Regarding your cover story on John Forsyth, chairman and chief executive officer of Wellmark Blue Cross and Blue Shield also serving as the president of the board that oversees University of Iowa Hospitals and Clinics ("Too close for comfort?" May 3, p. 6): If the issue is that we need to accept such obvious conflicts of interest because there is no one else in all of Iowa qualified to fill this position, Iowa is in big trouble.
Chief financial officer
Keokuk (Iowa) Health Systems
Doc execs need new skills
Michael Romano's special report about physicians moving from the bedside to the executive suite points out that chances of failure are higher if the physician is not willing to learn new behavioral competencies ("Ready. Or not," April 26, p. 26). Physicians may fall into the trap of believing that if they gain the technical competencies needed to manage they are prepared to become chief executives.
It's essential to either get a master's degree in business administration or at least take some business courses, but that only gets the physician so far. The physician executives who acknowledge that the behavioral competencies needed to be a great doctor are very different than those of a great CEO will be the ones who thrive in running the show.
Morgan Executive Development Institute
Ponte Vedra Beach, Fla.
Drug cards, but few discounts
Regarding your article about providers answering patients' questions about Medicare drug discount cards, I may be a bit more skeptical than others about where drug costs are being shifted ("Learning the rules," April 26, p. 14). The sentence that concerns me is, "(Mark) Merritt (president of the Pharmaceutical Care Management Association) and others, including CMS officials, said they did not know how much of the discounts would be absorbed by manufacturers and how much by retail pharmacies."
The rise in average wholesale price of brand-name drugs has far exceeded the consumer price index since Medicare drug benefit legislation was first proposed in 2001. Instead of reaping savings of 10% to 25% on prescription drugs, as your story suggests, I think the "discounts" have already been primarily absorbed by those who are already paying the price, the consumer.
As a pharmacist, I was thrilled to see passage of the prescription drug benefit for Medicare patients. This first attempt is laudable; however, the interim prescription drug discount cards and the "doughnut hole" coverage planned for implementation in 2006 leave substantial gaps in coverage for the pharmaceutical care of Medicare patients.
Director of pharmacy services
University of Kentucky Hospital
Patches over pride
I read your Outliers item on "Patches of honor," about an effort to better identify registered nurses (April 26, p. 36). We nurses have brought this identification issue of not being able to tell who is the nurse upon ourselves by dressing down. It's sad when the patient or doctor cannot identify the professional nurse from the nursing assistant.
This is what happens when nurses wear pajamas to work. It's too bad that professional nurses are not proud enough of their profession to dress with dignity and pride.
So now let's slap a patch on our pajamas and see if that will fix the problem.
Manager of emergency room care
Ready as we can be
As the post-Sept. 11, 2001, point person for our hospital's emergency preparedness program, I wasn't surprised by the observations made by Todd Sloane in his editorial on the lack of bioterrorism readiness ("Rough and unready," April 19, p. 17). What surprises me is that there was so little recognition of the underlying problems that hospitals face in becoming prepared. The most obvious of these is that hospitals are so riveted on bottom-line financial survival that they have few if any resources to spend on preparing for something that might happen.
Emergency preparedness is not a priority for most Americans (as it is, for example, in Israel), and it is a low priority for healthcare institutions struggling with nurse shortages, scarce capital and shrinking reimbursements.
I can tell you that in Ventura County, Calif., our local hospitals have made a concerted effort with meager resources to better prepare our region for terror response. This effort was made not because it was cost-effective or because we were intent on attending fancy seminars on a hot topic, but simply because we care about our neighbors. And believe me, when and if a terror event strikes our locale, it will be this spirit of dedication that will be the most valuable resource we have in responding effectively.
Administrative director and laboratory project manager
Los Robles Regional Medical Center
Thousand Oaks, Calif.
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