In an op-ed piece for your publication published last week, I referenced the "75% rule" as one of the challenges facing HealthSouth Corp. ("A tough job, but I love it," March 7, p. 27). In an effort to clarify the rule, Modern Healthcare added a phrase to the article that incorrectly explained the rule as a change in Medicare rates. The 75% rule is not about rates and does not affect them; rather it substantially reduces the number of conditions eligible for inpatient rehabilitative care.
The confusion over the 75% rule and its consequences are not atypical in the industry. Here are the facts: Under the new rule, an inpatient rehab facility must ensure that 75% of its patients are receiving treatment for one or more of 13 medically complex conditions. The new list of 13 conditions marks a significant change from prior Medicare policy and is making it difficult for some patients to receive the inpatient rehabilitative care their physicians have ordered. In particular, the 75% rule affects patients with severe arthritis, hip fractures, cancer, cardiac and pulmonary problems, and joint replacements.
The purpose of the op-ed was to discuss my experience at HealthSouth and the turnaround plans that we are putting in place. This includes a primary commitment to ensuring access to high-quality care for patients through all of our inpatient and outpatient facilities.
President and chief executive officer
A missed tort message
Although Neil McLaughlin's editorial on the Joint Commission's recent medical liability system white paper correctly identifies some of its key points, he misses the paper's fundamental message ("Holy tort! A reasoned JCAHO study," Feb. 28, p. 28). The current tort reform debate-a continuing series of battles and finger-pointing skirmishes among healthcare providers, trial lawyers and insurers-needs to be reframed to focus on the interests of patients and their safety.
As the policy paper illustrates, the existing system seriously undermines patient safety and will continue to do so, no matter how many bandages are applied, until it is changed. The medical liability system must be redesigned so that it encourages improvements in patient safety-or is at least a nullity in this regard-and provides for appropriate dialogue with and compensation for those who are injured in the care delivery process. If properly designed, that system will delineate very different and constructive roles for the current combatants. And patients will be the winners, as they should be.
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.
Don't gain-share the work
Far be it for a University of Chicago graduate to criticize the use of economic incentives, but there is something both wrongheaded and mildly pathetic about the use of gain-sharing to encourage physicians to cooperate in reining in device costs ("Device costs go under the knife," Feb. 21, p. 6). Device manufacturers have had their way with hospitals the past few years. But the remedy isn't, as the consultants suggest, to pay physicians "to take on the extra job of reducing costs."
Medical devices are not necessarily commodities, and hospitals shouldn't ride roughshod over their physicians to achieve economies. Rather, physicians should be encouraged to bring evidence (however robust or flimsy) of specific devices' superiority home with them from conferences in Vail, Colo., or Naples, Fla., so their colleagues and hospital management can evaluate them. A transparent, public and well-staffed evidence-based review of competing claims, supported by uninvolved physicians their colleagues trust, can give hospital management the basis for narrowing vendor choice, and enabling aggressive bargaining for the best price. Kaiser (which, contrary to popular sentiment, cannot simply order their physicians to do things) has used a similar approach with both devices and pharmaceuticals for years, and has saved a lot of money.
The consultant's comment about "paying physicians to take on the extra job of reducing costs" is wide of the mark. Hospital management shouldn't have to pay physicians to do its job. Gathering evidence, including others in the process and providing leadership are less expensive and more appropriate remedies for the supply-cost problem.