‘45’ rule not the only rationing, reader contends

I read with interest your cover story on the “45% rule” (“Sensitive trigger,” April 30,

p. 6). Indeed, there is a rationing of healthcare across the board without the word being used. Because of the CMS’ 13 ruling (often referred to as the “75% rule”), hospital administrators across the country are being forced to deny patients who do

not fit into 13 specific categories.

This affects more than just Medicare. The effect is also felt in Medicaid, commercial coverage and workers’ compensation. In the past year, there have been well over 88,000 patients denied access to rehabilitation hospitals across the country, and the public is just not aware of this silent epidemic in the political arena. Physicians have referred patients out of medical necessity but hospitals are forced to deny admission in order to maintain the 60% (and climbing) ratio of patients meeting the 13 criteria, which determines whether a rehabilitation hospital will receive reimbursement. There is legislation pending in the House and Senate to freeze the rationing at 60%. Many of the legislators have signed support for this bill but we need more visibility and support to ensure its passage this summer.

Pam Stanberry

Chief executive officer

Wesley Rehabilitation Hospital

Wichita, Kan.

I’ve filed Chalmers Nunn’s lament—that few are seriously interested in improving quality—with the rest of such assertions by academics (“A map quest for quality,” May 7, p. 20). Evidently there’s good grant money in asserting that American healthcare is a disgrace. Don’t believe it.

Physicians and hospital executives are acutely aware of the plaintiff’s bar being ready to hold their feet to the fire on quality. And the U.S. produces its fair share of innovative science. There simply is no groundswell of dissatisfaction with the “standard of care” approach. Rich Americans don’t go elsewhere for care, and the rich of other nations come here. The one-at-a-time, face-to-face paradigm for healthcare has not been replaced anywhere and isn’t something we should be ashamed of.

Jeffrey Denning

Practice Performance Group

La Jolla, Calif.

I’d like to commend authors Paul Barringer and Edward Dauer (“End the blame and shame game,” May 21, p. 36) and reporter Jennifer Lubell (“Bill could create health courts,” May 28, p. 8) for addressing the need for alternatives to today’s medical justice system. The current system for malpractice lawsuits leaves doctors and patients unsatisfied. With health courts, disputing parties are greeted with rational, expert decisionmaking and efficient, cost-effective procedures. These fundamental components promote consistency and expedite compensation to injured patients.

However, the fact is that these components are already in place through healthcare arbitration. Arbitration is a fully functioning “health court” that is endorsed by Congress through the Federal Arbitration Act and supported by state and federal courts throughout the U.S. Arbitration is a viable means to avoid lengthy, expensive, and cumbersome med-mal lawsuits and compensate injured patients and promote safety. In fact there is a strong movement toward legislatively mandated arbitration and a growing trend of parties privately contracting for arbitration through payer-provider contracts and patient-provider admission documents.

Health courts are a good alternative. What’s better is that they exist already in the form of arbitration. Parties need only contract for them.

Keith Maurer

Director of healthcare and insurance

ADR Services

National Arbitration Forum

Minneapolis

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