As noted in recent articles about medical information technology ("One step at a time," July 5, p. 20, and "The process comes first," July 12, p. 28), reducing medical errors and improving patient safety are key drivers behind the push for improved healthcare IT.
It's vitally important that information systems be able to communicate. Our institution's experience as a midsize community hospital has focused on integrating robotics and a sophisticated laboratory information system with IT elements in other departments. Our hospitalwide approach emphasizes unique patient identifiers, bar-code labeling by phlebotomists at the patient bedside, automated laboratory testing and other technological approaches. We've also reduced testing turnaround so that critical test results are reported as quickly as possible back to clinicians.
Equally important, however, is that clinicians and laboratory staff also do a better job of talking to one another. Our laboratory and physicians engage in regular communications to better address our mutual interest in maximizing the value of lab testing, thereby furthering patient-safety efforts. I strongly recommend this latter approach, as well as better clinical information technology itself.
Administrative director/clinical chemist
John T. Mather Memorial Hospital
Port Jefferson, N.Y.
Dangerous assumptions in N.J.
The New Jersey Hospital Association and its members may want to delay their celebration of the new tax on ambulatory-care centers and cosmetic surgery procedures that they successfully lobbied for and which the governor signed into law late last month. ("Increased friction," July 5, p. 6).
This apparent victory may have some unintended consequences, not the least of which is a pilgrimage out of the state for ambulatory surgery, including cosmetic surgery. Many New Jersey physicians are licensed in Connecticut, New York and Pennsylvania. It is neither a hardship for them nor for their patients to travel a short distance across state lines to perform procedures just as safely but often less expensively.
Second, given that state audits will undoubtedly be necessary to verify that these two new taxes are being paid as they should, there are clearly privacy concerns that will unfold. These concerns-both on the part of physicians and patients-will be another catalyst for out-of-state procedures.
In addition, New Jersey legislators made a dangerous assumption about "buyers" of plastic surgery. They assume this new tax will affect only the affluent. A decade ago, that may have been the case, but today plastic surgery, particularly less-invasive procedures, is a middle-class phenomenon. In other words, this tax will not have an adverse impact on socialites but on a much more diverse and less wealthy group.
A final point: Hospitals and physicians have their fair share of regulatory hurdles to clear-together and separately. More than ever, we need to present a united front and work together to preserve access to high-quality affordable healthcare. Divisiveness can only work against all of us. Given that, it is disheartening that a state hospital association would initiate this type of economic warfare in the legislative arena.
So, in the final analysis, who should celebrate the passage of these two taxes? The answer is no one, not physicians, not hospitals and certainly not the people of New Jersey.
American Society of Plastic Surgeons
Arlington Heights, Ill.
No CON, no caring
Regarding your article "Surveying the competition" (July 26, p. 12) about a report by the Federal Trade Commission and the Department of Justice antitrust division recommending abolishing certificate-of-need laws: A federal judge once explained to me that the essential mission and responsibility of the FTC-and by association the antitrust division of the Justice Department-is to protect competition. A corollary of that is that the agencies' missions have nothing to do with consumer or provider rights or needs.
Taken in that context, a report that challenges CON laws is not particularly surprising.
Michael O'Grady Jr.
Vero Beach, Fla.
Too much negativity
As the chief executive of a small medical complex consisting of a 25-bed rural hospital and a 68-bed nursing home, I am sick and tired of reading in your magazine about how terrible the not-for-profit hospital industry is ("Mission unaccomplished," July 5, p. 17). In fact, I am pretty fed up with what I see as your publication being the supermarket tabloid of the hospital industry.
Our primary mission is to be able to provide medical care to the residents of our county who cannot afford to pay us anything for it. The rest have to pay so we can maintain that mission.
My public hospital spends 33 cents of every dollar of expense on uncompensated care. That is five times the national average. Our emergency room collects less than 3 cents of each dollar of charges for emergency room care from self-pay patients.
We do not hound people for payment if they are the working poor and have no assets but do pursue those who do and should be paying. Bad debt from poor people who don't qualify for charity or government programs is still free care.
The hospital industry provides millions of dollars worth of free care every year. State and federal governments use hospitals as their personal providers of healthcare through government-sponsored programs, pay less than costs and pass legislation that requires hospitals to lose money. No other industry is required to accept less than cost for its services.
If you really want to help the hospital industry, try finding positive things to write about the industry.
