Letters: Hospital capacity 'relief valve' could have limitations

The article “Potential relief valve for acute-care hospitals: specialty facilities” represents an interesting consideration. Unfortunately, there are possible flaws in the assumptions.

The first, and certainly the largest assumption is that there would be an adequate number of nurses available to provide 24/7 care in these outpatient surgical centers or hospital-based surgery/recovery beds. Those departments typically are staffed at a fraction of what would be needed for 24/7 inpatient care. Another complication could be state or union-negotiated minimum RN staffing levels for patient care. All of these assumptions also ignore the reality that the current supply of caregivers will not remain constant because many could well become infected and ill themselves.

The second flawed assumption is that free-standing surgical centers would voluntarily cancel all surgeries and make themselves available for medical patients. A significant number of these centers are investor-owned, so that ownership model creates the first possible impediment to a change in a facility’s business plans. Another impediment is the reality that the physicians who operate at these facilities have mortgages, tuition, student loans and multiple other financial needs that, for an uncertain number, might preclude them from a willingness to virtually eliminate their income stream.

William Bodnar
President
The Leader’s Board

Regarding the recent “Breaking Bias” column “Experience with diversity provides tools to build an inclusive culture,” if you think about inclusion as not spending time, energy and effort breaking down bias but including bias, there is a much better chance of needed culture change to solve the problems happening now.

Women and minorities of leadership age are more likely socialized by our value system to address the physical, social and emotional needs of patients, whereas the currently dominant Euro-centric core culture of white males is socialized to system, process, structure, strategy, profit. Current problems are desperately being addressed with an economic hammer because that’s all the majority of healthcare leaders—white males—know, at the executive and board levels. We need both bias sets now. We need cultural integration now. At least 50% of your board and leadership should be made up of women, minorities and immigrants, now. We have a resource problem that women and minorities can solve. In fact, we do it all the time.

Egos have to be sidelined. Put the best players in with the beliefs, attitudes, practices and protocols of a culturally integrated team where all biases belly up to the table.

Linda Galindo
Half Moon Bay, Calif.

Regarding “ACA’s impact on health yet to be seen,” if you truly want to evaluate a policy, it should include the costs of that policy, in terms of total 10-year healthcare spending by the federal government (the Congressional Budget Office has this at $1.8 trillion in 2012) and state governments, and then look at the effects on the private sector, such as small-group insurance without subsidies and claims costs for self-funded plans.

On top of this, add the net federal cost for nonhealthcare programs that were used to fund the Affordable Care Act (that is, to reduce the supposed net cost to zero over 10 years, after including tax revenue), especially taking over student loans (originally forecast to earn billions in profits for the federal government, with the latest forecast showing 
$200 billion to $300 billion in losses).

I will not argue that randomly spending $200 billion to $300 billion annually on healthcare will not have beneficial effects. But is this “good policy” or could targeted initiatives have achieved the same documented improvements at a far lower total cost?

Jim Price
Roswell, Ga.