Regarding the cover headline in your Feb. 28 issue, "Talking trash," your editors could use a refresher in modern colloquialism.
According to the Urban Dictionary, a compendium of modern-day slang, "talking trash" means to talk nonsense, to utter complete fabrications, especially when one knows them to be untrue. American Hospital Association members gathered last week to reinforce to members of Congress the importance of preserving Medicaid to protect the poor and disabled and to look carefully at the negative impact that specialty hospitals have on preserving the community healthcare "safety net."
These issues aren't nonsense, and their impact on the communities we serve are not fabricated. They are very real issues, and they deserve a more thoughtful approach from Modern Healthcare.
American Hospital Association
President and chief executive officer
Egg Harbor Township, N.J.
I was surprised to see that the case studies on Pursuing Perfection that Modern Healthcare has been running were written by the executives of the institutions involved in the project. In the article on Feb. 14, James Anderson and Uma Kotagal write things that sound like propaganda from a company brochure ("Quality in an academic setting," p. 36).
The authors should have reported on why their quality initiative was made, exactly what its effects are and why it is different from other quality initiatives. The article should have been validated through interviews with patients, community physicians and industry experts. In short, what was needed was factual reporting on an important initiative of the Institute for Healthcare Improvement.
Clarifying the money
I appreciated Laura Benko's Feb. 14 story on the California Healthcare Coalition ("Putting a price on care," p. 25), but an important correction to her reporting needs to be made.
Benko reported that Blue Shield of California donated $200,000 to the coalition. In fact, the $200,000 to which she refers was awarded by the Blue Shield of California Foundation to the California Works Foundation, or CWF, for one purpose and one purpose only: to provide labor leaders and health and welfare trustees with the information and training they need to assure the highest quality healthcare for their plan beneficiaries.
Although the CWF provides coordination for the coalition, its work is funded through the financial and in-kind resources of coalition members themselves.
California Works Foundation
Todd Sloane's editorial on President Bush's interest in information technology leans to cynicism, and the rhetoric he uses is more revealing than the questions posed ("Cynicism or realism?" Feb. 7, p. 22).
Saying that Bush "cronies" are engaged in a "sleazy" effort and the president is so "fixated on this" aren't helpful to those of us more interested in making legitimate progress on healthcare IT.
I prefer to assign more positive motives to his healthcare IT reform. Realizing that national reform efforts have many nuances and take many sidesteps before real results are achieved, I prefer that we make an attempt and strive for the best solution we can attain.
We live in a political world, and reform is difficult, but the president is at least taking his best shot, and that's all I ask. As a career healthcare IT professional, doing nothing is not an acceptable option.
Technology Services Group
Carilion Health System
Tort reform no solution
Todd Sloane was right on point in his editorial on tort reform ("The wrong solution," Jan. 17, p. 24). The consumer stands to be the ultimate victim while the insurance companies stand to gain the most.
California is the perfect example illustrating the point that tort reform without insurance reform is a failed policy. It wasn't until California passed Proposition 113 regulating the insurance industry that it saw a significant reduction in malpractice insurance rates.
This is an emotional issue, and tort reformers want to ignore the research. The literature clearly suggests that tort reform won't solve either the crisis in access to care or rising healthcare costs.
For some empirical, nonpartisan information on this topic I would suggest reading the Congressional Budget Office report on tort reform, the Weiss Ratings reports on malpractice settlements and the Florida Center for Public Policy and Research's report on that state's malpractice insurance crisis.
Department of management and marketing
Our Lady of the Lake University
A caveat on gain-sharing
As a hospital materials manager I can see that gain-sharing could be an effective tool to help control supply costs on items like orthopedic implants and has the potential to keep price increases under control and improve costs overall ("Device costs go under the knife," Feb. 21, p. 6). One possible problem I see is that hospitals and clinics that have worked hard and managed to standardize on major components and implants might see an overall cost increase.
If, for example, physicians practicing at facilities that have standardized sole-source agreements for implants decide that gain-sharing should apply to them, these facilities could be forced into sharing savings that aren't really there. In many cases with Medicare reimbursement, even having the best pricing in place on implants still does not cover costs. Gain-sharing in these cases could drive hospital costs higher while physicians win revenue for participating.
Gain-sharing is a great tool for facilities that have not been able to get physicians to standardize, but it could present a problem for those who have. I believe that if sole-source group purchasing contracts are in place then gain-sharing should not be an option and would only be counterproductive.
West Park Hospital