The July 21 letter written by Dave Rogers, M.D., regarding Cinda Becker's article, "Specialty cardiac hospitals treating less ill patients," suggested that the title is a self-evident presumption. I respectfully disagree, and found the article worthwhile. Many internists like myself might find it very logical to refer complex, ill cardiac patients to a specialty hospital if such hospitals accept these patients -- but who knows whether this happens without looking at the data?
Contrary to Dr. Rogers' assertion, it's not only "big hospitals . . . trying to protect their book of business" that are concerned by specialty facilities. Small and medium-sized general hospitals are the healthcare backbone of many communities; they accept all comers, providing hefty amounts of uncompensated care. These facilities are legitimately worried that specialty hospitals will woo the younger, less-complex, best-insured patients and turn away others.
The real problem is that differences in patient population, and therefore costs of treatment, are often inadequately reflected in reimbursement. It is important to investigate whether the severity of illness, or case-mix index, is substantially different. If the July 12 article's conclusions are valid, a variety of approaches could be used, for example, requiring specialty facilities to provide a minimum amount of care to uninsured or underinsured patients. In this regard, I found the article helpful.
Paul McKenney, M.D., private-practice internist, Warwick, R.I.