Monday, 23 May 2005

Princess Health and From Nevada, More on Hospitals' List Prices. Princessiccia

Princess Health and From Nevada, More on Hospitals' List Prices. Princessiccia

The Las Vegas Review-Journal reported on the high cost of hospitalization in Nevada, where it asserted hospital charges are currently the highest in the US. For example, it compared charges for heart valve replacement at the Cleveland Clinic ($88,273) and the Mayo Clinic in Phoenix ($79,601), with charges at some Las Vegas hospitals: Valley Hospital Medical Center ($233,259), St. Rose Dominican-Siena ($199,179), Sunrise Hospital ($196,908), Desert Springs Hospital ($186,622), and University Medical Center ($156,953).
Bill Welch, head of the Nevada Hospital Association, blamed the high prices on "a high number of uninsured patients, a nursing shortage that drives up salaries, a mental health crisis that sees many people with emotional problems going to expensive emergency rooms for treatment, and a large percentage of patients who go to expensive emergency rooms for primary care."
However, these problems are common across the country.
University of Southern California Professor Glenn Melnick raised the issue of exaggerated list prices. "Raising list charges, which often bear little relationship to the actual cost of services... is a way hospitals also increase the amount they get from insurers, which often use the charges as a starting point in negotiating discounted contracts for their policy holders."
Once again we are hearing about how managed care organizations and insurers, who are often touted as tough agents for lowering health care costs, seem to think they are getting a great deal if they negotiate a fixed discount off wildly exaggerated list prices.
Nevada may be particularly at risk for high list prices because it is a state which attracts tourists. Melnick suggested that hospitals can make "millions" by charging sick or injured tourists full list prices.
Although Nevada hospitals appear not to be unduly profitable, Melnick also suggested that hospitals that are part of inter-state corporations may reduce their apparent profits by paying high prices for services provided by their corporate parent. "For example, if the corporate parent owns all the hospitals in a chain, it will often charge its hospitals high rent. It will do the same thing with the supplies that it buys for the entire chain.""The same goes for legal fees."
In summary, this article corroborates the previous post about California. Hospitals may charge very high list prices, because managed care organizations and insurance companies think they are getting bargains if they negotiate fixed percentage discounts off these prices, and because hospitals can get a away with charging tourists these full prices. Unfortunately, the uninsured are often charged the same high list prices, even if they are the least able to pay. The great variability in prices charged for the same service suggest that some hospitals are making unreasonable amounts of money for particular services even after the managed care organizations' or insurance companies' fixed percentage discount. Furthermore, hospitals can reduce the apparent profitability these prices generate by paying exaggerated rates to their parent health care system for services it provides them.
It's not a system that is likely to be give patients the best care for the most reasonable prices.
Let's see if anyone in managed care or government, who persistently seem to direct their cost-cutting efforts at primary care, will notice where much of their money really seems to be going.
Princess Health and  From Nevada, More on Hospitals' List Prices.Princessiccia

Princess Health and From Nevada, More on Hospitals' List Prices.Princessiccia

The Las Vegas Review-Journal reported on the high cost of hospitalization in Nevada, where it asserted hospital charges are currently the highest in the US. For example, it compared charges for heart valve replacement at the Cleveland Clinic ($88,273) and the Mayo Clinic in Phoenix ($79,601), with charges at some Las Vegas hospitals: Valley Hospital Medical Center ($233,259), St. Rose Dominican-Siena ($199,179), Sunrise Hospital ($196,908), Desert Springs Hospital ($186,622), and University Medical Center ($156,953).
Bill Welch, head of the Nevada Hospital Association, blamed the high prices on "a high number of uninsured patients, a nursing shortage that drives up salaries, a mental health crisis that sees many people with emotional problems going to expensive emergency rooms for treatment, and a large percentage of patients who go to expensive emergency rooms for primary care."
However, these problems are common across the country.
University of Southern California Professor Glenn Melnick raised the issue of exaggerated list prices. "Raising list charges, which often bear little relationship to the actual cost of services... is a way hospitals also increase the amount they get from insurers, which often use the charges as a starting point in negotiating discounted contracts for their policy holders."
Once again we are hearing about how managed care organizations and insurers, who are often touted as tough agents for lowering health care costs, seem to think they are getting a great deal if they negotiate a fixed discount off wildly exaggerated list prices.
Nevada may be particularly at risk for high list prices because it is a state which attracts tourists. Melnick suggested that hospitals can make "millions" by charging sick or injured tourists full list prices.
Although Nevada hospitals appear not to be unduly profitable, Melnick also suggested that hospitals that are part of inter-state corporations may reduce their apparent profits by paying high prices for services provided by their corporate parent. "For example, if the corporate parent owns all the hospitals in a chain, it will often charge its hospitals high rent. It will do the same thing with the supplies that it buys for the entire chain.""The same goes for legal fees."
In summary, this article corroborates the previous post about California. Hospitals may charge very high list prices, because managed care organizations and insurance companies think they are getting bargains if they negotiate fixed percentage discounts off these prices, and because hospitals can get a away with charging tourists these full prices. Unfortunately, the uninsured are often charged the same high list prices, even if they are the least able to pay. The great variability in prices charged for the same service suggest that some hospitals are making unreasonable amounts of money for particular services even after the managed care organizations' or insurance companies' fixed percentage discount. Furthermore, hospitals can reduce the apparent profitability these prices generate by paying exaggerated rates to their parent health care system for services it provides them.
It's not a system that is likely to be give patients the best care for the most reasonable prices.
Let's see if anyone in managed care or government, who persistently seem to direct their cost-cutting efforts at primary care, will notice where much of their money really seems to be going.
Princess Health and Conflicts of Interest and Jackson Memorial Hospital's Pharmacy Contract. Princessiccia

