Readers respond to Reporter's Notebook

Regarding your coverage of University General Hospital Systems’ new plan for a boutique hospital chain (“Betting big on doc ownership,” Dec. 11, p. 6): In my nearly 40 years of operations in hospitals, I have seen a number of announcements regarding the “model for healthcare.” Once we were told that the system would collapse into three or four capitated providers. HCA has developed, been sold, taken public and gone private. The total number of for-profit hospitals has not changed appreciably since the 1970s. So I take the announcement by another entrepreneur with a grain of salt. Kamran Nezami will probably make a lot of money, but will he change the face of healthcare?

I believe that the ultimate healthcare system must incorporate physicians and other providers into a coherent system of providing care. Integrating physicians into the decision processes is necessary to control the cost of healthcare, prevent unneeded capital expenditures and rationalize the delivery of care. Hospital administrators must learn to listen to the individuals who actually deliver the care. No patient enters an institution except through contact with a physician.

Perhaps the better model is the British system wherein the hospital and specialists are a single organization. Physicians practice outside the hospital and refer all cases that require a procedure or inpatient stay, or they practice solely in private institutions. Primary-care providers are given incentives to keep patients out of institutions.

An equivalent practice in the U.S. would be to not provide practitioners who are investors in for-profit institutions with privileges in the public facilities. This would prevent their triaging cases into the public systems based on ability to pay. Another thought would be to require specialty facilities to maintain a 24-hour emergency room and therefore subject to Emergency Medical Treatment and Active Labor Act regulations. Since the majority of admissions to hospitals come in through the emergency room, this might spread the burden more fairly, although these facilities are most likely being built in areas that have excellent demographics.

There is a lot more that could be said or debated about the issue of limited service providers, but I am not going to worry about the addition of one more investor-driven “model.”

Ralph Sorrell

Chief financial officer

Adena Health System

Chillicothe, Ohio

When Kamran Nezami says his physician-owned hospitals will “accept any patient who walks through the door,” is he referring to the front door or an emergency room door? If these hospitals don’t have an emergency room, this is a disingenuous statement. The only patients walking through the front door will be patients referred by the physician owners, and they probably won’t be indigent or uninsured.

Also, the physician-owners will no longer have to keep their privileges at hospitals with emergency rooms and care for the uninsured via call coverage. Emergency rooms are the glue that holds together the awful mess that is our delivery care system to nearly 50 million uninsured.

Although it is true these for-profit hospitals will pay taxes on their profits, will these taxes be transferred to other facilities that render charity care? Probably not, and the burgeoning burden of the uninsured and indigent will be transferred at great financial hardship to hospitals with ERs. This business model (if it does not include emergency room service) is a brilliant capitalistic work-around to a huge societal problem that gets worse every year.

John Mitchell

President and chief executive officer

Grays Harbor Community Hospital

Aberdeen, Wash.

I enjoyed your cover story about University General Hospital Systems. I have had no luck in finding contact information for this company. Could you help?

Joe Weinrich

Vice president

Sales

AVP Healthcare Hospitality

Shawnee, Kan.

Editor’s note: Here’s a company contact: Dena Pawlowski, executive assistant to CEO Kamran Nezami, 713-375-7000. Main address: 7501 Fannin St., Houston, TX 77054.

Editor’s note: We received many responses to an online Reporter’s Notebook column written by reporter Andis Robeznieks about the recent national conference of the Institute for Healthcare Improvement in Orlando, Fla. (“To really learn about medical errors, turn off the PowerPoint.”) The piece can be read on our Web site, Modern Healthcare Online, at modernhealthcare.com, as can prior columns by our staff.

Andis Robeznieks’ report really got to the meat of the problem and addressed several different issues, many still unresolved:

Delivery of medicine is a complicated business that demands a strong skill set, including plenty of emotional intelligence.

Errors happen because of systems, but they also happen when medical personnel consciously or semiconsciously bypass good practices; we need to get away from the glib expressions about the causes of error. There is a big difference between blame and responsibility. Emotionally intelligent people know the difference.

Medical systems that run lean risk overworking and overtaxing the people who provide those services.

Some people do not belong in healthcare. Just because one has chosen that field doesn’t mean it is the right choice.

Some of the offenders in medical errors may be retrainable. Many need to find a new way to make a living. We need to understand this phenomenon and deal more effectively with the suitability of people for the work they do.

Vignettes about mishaps and the reluctance of medical personnel to face them arouse our emotional juices. Too bad the best of the conference Andis Robeznieks attended was more like a sideshow than a keynote.

Richard Smith

Chief of pathology

Sturdy Memorial Hospital

Attleboro, Mass.

---

I want to thank Andis Robeznieks for the piece. I know too well the personal pain from medical errors, having lost my mother when they could not track her laboratory results electronically and the horror of a hospital-acquired infection that has left my 26-year-old nephew paralyzed.

Thanks for the sensitivity in the article to bring out what really matters—there are people behind these errors. It is not just a statistic to talk about improving.

