I would like to take this opportunity to thank you for having the courage to place one of the most powerful images in spirituality on the front cover of your April 11 issue. With all due respect to political correctness, it has made us fearful of expressing the fact that many of us regard our careers in healthcare to be a calling more than simply a career choice. In my view all hospitals are built on "holy ground" with spaces for healing and shelter within their communities. Your coverage of the role of spirituality in acute hospital care would be greatly appreciated.
President and chief executive officer
Shore Memorial Health System
Somers Point, N.J.
The nurse CFO
Regarding your article on nurses as chief financial officers, I had been CFO of several hospitals before I became a registered nurse in order to better understand healthcare from a clinical perspective ("Another nursing shortage," April 11, p. 36).
I am now the CFO of a large combined hospitalist and emergency physician group in California. It has definitely been an asset having both backgrounds when dealing with today's healthcare environment. I supervise a peer-review group, provider credentialing, claims and coding, and accounting. I also help with the appeal process for denied insurance claims. Most of these duties would be impossible to perform or understand if I did not have a background in both finance and nursing.
Congratulations on your article and for recognizing that nursing can help steer the financial side of healthcare.
Chief financial officer
Primary Critical Care
North Hollywood, Calif.
I'm a little behind in my reading, but thank you for your March 28 cover story, "Priceless" (p. 6). What is priceless is Rep. Dan Lipinski's (D-Ill.) lack of understanding about pricing in any business.
As I was reading, I expected to see another reference to a $50 aspirin. Instead, the example was a $5 single-use packet of antibiotic ointment. Yes, Lipinski could have purchased the same on his own, getting 32 times as much product for $6. The hospital, however, cannot normally use an ointment packet more than once (unless you mark it, track it and keep it sterile-quite a cumbersome process for any size hospital), and definitely not on a different patient. The hospital had to purchase it in a small amount, and most people understand a large cost of any product is the packaging.
On top of that, the overhead cost of the product is considerably higher in a hospital than it is in a pharmacy or retail outlet. Labor and capital costs are higher in a hospital. If you go to a restaurant and order eggs, toast and bacon, I would bet that you are going to pay close to three times (or more) what the same ingredients would cost in the grocery store. Restaurants pay less than minimum wage to their wait staff, and the cost to build a restaurant is considerably less than that of a hospital, yet you expect to pay more in a restaurant than if you cook yourself.
I wish all hospitals would publish their chargemasters on the Internet. I would love to have some price comparisons available without having to use 1- or 2-year-old data and not have to worry about antitrust issues. It would be good for the consumer and good for hospitals. Restaurants publish their menus; let's publish ours.
Vice president and chief financial officer
Marshall (Texas) Regional
Behind Part B's cost rise
Regarding Todd Sloane's editorial on Medicare physician reimbursement, one of the primary drivers of the 15% increase in Medicare Part B spending is the inappropriate utilization of medical imaging procedures by a growing number of nonradiologists ("A reimbursement conundrum," April 11, p. 30).
The Medicare Payment Advisory Commission recently showed that medical imaging is growing twice as fast as other physician services. Further, imaging utilization among nonradiologists is up to more than twice that of radiologists, as physicians increasingly invest in new technologies and perform tests in their own practices, often without the required skills and expertise.
Placing the financial desires of physicians engaged in inappropriate utilization of medical imaging ahead of patient care may restrict access to care for those who need it most and may ultimately drive reimbursement down to the point that physicians are no longer able to practice the profession that we love.
Board of Chancellors
American College of Radiology Reston, Va.
I was very interested in Susan Tolle's commentary on the Terri Schiavo case and what providers can do to prevent a repeat of that situation ("A study in what not to do," April 4, p. 22). I would like to know where I can get a copy of Physician Orders for Life-Sustaining Treatment, which she referenced in her piece.
St. Luke's Cornwall Hospital
Editor's note: The document can be obtained at ohsu.edu/ethics/polst.
What do you think?
Write us with your comments. Via e-mail, it's [email protected]; on the Web, use modernhealthcare.com; by fax, 312-280-3183; or through the mail, Modern Healthcare, Letters to the Editor, 360 N. Michigan Ave., Chicago, Ill. 60601. To publish letters, we need your name, title, affiliation, location and phone number.