Princess Health and Conflicts of Interest and Jackson Memorial Hospital's Pharmacy Contract. Princessiccia

The latest in the hit-parade of hospital management shenanigans, highlighting issues of conflict of interest, is this story in the Miami Herald.
The newspaper's investigation has uncovered a story of dubious management at Jackson Memorial Hospital, a major University of Miami teaching hospital.
In summary, after hospital President Ira Clark had announced his retirement in 2002, in 2003, the hospital's Fiscal Affairs Committee, chaired by Andres Murai Jr, hired Alson L. Cook as Vice President of Logistics, at a salary of $160,000. Cook advocated giving Cardinal Health a five-year, no-bid contract to manage Jackson Memorial's pharmacy, and to control its drug purchasing, worth $85 million a year.
Murai, it turns out, also is President and CEO of Berna Products Corp, a subsidiary of Acambis plc, which sells a typhoid vaccine to Cardinal Health.
The contract between Jackson Memorial and Cardinal in retrospect also had a significant built-in conflict of interest. "One branch of Cardinal was telling Jackson how much to pay for drugs - purchased from another branch of Cardinal," according to the Herald.
Cardinal's staff at Jackson Memorial included project manager Kevin Reece and pharmacy director Marc Calhoun.
In early 2004, G. William Tomecko Jr., the hospital's Associate Pharmacy Director, noticed billing errors in Cardinal's records. He wrote Calhoun, "This will cause serious consternation at the CFO level. We were supposed to reduce costs by $4 million." Tomecko said Calhoun resisted his enquiries, and "took all the documents from me and requested that I not continue to determine the concerns." Calhoun has since left Cardinal.
Tomecko also found invoices from Reece from a strip club, liquor stores, and fishing boat campgrounds. Reece has since been charged with fraud.
Cook, who had gone fishing with Reece, and approved his bills, resigned and moved out of state.
An outside audit showed that the contract with Cardinal, which was supposed to save $4 million a year, actually cost the hospital $15.5 million. The audit identified $3.1 million in incorrect billing, and $5.9 million in patient under-billing.
A million here, a million there, and after a while these add up to serious costs for the health care system....
Princess Health and  Conflicts of Interest and Jackson Memorial Hospital's Pharmacy Contract.Princessiccia

Princess Health and Conflicts of Interest and Jackson Memorial Hospital's Pharmacy Contract.Princessiccia

The latest in the hit-parade of hospital management shenanigans, highlighting issues of conflict of interest, is this story in the Miami Herald.
The newspaper's investigation has uncovered a story of dubious management at Jackson Memorial Hospital, a major University of Miami teaching hospital.
In summary, after hospital President Ira Clark had announced his retirement in 2002, in 2003, the hospital's Fiscal Affairs Committee, chaired by Andres Murai Jr, hired Alson L. Cook as Vice President of Logistics, at a salary of $160,000. Cook advocated giving Cardinal Health a five-year, no-bid contract to manage Jackson Memorial's pharmacy, and to control its drug purchasing, worth $85 million a year.
Murai, it turns out, also is President and CEO of Berna Products Corp, a subsidiary of Acambis plc, which sells a typhoid vaccine to Cardinal Health.
The contract between Jackson Memorial and Cardinal in retrospect also had a significant built-in conflict of interest. "One branch of Cardinal was telling Jackson how much to pay for drugs - purchased from another branch of Cardinal," according to the Herald.
Cardinal's staff at Jackson Memorial included project manager Kevin Reece and pharmacy director Marc Calhoun.
In early 2004, G. William Tomecko Jr., the hospital's Associate Pharmacy Director, noticed billing errors in Cardinal's records. He wrote Calhoun, "This will cause serious consternation at the CFO level. We were supposed to reduce costs by $4 million." Tomecko said Calhoun resisted his enquiries, and "took all the documents from me and requested that I not continue to determine the concerns." Calhoun has since left Cardinal.
Tomecko also found invoices from Reece from a strip club, liquor stores, and fishing boat campgrounds. Reece has since been charged with fraud.
Cook, who had gone fishing with Reece, and approved his bills, resigned and moved out of state.
An outside audit showed that the contract with Cardinal, which was supposed to save $4 million a year, actually cost the hospital $15.5 million. The audit identified $3.1 million in incorrect billing, and $5.9 million in patient under-billing.
A million here, a million there, and after a while these add up to serious costs for the health care system....
Princess Health and Support for the "Endangered Primary Care MD". Princessiccia

