Louisiana lawmakers question VA secretary's leadership

On behalf of Louisiana veterans, we express extreme dissatisfaction with Modern Healthcare's selection of Veterans Affairs Secretary Robert McDonald as one of the “healthcare winners” in 2014 as part of the Year in Review feature.

Your description says he “won $16 billion from Congress to improve care for veterans.” Beyond funding provided by Congress, veterans also deserve a competent, proactive leader who will reverse the VA's poor performance nationwide. Unfortunately, this VA secretary remains unresponsive to chronic medical-access problems facing Louisiana veterans.

McDonald has yet to acknowledge or reply to our congressional delegation's September 2014 letter asking him to improve the timeliness of payments for veterans' emergency medical services at hospitals and from ambulance services outside the VA, as directed by the Veterans Access, Choice and Accountability Act of 2014. The VA has admitted to years of inappropriate claim denials that harmed the credit ratings of veterans. While the secretary delivers lofty speeches about rebuilding trust, these unjust denials force thousands of veterans into a lengthy and avoidable appeals process. As a “healthcare winner,” the new secretary should care enough to respond to congressional concerns about clear harm to veterans and demonstrate personal leadership on these chronic problems.

U.S. Sen. David Vitter (R-La.)

Professor Uwe Reinhardt's recent commentary, “Hospital CEOs need different model for managing physicians”, would be funny if it were not so tragically mistaken.

His inference that out-of-control hospital costs are due to “itinerant,” independent, self-employed physicians is akin to arguing that the accounting profession is at fault for the size of our national debt. The well-documented waste in our healthcare system can be traced to many sources, but independent physicians are far down the list of culprits.

Let's start with the CEOs of the hospitals Reinhardt is advising. A Modern Healthcare compensation report in 2014 found that average compensation for 147 not-for-profit hospital CEOs grew 24.2% from 2011 to 2012, with average cash compensation coming in at a whopping $2.2 million . Further, a recent Health Affairs study found that hospital administrative costs in the U.S. have more than doubled in the past decade, to $667 per capita—more than double what the Netherlands and England spend. Keep in mind that there is no significant relationship between higher administrative costs and better care.

Perhaps the larger question is this: Does the tactic underlying Reinhardt's article—the acquisition of independent physicians by hospitals—really help control costs? Recent research is replete with studies telling a different story. A 2014 study by the University of California at Berkeley found physician-owned organizations had mean expenditures 26% lower per patient than hospital-owned organizations and 36% lower than those owned by multihospital systems. And the National Institute for Health Care Reform last year found that hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the identical services provided in a physician's office.

Why do public policies and hospital management tactics continue to discriminate against the independent practice of medicine when those tactics only serve to drive up the costs of healthcare? As healthcare professionals, don't we owe it to our communities to build a healthcare system the community can actually afford? There are many paths toward a more rational and affordable healthcare system in this country, but driving independent physicians out of business and bankrupting the public in the process are not among them.

Jan Vest