As a retired executive-compensation consultant to hospitals and healthcare organizations, I was most interested in your cover story on proposals by the Panel on the Nonprofit Sector for improving accountability and transparency of not-for-profit hospitals ("A higher standard," June 27, p. 6).
Unquestionably, there have been and are executive compensation abuses, but it is also obvious to me that some of those advocating proposed reforms don't have the foggiest idea about the complexities of today's healthcare organizations. Managing these organizations requires the best and brightest at all levels and in order to attract such people compensation must be competitive with the for-profit sector.
When I began my 35-year consulting career, the common practice was that hospital managers received the same annual across-the-board increase as the rank and file. When I advocated that compensation at the management level be based on performance criteria, I was often told this was not possible as it was too difficult to establish such standards for hospitals. When I retired in 1995, performance-based executive pay was the norm, in both for-profit and not-for-profit healthcare organizations. This was a welcome development for the high-performing managers.
Reasonable oversight and standards are important, but don't hamper organizations' ability to attract, reward and retain the best and brightest.
Jerad D. Browdy Inc.
. . . but boards should decide
As a community hospital trustee and a governance professor and consultant, I agree with the suggestion by the Panel on the Nonprofit Sector that the full board should approve the chief executive officer's compensation. Because the full board is potentially liable for any unreasonable executive pay, compensation approval should not be delegated.
Armstrong County Memorial Hospital
Don't quote Wolfe
Paul Barr's article on successful efforts to minimize surgical site infections was an accurate review of the project, but his use of Public Citizen's Sidney Wolfe as a source was ill-advised and detracts from the credibility of the article ("Old lessons learned," June 27, p. 8).
Wolfe is the scourge of the medical profession and has earned the animosity of all healthcare professionals. The only groups that listen to him are reporters looking for an opposing viewpoint.
Director of pharmacy
Wenatchee Valley (Wash.) Medical Center
Building on Brailer's success
In his editorial "Lighting a fire under IT," Todd Sloane expresses impatience with David Brailer's approach (June 13, p. 20). The American College of Physicians believes Sloane's frustration is misplaced.
Brailer's appointment as the nation's first healthcare IT coordinator in May 2004 generated considerable excitement and support from those interested in modernizing America's healthcare system. In slightly more than a year, with limited resources, Brailer has accomplished a great deal, including authoring the Framework for Strategic Action in July 2004, building the Office of the National Coordinator for Health Information Technology, and establishing a process to collect, analyze and report on more than 500 responses to the request for information about how to move forward on the development and adoption of a nationwide health information exchange. Brailer also established an environment of open participation and collaboration among a diverse set of stakeholders with varying and often competing interests. The Certification Commission on Health Information Technology is just one example of his guidance and strategic insight.
Brailer has navigated and led the healthcare community through a very complex and necessarily deliberate process to achieve as much consensus as possible. The American College of Physicians believes that HHS Secretary Mike Leavitt's decision to establish the American Health Information Community is a sign of progress and success, not failure, in achieving the Framework for Strategic Action that was developed under Brailer's able leadership.
As much as Brailer is accomplishing, the simple fact is that a personal commitment from the level of HHS secretary can only help accelerate the process by commanding additional resources to support the effort. The college applauds Secretary Leavitt's initiative to build upon the work already done by Brailer and his staff and welcomes the opportunity to work with Leavitt and Brailer to attain the vision of a national electronic medical-record system expressed by President Bush in April 2004.
Executive vice president and chief executive officer
American College of Physicians
What do you think?
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