Reader notes states are passionately opposed to reform, and more news . . .

Thank you for your recent article: “The states go marching in” on Feb. 15, (p. 6). It solidifies my concern not only as a citizen but also as a healthcare provider in regards to the current healthcare reform law. As you pointed out, there are a number of states in opposition to the recommendations being offered, so much so that they are in the process of taking legal action. As Rebecca Vesely stated, “Most of these state pre-emption bills were filed just after the new year.” This further concludes, in my opinion, how passionate we have come in opposition to the reform. The ideas contained in the reform law have not even been implemented, and the states feel the need to take immediate action. Ms. Vesely also has exposed the inconsistency with the legislative programs. How can the government guarantee funding federal program mandates for one state and not another? How can one not feel their constitutional rights are being impinged upon when one is required to purchase healthcare or at risk of being fined a percentage of their income? At the same time, I am extremely concerned about the reimbursement issues that will come into play in my own community hospital. I am also concerned about the domino effect that it will have on patient care as well as staffing and job security. I do appreciate the efforts being taken by different states to effectively reform programs at the state level. These programs inherently want to support the individuals and their care without additional and extraneous strains on the taxpayers and/or business. BadgerCare Plus Basic in Wisconsin is a basic health plan that most healthy people would enjoy for a premium of $130. Oregon and Utah both want to expand the exchange programs that would encompass the work force and insurance programs. Thank you for acknowledging their efforts. I am quite sure, given the proper support, most states would be able to clean up, enhance or do away with cluttered programs that are no longer effective. This, in turn, would not only lend a hand toward the financial burdens, but also support the autonomy of individuals and the states. Ms. Vesely pointed out that “news broke that Anthem Blue Cross of California, a WellPoint subsidiary, planned to raise rates on the individual market by up to 39%, setting off a firestorm in Washington and in Sacramento.” This should send a firestorm throughout the country. This shows once again the greed and willingness to push the limits by some individuals/organizations. No matter what rules, policies or recommendations come into play, someone will always want to manipulate the system or work around the rules. I don't think that anyone with compassion or a conscience denies the fact that we need healthcare reform in this country. Unfortunately, care and caretakers come with a price. If we as a country don't seriously consider every aspect of each level of reform, we are destined for failure. Even if every intention is good, the massive change being generated through this law is setting us up for chaos and financial ruin. I would like to thank your publication for exposing positive and negative elements of this reform that we as a country are facing.

Theresa Thetford

Nursing studentUniversity of Texas at El Paso

The union at Jackson Health System won't budge on being asked to add a $50 increase to their biweekly premium contribution (“Jackson unions say no to more pay cuts,” Daily Dose, April 22)? And as a result a birthing center will close and a bunch of this group's co-workers will lose their jobs? This is a classic example of the madness that unions are trying to force on hospitals, governments and other employers right now. At this time in America's history when double-digit millions of Americans are unemployed or severely underemployed and untold millions of Americans who are working and are not unionized have seen severe decreases in their income, the union cannot agree to pay $50 biweekly for a benefit millions of Americans would cry to have access to? I believe that union behaviors like this will lead to an end result of ever-increasing amounts of backlash against them. Good luck with that.

Sorel Dietzler

San Diego

If this were a basketball game, a well-performing team would forfeit several points because they were a good team (“Inpatient payments to decline 0.1% under proposed CMS rule,” ModernHealthcare.com, April 19). The CMS made the rules, hospitals followed the rules and they are now being penalized for following the rules. Only the government can change the rules of the game just because hospitals have become good at following the rules.

Patrick Garrett

Battle Creek, Mich.

This is “breaking news”? A whopping 0.1% cut while doctors have the uncertain ax hanging over their heads of a 21.2% cut?

Dave Fitzgerald

CEOProliance SurgeonsSeattle

Certainly this is a top subject in many conversations (“ACP plans to release evidence-based recommendations,” Modern Healthcare.com, April 25). Any abatement of unnecessary costs will improve the financial burden placed upon the system. We must also be aware of cause and effect with anticipation of negativity if the delivery of details and information is not appropriately vetted or reasonable in the context to the patient and practitioner. We do recognize that this may be too little, too late based on the recent passage of healthcare reform. As the regulations have not been totally contemplated, evaluated or understood, we can only hope that the regulators may adopt some sound medically focused cost-conservation measures as expressed from this article. Society is becoming aware that unintended consequences evolve from best efforts in solutions; healthcare reform is only one of these areas that awareness is developing in society. After the last announcement of overexuberance of mammograms, let's hope that information coming from this expert group is more appropriately delivered with common sense and collaboration with medical professionals. Solid metrics for cost avoidance, risk, transparency and occurrence need to be part of this effort to establish credibility and standing.

