Todd Sloane's editorial and the commentary by John Bagnato in your May 9 issue left the reader with the impression that the majority of this country's community not-for-profit hospitals have significant profit margins, large cash reserves, and provide little charity care or discounted rates to those who have no insurance, while for-profit hospitals are leading the way in providing care to the uninsured ("Beyond Scruggs," p. 22; "Unaccountable on the uninsured," p. 24).
It is somewhat understandable that people naive about the healthcare industry, Medicare and Medicaid payment shortfalls, rising levels of indigent and uninsured patients, and the constant struggle of community hospitals to maintain quality of care and access to care for their communities might espouse such a view. I am amazed, however, that a Modern Healthcare editor would voice support of this view, that you did not publish any corresponding article or editorial in the same issue providing some of the real information and that there weren't any responses to these articles in the next issue of Modern Healthcare.
As the chief financial officer of a not-for-profit community hospital, I would encourage you to present a more comprehensive picture of the situation rather than mislead readers to think that only a "handful of not-for-profits have also instituted better policies on treating the uninsured." The truth is that all of the not-for-profits that I have been associated with, and most that I have been acquainted with through organizations such as the Healthcare Financial Management Association and the American College of Healthcare Executives, have always had what amount to charity policies that provide significant assistance to any uninsured patient, while at the same time caring for all Medicare, Medicaid and indigent patients, even as they pay less than cost. In our own case 70% of our patients are Medicare, Medicaid, indigent, underinsured or uninsured, or pay less than 75% of the cost of their care.
Cost-shifting of government and indigent shortfalls should by now be no surprise to anyone who actually understands government payment mechanisms. If anyone has an answer for hospitals that have high levels of patients who pay less than cost, I would like to hear what they have to say.
There may, in fact, be hospitals (both for-profit and not-for-profit) that spend little on charity care, have excessive compensation packages for physicians and administration, have boards that "double deal" and otherwise do not fulfill their community obligations, but the vast majority of not-for-profit community hospitals should not be painted with that brush.
Walter Winkler
Chief financial officer
Keokuk (Iowa) Health Systems
Preserving Medicaid
I enjoyed reading Todd Sloane's editorial on the need to protect Medicaid ("Medicaid at a crossroads," May 16, p. 23). It is easy to identify big cuts in a program that spends lots of money. The problem is that it affects patients and providers.
In most cases patients do not elect to be poor or fit in a Medicaid-eligible category. Providers who take care of Medicaid patients are not doing it to get rich. Any cuts in reimbursement would cause providers to consider limiting or eliminating care for these patients.
We can't let this happen.
Rick Gilstrap
President and chief executive officer
Halifax Regional Medical Center
Roanoke Rapids, N.C.
No surrender
I found Mark Taylor's special report on the various movements toward quality processes in healthcare to be intelligent and well-written, but one statement greatly vexed me ("Quality as gospel," May 2, p. 32).
He writes, "Just as animism and paganism surrendered to Judaism, Christianity and Islam, new processes emerged from the earlier doctrines of TQM, CQI and quality circles." Pray educate me. Since when is one faith an improvement or more advanced than another? As a practicing pagan, let me inform you that animism and paganism did not "surrender" at all; they were, for the most part, purposely wiped out. American Indians (many of whom today are practicing animists) were forced to abandon their way of life; they did not "surrender" it.
Though I gladly sing "hallelujah" when quality systems are "preached" as company doctrine to improve patient care, I find equating religious faiths of any ilk with them is misleading and just dead wrong.
Phred Jenkins
Administrative secretary
Quality and risk management
Mercy Medical Center
Springfield, Mass.
The fourth vendor
We at Medline Industries beg to differ with the headline-"And then there were three"-on your recent cover story about consolidation and product bundling in the medical-device supply industry, because of course, Medline makes four (May 16, p. 6). As a manufacturer we sold direct for decades, but over the last seven years, Medline has become the fastest growing distributor of medical and surgical supplies in the country.
Andy Mills
President
Medline Industries
Mundelein, Ill.
Daily Dose fan
I want to say thank you for your organization's great work on the Daily Dose e-mail newsletter. It's a clear, simple way to get a digest of events.
Kevin Barron
Director
Managed healthcare
West Tennessee Healthcare
Jackson
What do you think?
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