I strongly agree with full disclosure to the public of physician competence, quality of care and results as advocated by Joan Claybrook, the president of Public Citizen ("System failure," July 25, p. 6).
However, reports of malpractice events and dollar amounts are not, in most cases, a measure of quality of care provided by physicians. They are usually the result of frivolous lawsuits. To say otherwise is like saying that the number of mosquito bites on an individual is a major indicator of a person being a carrier of the malarial parasite.
The boards of Public Citizen and the Public Citizen Foundation are almost exclusively from one political party, which represents the interests of trial lawyers. I would like to see the results of actions against plaintiff lawyers made public in the same way that actions by state medical boards against doctors are. Perhaps Public Citizen could start studying litigation excesses, or does that run counter to its charter?
Professor of clinical surgery and medical director
Noninvasive Vascular Laboratory
Ohio State University College of Medicine
A costly mindset
To blame the high cost of U.S. healthcare on prices is ludicrous ("Malpractice not the issue," July 18, p. 8). Prices limit what people can consume (demand) and determine what resources will be shifted from other endeavors to meet the demand (supply). Healthcare in the U.S. is expensive not because prices are high but because consumers are demanding more.
Consumers are demanding more because they have been very successful in shifting the responsibility of paying for healthcare from themselves to their employers, government and providers. Prices therefore do not restrict consumption and demand grows unfettered. As demand increases so do prices.
The mindset in America is that someone else should pay for healthcare. That mindset, not prices, is the reason healthcare is so expensive.
Executive vice president
A top 100 question ...
Why doesn't the 100 Top Hospitals study include critical-access hospitals and other small rural hospitals with fewer than 25 beds? (Supplement, July 25). There are about 30 of us in Ohio. How many more must there be in geographically large states with small populations such as Montana and Wyoming? Solucient should do another study of the top small hospitals and Modern Healthcare should publish the findings.
Director of quality services
Fostoria (Ohio) Community Hospital
... Solucient replies ...
Solucient would like very much to include critical-access hospitals in the 100 Top study. However, most of those hospitals have very small patient volumes, which negatively affect statistical reliability. To assure reliable statistical results, Solucient applies the following volume-based exclusion rules to the U.S. hospital population:
* Hospitals with fewer than 25 beds.
* Hospitals with fewer than 500 total admissions.
* Hospitals with fewer than 100 Medicare discharges.
Our methodology, including all exclusions, is published in the 100 Top Hospitals study abstract. Many organizations, including the CMS, have struggled with a way to measure the performance of very small hospitals. Unfortunately, no solution has yet been identified.
Senior vice president
Performance Improvement and 100 Top programs
Solucient Center for Healthcare Improvement
Ann Arbor, Mich.
... but what about that cover?
I find it fascinating that the portrait of the members of St. Francis Hospital and Medical Center's "C-suite" on the cover of your 100 Top Hospitals supplement doesn't include the chief nursing officer.
No wonder nursing is in so much trouble.
Phoenix Medical Management
Pompano Beach, Fla.