEO of the hospital and its laboratory director resigned in the wake of a debacle in which nearly 500 patients may have received incorrect results from HIV and hepatitis tests from June 2002 to August 2003 ("Flunking out," April 26, p. 17). The hospital faces the loss of Medicare funding if it doesn't submit a corrective action plan for ongoing problems with its laboratory services.
How exactly would that qualify one's organization to be included in a list of most-improved hospitals? I fail to see how that question can reasonably be answered. It does point out serious deficiencies in these rankings often relied on by consumers and others to make purchasing decisions regarding healthcare services.
Name withheld by request
Smart, not lazy
In response to your April 5 editorial, "Over-the-top outsourcing (p. 19)," I would like to point out a few facts that were not mentioned.
Many of our nation's hospitals do not and cannot attract the talented managers now required in the more competitive and difficult environment resulting from the Balanced Budget Act of 1997. Thanks to the BBA we now have antiquated infrastructure, restrictive and noncompetitive compensation levels and dysfunctional administrative structures-just to name a few problems.
I have not met a single administrator who is an advocate of "outsourcing everything." However, I have met many smart (not lazy) hospital administrators who have differentiated the core competencies required to provide quality healthcare services in their hospitals from the specialized, often technical, services required to support those core competencies that can be more effectively and economically provided by outsourcing.
I do agree with you that outsourcing hospital functions as a quick fix is a mistake. However, outsourcing functions that are not a hospital's core competencies is just plain smart business-something other industries in our country figured out more than a decade ago.
Chief executive officer
Other U.S. prices high, too
I agree with the comments of Todd Sloane as to the issue of the U.S. healthcare system underwriting the cost of pharmaceuticals for other well-developed countries ("It's time to look at Rx pricing," March 15, p. 18). However, it should be pointed out that retail drug prices are merely part of a larger problem.
An additional and equally troublesome issue is the price discrepancies in the hospital market. Having worked extensively with Canadian hospitals, I can tell you that the prices for many hospital products, including pharmaceuticals, are dramatically lower than the prices available to hospitals in the U.S. Implants (hips, knees, pacemakers, etc.), for example, are also significantly less expensive in Canada. It seems this issue has been neglected because media attention has been focused on drugs.
Price differentials between U.S. hospitals and those throughout much of the rest of the world are a serious problem. Leveling prices worldwide would have a positive impact on the cost of healthcare in the U.S., but it would have a serious negative effect elsewhere. Since the vast majority of other countries fund their healthcare based on taxes (socialized medicine), every additional dollar of increase for supplies will result in an increase in taxes for the citizens of the countries affected.
I read and hear a lot about how high our healthcare costs are in relation to other countries. Could our "indirect funding" of the expenditures be one of the reasons for the difference?
This problem is long-standing and a solution is not one that should be rushed through Congress to appease voters in an election year. It should be pursued, however, as soon as possible.
Center for Modeling Optimal Outcomes