Heads firmly in the sand?" "Inertia in healthcare"? (Editorial, June 6, p. 20). Both profound understatements!
The history of complex organizations reveals that you have to shake things up a little before they change. Kind of like the way cars derailed the trains in America. Or the way vending machines cashed in on convenience consumption. And I won't even mention what computers have done. Apparently healthcare (and I'm not sure why we call it that because it is clearly sickcare) is destined to repeat organizational history. The medical world around us is boiling with new ideas and new approaches. The delivery system, however, remains cold to the touch of many new technical and consumer innovations.
I know, I know: Healthcare is different. Healthcare is not like any other business. Healthcare doesn't fit the traditional business model. Well, from a systems perspective, healthcare is just another service that people selectively want. Maybe we should just treat it like the service that it is instead of some special, immutable, inextricably fixed aggregation of disjointed parts. Let's forget about the way it is. Let's focus on the way it should be. That should shake things up. That should create some change.
Senior vice president and chief information officer
Altoona (Pa.) Regional Health System
Tenet Healthcare Corp. was inadvertently left out of your annual systems survey ("Operating room," June 6, p. 26).
For the record, Tenet had 69 continuing acute-care hospitals as of Dec. 31, 2004, vs. 67 at Dec. 31, 2003, net patient revenue of $9.55 billion vs. $9.7 billion, and 17,902 licensed acute beds vs. 17,771. In the survey, that would make Tenet the third-largest system overall (ranked by net patient revenue) and the second-largest for-profit system.
Senior vice president
Tenet Healthcare Corp.
Editor's note: Tenet did not return the survey questionnaire in time for its data to be included in the story and charts.
You don't know defensive
Andis Robeznieks hasn't a clue about the staggering costs of "defensive" medicine ("Wary physicians," June 6, p. 8), that include not only CYA, but more importantly, the relatives who demand "everything be done for Mom" (Medicare) and the multitude of Medicaid patients who know it's their "right" to see multiple physicians and get studies and all the newest medications advertised on television from each of them. Only rationing of drugs and services, about which no one will even speak, coupled with banning-absolutely-contingency fees, could possibly end this never-ending spiral.
Looking for measures
Pay-for-performance is all the buzz in Texas ("Performance anxiety," May 30, p. 6). I'm trying to find the 26 measures for outpatient care that are referenced in the above article. Please point me in the right direction. Thanks.
Editor's note: You can find the measures through the American College of Physicians Web site at www.acponline.org/college/pressroom/starter_set.htm
CHP isn't so charitable
One of the health systems featured in your April 11 "Mission: Margin" cover story ("Blessings from above," p. 6), Catholic Healthcare Partners, recently posted its 2004 audited financial statements on its Web site (www.health-partners.org/
content/financial.asp). As it turns out, CHP is not the leader in charity care it was reported to be. Its spending on charity care was only about one-third the amount cited in the article.
The $146.4 million (4.52% of net revenue) offered up by CHP was not the value of its charity care but of its total "benefits
to the poor." Roughly half that amount ($72.9 million) was reported as "unpaid costs of public programs." Only $54 million (1.67% of net revenue) was allocated to charity care, placing CHP fifth-not first-on the list of charity-care leaders among Catholic health systems.
By contrast, the figures cited in your article for other Catholic systems appear to represent true charity care. That was the case for six major systems whose financial statements were readily available and included charity-care breakdowns: Christus Health, Catholic Health Initiatives, Ascension Health, SSM Health Care, Trinity Health and Catholic Healthcare West.
This revelation only confirms the growing conclusion among policymakers that not-for-profit hospitals need greater transparency, meaningful reporting requirements, and clear standards to qualify for tax exemptions.
Executive vice president
Service Employees International Union
Your April 11 cover story highlights the commitment of Catholic health systems to serve their communities, especially the poor and underserved. At the same time, it is difficult to make apples-to-apples comparisons among health systems regarding issues such as charity care and community benefit because all systems do not measure and track statistical information in the same way.
