I read with interest the profile of Stanley Hupfeld ("Evangelism and antagonism," Nov. 1, p. 34). After spending much of my career in the full-service acute-care hospital industry, I have been chief executive of a specialty hospital for the past 12 months. I must say that it's a shame when executives would rather criticize the competition instead of trying to beat it. But then again why should Hupfeld approach his profession any differently than he did his college football career? As he says in your article, he quit the team because he didn't get the playing time he wanted.
The current attack on specialty hospitals reminds me of similar critiques of for-profit hospitals in the 1980s and '90s. What old-school executives like Hupfeld fail to understand is that only through continued innovation will our healthcare system remain the best in the world. Those leaders who embrace physicians as partners and truly give them a seat at the table will be the winners in our increasingly competitive industry. Those like Hupfeld will get "limited playing time."
President and chief executive officer
Austin (Texas) Surgical Hospital
... you don't get Hupfeld
Michael Romano's account of Stanley Hupfeld's career seems rather myopic and one-sided. Here is an executive who has been a major influence in shaping healthcare delivery in Oklahoma City for the past 17 years, but after reading this article one is left with the impression that he has only a single focus-opposition to specialty hospitals.
Having known Hupfeld for 20 years and been a member of his executive team for the past four years, I believe that the article fails to capture the many positive contributions he has made to our industry.
I also find it odd that out of the three people interviewed for this article, two are former employees who had short tenures with Integris Health. My opinion of an executive profile would have been more inclusive of not only former employees, but also current employees, physicians and board members. Long-term success in any industry, particularly healthcare, requires an open-minded, innovative team approach. It also requires making tough decisions that may not be popular to all parties involved. A personal observation in working with Hupfeld is that he strikes an excellent balance in all these areas.
C. Bruce Lawrence
President and chief operating officer
Integris Metro Facilities
I find it incredible that in commenting favorably on John Kerry's plan to cover the uninsured, Stephanie Thomas, the chief operating officer of Denver Health, would claim that her system had $240 million in uncompensated care last year and expects to provide $270 million this year ("Both ends of the spectrum," Oct. 25, p. 6). I assume she is basing those numbers on Denver Health's gross charges, which, as we all know, have no relationship to the fees that a hospital agrees to be paid in contracts with health insurers, Medicare and Medicaid.
An organization that would "lose" as much as $1 million per bed annually on uncompensated care is one that should go out of business. But I doubt that is the case.
New Canaan, Conn.
Denver Health responds
Although it's true that the $270 million figure for Denver Health's care for the uninsured is based on charges, it does not include any "losses" from contractual agreements under Medicaid and Medicare or other insurers.
Reporting of uncompensated care as a percentage of total charges is standard methodology. Some hospitals do include the difference between total charges and contractual agreements, but Denver Health does not. If it did, the total uncompensated care would be $443 million.
The uninsured represented 44% of our patient population in 2003.
Denver Health has become a model for the nation's safety net and has stayed in business because its integrated system allows multiple revenue streams, one administrative structure, salaried physicians, seamless care through sophisticated information technology, and maximum efficiency. Every dollar that comes into our organization from any source is allocated to the mission: serving those who need us.
Chief operating officer
I agree with Todd Sloane's editorial that the lack of political leadership on healthcare costs for employers is exactly what's missing ("The hidden debate topic," Oct. 4, p. 17). In Pennsylvania, where employers have faced double-digit increases for years, the cost of providing coverage is the No. 1 issue for the business community. This recently was confirmed in the 2004 Economic Survey of Pennsylvania Businesses commissioned by the Pennsylvania Chamber of Business and Industry.
Undoubtedly, the healthcare delivery system is terribly complex, and no single or simple solution will correct its current problems. But without political leadership to tackle the multitude of changes the healthcare system needs, it will be impossible to move forward.
I can tell you that as first vice chairman of the Pennsylvania chamber, the business community is ready to sit down with all the involved parties-providers, insurers, consumers and government-and start a dialogue and a process for healthcare reform. We did this in the early 1990s, but the spirit of cooperation, the willingness to listen to all sides and a sense of direction have gotten lost in the recent rhetoric.