Your article about schools picked for a pilot project in graduate healthcare education refers to critics who claim that the National Center for Healthcare Leadership's "principal goal is to protect the status quo by supporting big master's of health administration programs that already enjoy the lion's share of resources" ("Final four," May 24, p. 12). These critics are wrong. They are apparently unaware of the facts and the commitment of the NCHL board.
The NCHL was created in response to conclusions of a national symposium of healthcare leaders, which called for a transformation of health management education and practice. The bases of the conclusions are derived from the Institute of Medicine's studies, concerns of purchasers of healthcare and the pulse of the marketplace. The NCHL has a public commitment to promoting change to improve the performance of the nation's healthcare system. This is clearly not enhancing the status quo.
As a member of the NCHL board, I do not represent a particular university program or group of programs. Rather, my interests are to improve the education of undergraduate and graduate students in health administration and the practice of health administration throughout the nation with no bias toward any type of educational program or provider organization. Other members of the board share this commitment. To assume or allege any other orientation is both misleading and an unfortunate challenge to the integrity of myself and others associated with the NCHL.
Ohio State University
Critical help denied
The critical-access hospital program is helping many rural communities preserve much-needed primary acute-care services ("Critically acclaimed," May 24, p. 22). Unfortunately, as with "sole community provider," "regional referral center," "Medicare geographic reclassification" and other programs, the critical-access program does not help many hospitals that are in just as much need.
The development of all of these special programs, with arbitrary rules on bed size, geographic location, etc., is a testament to the fact that the general Medicare payment formulas are broken. Each time one of these programs is implemented and helps some hospitals, other hospitals and their communities are disadvantaged even more.
If this sounds like sour grapes, it is. Our facility, Keokuk (Iowa) Area Hospital, is surrounded by two sole-community providers 35 miles and 55 miles to the south, one critical-access hospital 14 miles to the east, a regional referral center 39 miles to the north and a reclassified hospital that receives higher reimbursement 20 miles to the north. Even though Keokuk at least qualifies as a Medicare-dependent hospital and disproportionate-share hospital, these programs make up only half of the difference between what it costs to care for Medicare patients and what Medicare pays.
At the same time, Keokuk competes in the same marketplace for staff as all of the surrounding hospitals that each now receive more Medicare funds.
Why doesn't Keokuk decide to become a critical-access hospital? The answer is, it cares for more than 25 patients per day, which precludes our community from benefiting from this program.
The bottom line is that Medicare payment formulas continue to inequitably distribute funds to the detriment of communities unfortunate enough not to be eligible for one of the programs designed to make up for this problem. These inequities, which have been in place for 21 years, have now grown to where those at the low end of Medicare payments are being very severely penalized and healthcare in their communities is in jeopardy.
The overall Medicare payment formulas are in need of overhaul, and as it will probably take a long time to alter these, one more special payment program should be developed to assist facilities on the bottom rung of payment that are not critical-access hospitals, sole-community providers, regional referral centers, etc. Although they don't meet the arbitrary criteria for these programs, these hospitals are just as critical to their communities as those that do meet the criteria.
Chief financial officer
Keokuk (Iowa) Health Systems
Tort reform savings
I am disappointed that Todd Sloane adopted the rhetoric of the Association of Trial Lawyers of America in his editorial ("Med malaise," May 24, p. 17).
The U.S. is not faced with an insurance crisis-it is faced with a healthcare cost crisis. Litigation and unlimited damages are a major driver in the spiraling cost of healthcare in this country. HHS, based upon Mark McClellan's research of the experience with California's 1975 tort reform law, has determined that national healthcare spending would fall by as much as 9% per year and the federal government alone could save as much as $50 billion per year if California's reforms applied nationally. That is more than enough money to pay for the Medicare drug benefit and cover a substantial portion of the uninsured without raising taxes or taking resources away from homeland security, not to mention the jobs that would be produced in the private sector with the savings on private health insurance costs.
Sloane's reliance on one GAO report-in some respects taken out of context-to support his case ignores the more comprehensive analysis and report of HHS, which concludes that adopting the HR5/S11-a bill that establishes a $250,000 limit on punitive damages-would not only reduce healthcare costs by billions of dollars but would actually help improve quality.
Coalition for Affordable and
Baylor Health Care System
NDCHealth is perplexed and disappointed that it isn't included in your "By the Numbers" feature, "Top healthcare software application providers," (May 17, p. 34).