Catholic Healthcare Partners has consistently reported its total community benefit in two categories: care for the poor and benefits for the broader community, which is the format recommended by the Catholic Health Association and the VHA. CHP provided $146.4 million in care for the poor in 2004. This includes char-ity care for those who could not afford to pay for their care ($54.1 million), the cost of unreimbursed care provided to the poor who qualify for Medicaid ($72.9 million) and financial contributions to other programs for the poor ($19.4 million). Our care for the poor represents the real cost of providing care. We do not include bad debt or losses from the Medicare program in this measurement. We believe all of these components of our care for the poor help tell the whole story of how we remain accountable to our communities.
Indeed, CHP does more for its communities than care for their most vulnerable. In 2004, CHP provided $211.5 million in total community benefit services, representing 6.7% of our operating expenses. This includes care for the poor cited above and benefits for the larger community such as medical education, research and community services. Independent auditors review these allocations to confirm they are accurately categorized as care for the poor and benefits for the broader community.
We are accountable to our communities to meet our mission. CHP has posted its community benefit results on its Web page for five years in both its annual report and its audited financial results. In addition, we also have estimated what we would have been required to pay in taxes in comparison to the charity care and community benefit we provided based on 2003 data. We provided $176 in total community benefit for every $100 that we would have paid in taxes. We provided more in care for the poor alone than we would have paid in taxes.
We are proud of our record, personified by the millions of lives that are touched through the healing hands of the thousands of CHP caregivers who so generously share their talents to serve the health needs of their communities.
Sister Doris Gottemoeller
Senior vice president
Mission and values integration
Catholic Healthcare Partners
Praise be to quality
Your excellent special report ("Quality as gospel," May 2, p. 32) shows that healthcare is looking beyond its own quality methodologies to embrace a strategy advocated by others including the American Society for Quality-adopting and adapting successful cross-industry quality approaches.
We've seen it in other industry and service sectors: Whether you call it "gospel fervor" or plain old management commitment, dedication and know-how that sometimes seems to border on zealotry is what will drive quality improvement in healthcare.
American Society for Quality
Finding that special place
Regarding your cover story on HCA's tactics in competing with a specialty hospital ("All's fair in healthcare?" May 9, p. 6), I have been a registered nurse for the past 25 years. When I completed my degree in 1980, I was so excited that I was finally going to be able to care for patients and help them on their road to recovery. I wanted to be the kind of nurse who was caring and made the patients feel good in spite of what they were dealing with involving their health.
The stress of regulations, paperwork and hospital budgets soon took over as the reality and I was not able to be that nurse who I aspired to become shortly after graduation. Patient-to-nurse ratios of 8-to-1 or greater kept me busy performing paperwork instead of being at the bedside treating the patient. I was losing faith in my chosen profession.
After years of attempting to be that type of nurse, I decided to go back to school and obtain my master's degree in nursing administration in the hopes that as a leader I could make change happen in how nursing care was delivered. But I was one nurse administrator and making a difference in most hospitals was not easy.
I moved to San Antonio three years ago and my search for another job led me to the Spine Hospital of South Texas. During my interview I wore a hard hat as I toured the facility that was being created. The person interviewing me talked about physician ownership and quality of care and how we as nurses could deliver care that was better than the larger facilities.
At that time, I did not know much about specialty or physician-owned hospitals, but I could feel the excitement during the interview and knew I wanted to be part of this new hospital. Since the day I arrived at the hospital wearing the hard hat the vision that was presented to me that afternoon has become a reality. The staffing ratio is 4-to-1 with a maximum of 5-to-1 on rare occasions. Our patient satisfaction rates are at 98% or better. Every day at least one person who is either a new patient, family member, staff member and even a doctor stops by to tell me what a wonderful place this is and why can't more facilities be like this.
We have patients who do not want to leave because the care is so superior to what they can get at the larger hospitals. Our outcomes are better, infection rates lower, length of stay is shorter, and I could go on and on about the benefits. But the bottom line is that we give outstanding care. The patients are happy. The employees are happy. The physicians are happy. It is a great place to work and the rewards of happy people make my job that much better.
It should not be about insurance contracts or lawsuits or lack of service. There is room for all types of facilities-for-profit, not-for-profit, physician-owned, ambulatory surgery centers, etc. The list can be even longer. Healthcare should be the choice made between the patient and the physician, not by the insurance company. If it were your family member who needed care, where would you want to go?
Chief nursing officer
Spine Hospital of South Texas
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