Your Nov. 8 cover story, "A bigger piece of the pie" (p. 6) is woefully misleading and misses a fundamental point. The reality, looking at the very data contained in the article, is that there was virtually no change in the percentage of investor-owned hospitals between 1997 and 2003, and that over a span of two decades the percentage increased by only about 3 percentage points.
So where is the story here? Although reporter Vince Galloro notes important challenges facing not-for-profit hospitals, he fails to ask how investor-owned hospitals are going to be able to satisfy their shareholders' demands for strong profits as the government tightens its purse strings and businesses shift more costs to employees.
The real story will be whether these for-profit hospital shareholders will be disinvesting as they seek greener pastures elsewhere. In fact, in a Nov. 14 article, "Changing market saps health of hospital stocks," the Tennessean reported that this is already beginning to occur.
Alliance for Advancing
Accrediting ambulatory quality
Although we applaud David Burda's editorial on quality-improvement programs and voluntary reporting in the hospital setting, we would have been even more pleased if he had included information about the rising importance of benchmarking and quality-improvement initiatives within the ambulatory setting ("Quality reporting is no game," Sept. 27, p. 36).
The Accreditation Association for Ambulatory Health Care established the AAAHC Institute for Quality Improvement in 1999 to provide ambulatory-care organizations with opportunities to participate in clinical performance measurement studies and educational programs. To date, the institute has conducted and published 19 clinical performance-measurement studies and convened an annual national forum on quality improvement in ambulatory care. Involvement in clinical performance measurement is a signal to patients, government agencies, professional liability insurers and third-party payers that an ambulatory health organization is concerned about continually improving the care it provides to patients.
Benchmarking studies have been conducted dealing with key ambulatory procedures such as colonoscopy, arthroscopy, cata-ract-lens extraction and liposuction. This year, the institute fielded its first nonclinical benchmarking study and is planning new studies on asthma and myringotomy.
Also new this year, the AAAHC Institute announced a new national award recognizing healthcare excellence and innovation. The Innovation in Quality Improvement Award recognizes quality-improvement initiatives that have positively affected the quality of care in the ambulatory environment.
Voluntarily undertaking and completing a quality-improvement study for the purpose of enhancing the quality of care delivered by an ambulatory-care organization is a challenging but rewarding initiative.
Accreditation Association for Ambulatory
Health Care's Institute for Quality Improvement
On safety, leadership needed
If we are serious about wanting to improve patient safety, we need to establish who is responsible for doing it. In the seven pages of your Nov. 1 cover story, "Patient safety proves elusive" (p. 6), the only reference I spotted to the responsibility question was in the report of the results of your reader poll (p. 25). In a 1-to-5 (least responsible to most responsible) ranking, hospitals-which led the list-barely edged out physicians by a score of 4.56 to 4.32.
This ambivalence goes far to explain why there has been so little progress since the Institute of Medicine report five years ago. The way you achieve something in this world is to make somebody responsible for getting it done and then holding that somebody accountable for results. It is all well and good to say that physicians are responsible, but how can they be held accountable?
The poll also ranked a list of developments having a potential effect on improvement. I found it significant that the list did not include "better management." When things aren't up to par in every other form of organized activity, we blame management. Somehow, we can't bring ourselves to do that in healthcare.
But until we do, progress is going to be somewhere between slow and nil.
Editor's note: The writer is a retired senior healthcare executive.
Another group practice model
Regarding your special report, "More docs say: Super-size it" (Oct. 4, p. 24): I certainly agree with the premise that small group and/or solo practices are becoming more difficult to sustain as expenses and workload increase and reimbursement decreases. It's also true that large multispecialty groups are better able to negotiate successfully with large payers.
However, I would suggest that another model exists that can empower small practices as well as purchasers of healthcare services (patients and employers). This clinical integration model maintains individual practice autonomy and preserves the entrepreneurial atmosphere of small group practices but also involves shared IT, including an electronic medical record, and joint contracting. Additionally, if members are so inclined, the administration of this model could perform central business office functions to increase purchasing power for its otherwise independent practice members.
This model is a viable option in any community of physicians, urban or rural. It empowers physicians and their patients. It provides health IT for its members. It brings accountability and value to the healthcare market. It provides sustainability for member practices. It also answers the call from the Bush administration to implement a national EMR.
Integrated Physician Network
What do you think?
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