In 2003 NDCHealth enjoyed overall revenue of $429 million, with our network services and systems segment contributing more than half of that total figure, or $214 million. In reviewing several other listed companies' earnings releases, it is evident that their overall revenues, not solely software/system revenues, were cited as their 2003 revenue figures. Our network systems and services revenue alone exceeded that of eight of the listed companies.
Obviously, we regret that our company was excluded from being recognized for its market acceptance and presence. More importantly, we feel your readers may have inadvertently been given misleading information.
Director of public and media relations
Regarding your cover story on technology at the bedside ("Too much too soon?" April 26, p. 6): In the Atlanta market, it seems like many hospitals are trying to address the Leapfrog Group's goal to have computerized physician order entry installed before addressing medical errors at the bedside. Atlanta was one of the original Leapfrog target cities used to access where the industry is with regard to protecting patients from avoidable harm.
I don't think anyone from my company would argue that computerized physician order entry isn't valuable or necessary. We also know it's expensive and has been met with significant physician resistance. The issue that consultants like myself face daily is how to persuade hospital leaders that the place where there is the most potential liability for everyone is when the nurse presses "start" on a critical medication infusion. The registered nurse is the only judge as to whether the programming is right or wrong. Sure, computerized physician order entry ensures the nurse is receiving the correct dose information, but if the nurse inadvertently makes a wrong keystroke, resulting in the fatal delivery of the correct drug, computerized physician order entry with all its cost and technical advantages did nothing to avert the horrific outcome for that patient, his or her family and the nurse who made the mistake.
It's a chicken-or-the-egg question. Which comes first: protecting the patient from a potentially fatal dose programming mistake at the moment of drug administration or protecting the patient by making sure the drug order is for the right drug for the right patient at the right time? I'd be grateful to see someone address this question.
Senior system consultant
Alaris Medical Systems
Welcome to the ACPE ...
Donald Hutton's response to your April 26 special report on whether physicians make good hospital chief executives (p. 26) states that doctors ought to get an MBA or at least take some business courses ("Doc execs need new skills," May 10, p. 21).
Hutton should be happy to discover that the American College of Physician Executives, based in Tampa, Fla., has more than 15,000 members. This association is devoted to training and certifying physicians who are entering or considering medical administration.
Not only do their courses involve finance, management and other administrative issues, but more importantly, developing skills in bioethics, managing specific issues such as disruptive physicians and the ability to communicate with physicians as a colleague.
Although I realize that more and more physician executives are getting advanced management degrees, these programs are a fine adjunct.
... CEOs have different skills
I was one of the attendees at the American College of Physician Executives' Physician Leadership Academy and I would reaffirm Howard Horwitz's statement in your special report that the transition from physician to top executive requires "education, background and internal makeup" ("Ready. Or not," April 26, p. 26).
There has been a lot of recent literature debating the suitability of physicians as candidates for the chief executive officer position. From my perspective, there is no debate. The CEO position requires a unique skill set for success. It requires leadership, vision, collaboration and expertise in organizational management, not to mention a working knowledge of corporate structure, business planning, human resources, information technologies, materials management, etc. This is achieved through education and extensive experience.
Just like medical school completion does not make a competent doctor, so it is true of the advanced management degree and the making of a CEO. The medical degree in itself does not make a better CEO.
As a physician, I do bring a unique perspective to the table, but it is only an organizational asset if I qualify to be the CEO independent of my medical degree.
Vice president and chief medical officer
Edward Hospital & Heath Services
FYI, part I
Do you have a link or additional information about the Centers for Disease Control and Prevention study on emergency rooms and uninsured patients alluded to in the Late News section of your May 24 edition ("Some ERs see more uninsured," p. 4)? Any information you can send will be appreciated. Thank you.
Associate for health
Florida Catholic Conference
Editor's note: To view the report, go online to cdc.gov/nchs/data/series/sr_13/sr13_155.pdf.
FYI, part II
In your April 16 Daily Dose, you mention a 64-page report from the Society for Cardiovascular Angiography and Interventions providing recommendations on the use of drug-eluting stents. Where might I access the full report?
Editor's note: To view the report, go online to scai.org/pdf/des%20Task%20Report%20FULL%20Version%20FINAL.pdf.
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