Chief executive officer
Baker County Medical Services
In defense of Fla. statute
Although I agree with some of the assertion's made by David Burda in his editorial on Florida's changes to its certificate-of-need law, I do not believe he based his conclusions on all the facts ("Raining on competition," July 12, p. 20).
Florida, indeed, passed comprehensive CON legislation, which had the net effect of relaxing CON for open-heart surgery and addition of beds, among other things. It also banned specialty hospitals, but our definition of specialty hospitals seems to be somewhat different than Burda's.
This problem is much more complex than he gives credit for in his editorial. The bill signed into law by Gov. Jeb Bush resulted from a great deal of thought and research.
Competition at all levels has rules of engagement. The government's role is not to involve itself in the competitive market but rather to support a framework by which there is reasonable entry to the market, the market is fair and patient outcomes are paramount. This was the driving principle behind our decision to support this element of our bill, and we stand by it.
To assert, as you did, that Florida does not have specialty hospitals is false. For example, H. Lee Moffitt Cancer Center and Research Institute in Tampa is one of the most respected cancer institutes in the world. Florida is also home to some elite children's hospitals and some of the most respected, high-volume heart programs in the country.
While Florida has been among the most aggressive states in terms of insuring children, it's unfortunately also saddled with the dual problem of having 2.8 million uninsured residents and a medical liability challenge depleting our supply of practicing specialists.
The essence of true competition is a level playing field. To have a facility focused on narrow surgeries in a particular specialty drawing primarily paying patients is not fair competition and would pose a serious threat to this safety net.
The CON law you referred to makes open-heart surgery programs subject to state licensure. Your editorial implies small community hospitals will be doing open-heart surgery. This is not the case, as the law clearly provides protections against low-volume programs. Again, because of Florida's unique demographics, we have some pockets of the state with high population growth. In those markets, we want the hospitals to be able to provide tertiary services such as open-heart surgery with a minimum of barriers and delay. Because most, if not all, of these hospitals have exclusive arrangements for the cardiac surgeons, the experience level of these doctors is very high. Our law also calls for standards consistent with the American College of Cardiology, and importantly, for the first time, there will be quality measures for open-heart programs that permit the state to require plans of correction and/or revocation of licensure for those that don't meet certain quality standards.
You ask why not ban other specialty hospitals that are focused on services such as burn units? This makes our point, exactly. Burn units are not profitable, and thus, the only hospitals we have offering them are a few primarily teaching hospitals. By way of example, you are arguing that it is acceptable for Tampa General Hospital, which is a trauma center that offers a full range of services, trains medical residents and serves a disproportionate share of the uninsured and Medicaid population, to face competition from a hospital that gives physician partners incentives to drain the most profitable services from Tampa General. I ask, who is left to pay the bill? And if the CMS changes reimbursement methodology for these high-margin services, what happens when a specialty hospital leaves a market? Of course the safety-net providers will be expected to fill the gap, even at a loss. We believe competition should be fair, with everyone playing by the same rules.
From a public financing perspective, if profitable services are taken away from our established safety-net hospitals, the state, likely through Medicaid, will have to subsidize them. Because Medicaid has doubled in size from $7.5 billion in 1998 to $15 billion this year, we simply do not have the resources to increase our subsidy to these hospitals.
Secretary Florida Agency for Health Care Administration
A must read
Regarding your editorial "The readers' place" (June 28, p. 38): I have been a hospital trustee for 19 years and have attended hospital board meetings as legal counsel for 30 years. I think of myself as a quick study, but the hospital industry is such a hodgepodge of roiling issues it is hard to garner any clear sense of the big picture outside your own institution.
The best thing we do for trustee education is give each trustee a subscription to Modern Healthcare. At almost every board meeting, some trustee will comment on a recent article-and how it may apply to us.
Lakeview Medical Center
Rice Lake, Wis.
I have been following closely your recent articles relating to the class-action lawsuits against not-for-profit hospitals ("Scruggs' hospital lawsuit grows," July 12, p. 14). I find these articles and your Web site, modernhealthcare.com, very useful, but I would like to suggest that you list the names of the providers that have been sued. As more hospitals are named, the list could be updated.
Banc of America Capital Management
Editor's note: The list of defendants is available at modernhealthcare.com, under the "Legal" link from the home page. For past articles on this or any other subject, use the search function on the home page.
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