Robin Raiford

Director of government initiatives Product Solutions Group Eclipsys Corp. Chairwoman HIMSS Patient Safety and Quality Steering Committee Coppell, Texas

---

My thanks to Andis Robeznieks for writing such a kind review of our session. I’m glad he was there. I passed on the piece to my excellent team at IHI. I never know if I am making an impact by sharing Justin’s story, or not. Disclosure is contentious but it is basically about doing the right thing. Some folks need to be reminded, and I guess that is part of my mission. You made my day!

  Dale Ann Micalizzi

Advocate for Pediatric Patient Safety and Transparency in Medicine Founder, Justin’s HOPE Decatur, Ga.

---

Thanks for the article on patient safety. I am a healthcare planner specializing in evidence-based design. I’ve always used my parents as examples of the need for improved patient safety when talking with clients and co-workers. During a stay in the hospital, my father fell going from his bed to the toilet—the most common area for patient falls—which caused a staph infection in an open wound and ultimately ended in the amputation of his lower leg.

My mother has incurred a medication error after open-heart surgery, which resulted in a five-day stay in the hospital. Also, during ankle-replacement surgery, the physician pushed too hard on her leg and caused a fracture that extended her healing time.

All in all, my family has directly been affected by a patient fall, nosocomial infection, medication error and medical error. At no time did anyone accept responsibility or apologize, nor did my parents place blame.

The topic of patient safety has hit even closer to home. On Dec. 6, 2006, I had ankle ligament reconstruction surgery. Two days later I returned to the doctor, had my dressing changed and was told—in a 45-second consultation—that all looked well. In the following days, the pain in my ankle became more intense. I contacted the physician and was told to keep it elevated and continue on the pain medication.

When I returned to the doctor a week later, the ankle was red and swollen. The doctor said that I had cellulitis. I said, “Oh, it’s infected.” His response? “No, cellulitis.” Now, I’m no doctor but even I know that cellulitis is an infection caused by bacteria. In my drug-induced euphoria, I didn’t argue. Now the doctor isn’t too concerned, except about his good name I’m sure. I, however, am coming up on two weeks off work which has implications for me.

In my line of work I encourage designers, architects and engineers to do what they can to increase safety and reduce errors through facility design. I believe that we all—patients, caregivers, families, executives, consultants—are responsible for asking questions, making informed decisions, taking responsibility for our actions and learning from our mistakes.

Julie Kern

Evidence-based design coordinator BSA LifeStructures Indianapolis

---

I was not able to attend the IHI conference this year, but I especially enjoyed Andis Robeznieks’ article.

While maybe only 40 people attended the session he did, “Disclosure: What’s Morally Right is Organizationally Right,” many more heard about it from him.

Matt Savage

Xenia, Ohio

I have something to add to James Mongan’s list of ways to improve the performance of our healthcare system (“The underachieving has to stop,” Dec. 18/25, p. 23). Chief executives such as Mongan could accept responsibility for what goes on in their own institutions. If the potential of information technology is not being captured sufficiently at Partners, if heart failure patients in his hospitals are not being properly instructed, if diabetics, asthmatics and heart-attack patients in the institution he heads are not receiving recommended treatment, as CEO he needs to be doing something about it.

As he says, healthcare providers cannot change the system by themselves, but individual institutions can clean up their own acts. It would be interesting to hear how he is doing that at Partners.

Richard Wittrup

Scituate, Mass.

How exactly is Seattle’s Virginia Mason Medical Center planning to protect the identification of patients in the future (“Guilty plea in patient ID theft,” Health IT Strategist, Dec. 19)? We hear the same spiel from administrators and spokesmen of the hospitals every time there is a breach of this type.

Hospital medical records are sitting ducks for crooks. I still do not understand why demographic data are stored on patients’ medical folder. The new mania about personal health records needs to address this problem. For example: It is silly to print a patient’s Social Security number, address and date of birth on the routing slip that goes to multiple people in the billing department, and these days even abroad to outsourced third-party billing companies in Pakistan and India. If a sick, tired patient as much as drops the copy of the bill with all his vital IDs on one paper, he is done for!

Here are some ideas for protecting this data:

The ID used for healthcare should be unique, using a combination of the most powerful encrypted radio frequency ID technology and biometrics.

No one except the patient and the people permitted by the patient should be allowed to view the medical files.

All administrative data should be separated from the medical file during data-sharing between doctor’s offices and hospitals. Hospitals must be forbidden from using Social Security numbers, mother’s maiden name, etc. for ID purposes.

An integrated biometric and RFID card with 512 megabytes of flash memory should be sufficient to store all personal data and medical data in one place.

For billing purposes the ID card should be all that is needed.

There should be a hefty fee for careless people who lose these ID cards. However if they lose it, the card should be rendered absolutely useless without the biometric pass.

Narayanachar Murali

Member

Gastroenterology Associates of Orangeburg

Digestive Endoscopy Center

Orangeburg, S.C

What do you think?

Write us with your comments. Via e-mail, it’s [email protected]; by fax, 312-280-3183.