Tom Kaye

Louisville, Ky.

Instituting universal medical coverage is a key step in pulling the plug on runaway medical malpractice lawsuits, and the unnecessary expense of defensive medicine that ensues (“New doc payment system needed,” ModernHealthcare.com, April 6). One key driver in keeping the medical malpractice industry going is the lack of alternative sources of funds for continuing care in many cases. Even in the absence of any malpractice whatsoever, a person or family facing a future of continuing high medical costs for a chronic illness or injury (brain damage from birth anoxia, for example), which is beyond their means of payment and is not covered by insurance is not likely to just crawl off into a hole and let things fester. They will go after the most obvious source of funding via a malpractice lawsuit. If there are any peeps from the conscience about whether the doctor is truly at fault, they will be sedated by the thought that “malpractice insurance will pay.” In contrast, in Canada where medical costs from whatever cause are entirely covered, malpractice lawsuits are rare, as is defensive medicine and superfluous testing. It is illegal to sue for pain and suffering from malpractice, so the only grounds are actual costs from lost wages, etc., stemming from the incident. And the only cases that are worth bringing under these circumstances are so obvious that it isn't worth it for the doctors to fight them for such small amounts.

Gerald Zuckier

Hamden, Conn.

It is hard to believe that people would publish data based on three years ago (“Prevention groups opposed to recent AHRQ report,” Health IT Strategist, April 20). Do the people collecting and analyzing data really think that things have not changed since 2007?

Candy Tabb

Registered nurse and infectioncontrol coordinatorGrady General HospitalCairo, Ga.

I would like to see biographies on each of the regional directors (“New HHS regional directors named,” ModernHealthcare.com, April 7). I hope they have a wide range of experience and knowledge, such as understanding basic claims payment to correct coding, which includes Current Procedural Terminology, ICD-9 and soon to be ICD-10 revenue codes, as well as understanding physicians and health plans and not just running a hospital system. Part of our problem is we continue to pick people who do not have an all-around knowledge of the total healthcare delivery system in America.

Donna Baker-Miller

Healthcare consultantPhoenix

Publicly traded companies are required to adhere to generally accepted accounting principles, or GAAP, which are promulgated by the federal government and administered by the Securities and Exchange Commission and the Public Company Accounting Oversight Board. As a result of the loss of an employer's tax deduction for retiree prescription drug benefits, Accounting Standards Topic 740 requires publicly traded U.S. companies to adjust deferred tax assets and reduce net income to reflect the change for all future years in the period in which the healthcare reform was signed into law. Willfully not adhering to GAAP exposes companies to regulatory action and executives (not only CEOs but also chief financial officers, corporate controllers and finance staff who are oftentimes certified public accountants with their own professional obligations) to prosecution, fines and potentially jail time. It is unfortunate that Neil McLaughlin (“Condemned to repeat it,” Editorial, April 19, p. 22) characterized executives of public companies, who by and large dispatch their duties with utmost care, as having some ulterior motive with these accounting charges and even smiling while their companies recognize these charges. It is even more unfortunate that McLaughlin must extend his opinion to the compensation these executives earn for the roles and responsibilities they serve. Suggesting that they have any motivation beyond integrity and ethical leadership is unfortunate and is sensational and irresponsible journalism.

Breht Feigh

Executive vice president, chief financial officerAmerican Dental PartnersWakefield, Mass.

We appreciate the front-page attention given to behavioral health in your April 12 issue (“Behavioral change,” p. 6). Jessica Zigmond did an excellent job of capturing the issues related to implementation of the federal mental health parity law. Behavioral health is integral to overall health, and we welcome continuing coverage of the policy decisions in our arena that ultimately have an important impact on all of healthcare.

Mark Covall

President and CEONational Association of PsychiatricHealth SystemsWashington