Princess Health and Support for the "Endangered Primary Care MD". Princessiccia

An op-ed piece in the Boston Globe by Ellen Lutch Bender, the Director of Health Care Strategies for the law firm Brown Rudnick, entitled "The Endangered Primary Care MD," speaks to the adverse consequences of the dominance of health care by ever larger organizations.
Lutch Bender extolled the virtues of primary care doctors whose ideal is "providing care within a patient-physician relationship based on understanding, honesty, and trust." Furthermore, she suggested that the decline in primary care relates to "consolidation [which] has created a concentration of giant market participants whose dominance has decreased competition." As a result, primary care doctors "spend so much time on paperwork that their ability to care for patients is strained. They work at a frenetic pace from dawn to duskc, seing more patients, faster, to meet productivity benchmarks. They operate in a resource-constrained environment that has skyrocketed the cost of managing their practice and racheted down their incomes." Sound familiar?
She concluded that "this trend has serious ramifications, not only to cost and quality of care but also in the potential loss of the heart and soul of the medical profession."
It seems like more and more people are noticing the issues that Health Care Renewal has been bringing up.
...if only they had some solutions to these problems. Unfortunately, Lutch Bender's suggested approach was pretty opaque, "there is enormous opportunity for physicians to think differently and seek innovative alliances with other providers in a way that will spur competition for those courageous and committed enough to protect the relationship between physicians and their patients." Hopefully, she will come up with something more concrete in the future.
Princess Health and  Support for the "Endangered Primary Care MD".Princessiccia

Princess Health and Support for the "Endangered Primary Care MD".Princessiccia

An op-ed piece in the Boston Globe by Ellen Lutch Bender, the Director of Health Care Strategies for the law firm Brown Rudnick, entitled "The Endangered Primary Care MD," speaks to the adverse consequences of the dominance of health care by ever larger organizations.
Lutch Bender extolled the virtues of primary care doctors whose ideal is "providing care within a patient-physician relationship based on understanding, honesty, and trust." Furthermore, she suggested that the decline in primary care relates to "consolidation [which] has created a concentration of giant market participants whose dominance has decreased competition." As a result, primary care doctors "spend so much time on paperwork that their ability to care for patients is strained. They work at a frenetic pace from dawn to duskc, seing more patients, faster, to meet productivity benchmarks. They operate in a resource-constrained environment that has skyrocketed the cost of managing their practice and racheted down their incomes." Sound familiar?
She concluded that "this trend has serious ramifications, not only to cost and quality of care but also in the potential loss of the heart and soul of the medical profession."
It seems like more and more people are noticing the issues that Health Care Renewal has been bringing up.
...if only they had some solutions to these problems. Unfortunately, Lutch Bender's suggested approach was pretty opaque, "there is enormous opportunity for physicians to think differently and seek innovative alliances with other providers in a way that will spur competition for those courageous and committed enough to protect the relationship between physicians and their patients." Hopefully, she will come up with something more concrete in the future.

Sunday, 22 May 2005

Princess Health and Comments by Jacobi Hospital's Former Executive Director: "I Feel Really Good". Princessiccia

Princess Health and Comments by Jacobi Hospital's Former Executive Director: "I Feel Really Good". Princessiccia

The Executive Director of Jacobi Hospital, who was fired because the hospital failed to notify hundreds of women about concerning Pap test results, had these comments for New York Post reporters:
  • "I feel good. Everything is wonderful. I feel really good."
When asked if he wished to apologize to the women who were not informed of their abnormal test results, he referred the question to the New York Health and Hospitals Corporation, and slammed the door.
Another example of a hospital leader showing real concern about quality of care, and the concerns of his institution's patients - not.