Author: cmh

Not Running a Hospital: Do I get paid too much?

Not Running a Hospital: Do I get paid too much?:

“Here are the facts. As noted by the Globe, my total compensation was about $1 million in fiscal 2005. Of this, $650,000 was the base salary. Also, I was eligible for a 30% incentive compensation payment if the hospital achieved specified results for clinical quality, patient satisfaction, and financial performance. I received the full amount that year, $195,000. The rest of the million comprised payments made by BIDMC for life insurance and retirement. (Don’t worry, there are no other perks, like cars or country club memberships!)

Now, some background on BIDMC: The hospital is a billion-dollar-a-year enterprise, about $800 million in clinical revenues and $200 million in research programs. Our annual capital budget is roughly in the range of $80 million. Last year, we raised $30 million in philanthropic donations from people in the community. We have facilities that cover about 3 million square feet. We see 50,000 emergency room visitors per year, 40,000 inpatients, and 500,000 outpatients. We have about 8,000 employees and about 800 doctors on staff. We are affiliated with six community health centers (one of which we own); several community hospitals and physician practices; and we own and run two off-site clinics in Chelsea and Lexington and one small community hospital in Needham.

So, if you were on my board, how would you set an appropriate salary?

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How the U.S. measures up to Canada’s health care system | Worldfocus

How the U.S. measures up to Canada’s health care system | Worldfocus:

“Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

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Will emphasis on screening be harmful to your health? – The Boston Globe

Will emphasis on screening be harmful to your health? – The Boston Globe:

“But a former government health researcher is concerned that political considerations are leading the Obama administration to lean too heavily on screening, which can have unexpected downsides. Dr. Kenneth Lin, a Washington, D.C.-based family physician who used to conduct research for the government agency that helped develop screening recommendations, wrote in a recent blog post that the government’s acronym PPIP — for put prevention into practice — should really stand for “prevention politics injures patients.’’

Those are fighting words, but Lin quit his job at the Agency for Healthcare Research and Quality last November after a meeting of independent experts to vote on recommendations for prostate cancer screening was unexpectedly delayed that month.

Lin blames politics and the maelstrom weathered by the Obama administration when those same experts — used by the government to set screening guidelines — downgraded mammography screening recommendations for women in their 40s, at just the time when the health care bill was being debated in Congress. The experts stop recommending routine screening of women in their 40s, leaving it up to women to decide with their doctors whether to have mammograms.

This touched off angry accusations that the government was trying to ration care to save money, and the furor ultimately led Congress to add specific wording to the bill stating that mammograms would be covered.

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New rules for health plans require clear summaries of benefits – Los Angeles Times

New rules for health plans require clear summaries of benefits – Los Angeles Times:

Moving to implement a much-anticipated consumer protection in the new healthcare law, the Obama administration issued regulations Thursday requiring health plans to describe what they cover in clear, standardized language that is understandable to consumers.

Starting this fall, insurers and employers that offer health coverage will have to provide a six-page form that summarizes basic plan information, such as deductibles and co-pays, as well as costs for using in-network and out-of-network medical services.

The forms will also include estimated out-of-pocket costs for two basic examples of care: delivering a baby and managing Type 2 diabetes.
The changes are designed to allow consumers to assess how much their care would cost under different insurance policies, and to simplify the process of evaluating health plans, a task that now can involve reviewing hundreds of pages published by insurers.
“One of the primary purposes of this is to ensure this apples-to-apples comparison across plans,” said Steve Larsen, the senior Department of Health and Human Services official overseeing insurance regulation.
The simplified forms, known as the summary of benefits and coverage, were mandated by the healthcare law signed by President Obama in March 2010.
Many consumer groups and patient advocates feared that the administration would back away from the requirement after insurers and employer groups complained that developing the forms would be costly and burdensome.

Found this via a post from Wendell Potter at Huffington Post. He notes that some advocates are calling for an illustrative case of cancer in the examples as well. I agree, as this can be among the most devastating events to a family, in every way including financially.

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Opinion | The role of faith in health-care delivery | Seattle Times Newspaper

Opinion | The role of faith in health-care delivery | Seattle Times Newspaper:

As the Catholic Church has been widening its influence and reach in American health care, it also has been flexing its muscles in health-care policy. Recently, it asserted that it should not have to provide contraception coverage to employees at church-run hospitals or universities around the country even when those employees are not Catholic, and when a large share of their salaries are paid for by tax dollars that flow through broad-based medical programs such as Medicare and Medicaid.

Moving beyond health care, the Catholic Church is also asserting its influence in ways that seek to expand religious-freedom protections to include the freedom to take broad-based taxpayer money and then spend that money in a manner that discriminates against Americans who don’t accept Catholic theology.

In Illinois, for example, the church recently asserted that its First Amendment right to freedom of religion is being compromised when its own discriminatory policies against gays make it ineligible for government contracts to find adoptive homes for children in need among well-qualified families, gay or straight.

In making these claims, the Catholic Church is seeking to transform a right that is vitally important — the freedom of people to decide for themselves which religion to follow without government interference or sponsorship — into a right for government support and funding for theology-based program implementation.

It’s one thing to say that because you’re using private funds, you don’t have to provide services that violate religious conscience. It’s another to accept public money in a market situation where “customers” don’t have free choice, and make that same assertion.

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Despite the hype, some new drugs aren’t effective for patients – Healthy Living

Despite the hype, some new drugs aren’t effective for patients – Healthy Living:

For years, I frustrated the Tekturna representative who came to my office. I refused to write even one prescription. Our conversations each week were identical. I would argue that there are generic high blood pressure medicines that are cheaper and just as effective, but much more importantly, I would argue that Tekturna did not have any proof that it was truly beneficial.

To this claim, the representative was astounded that I did not agree with the glossy graphs that showed how much blood pressures were lowered for people on the drug. For me and my patients, though, lowering blood pressure is not nearly enough; we need to know that the drug protects against the problems, such as strokes, that are linked to high blood pressure.

Despite showing that Tekturna lowered blood pressures, no research trial ever documented that it reduces the risk of heart disease, stroke and death.

We treat high blood pressure to reduce the risk for heart attacks and strokes. Period. Lowering the numbers we see on the blood pressure cuff is nice, but stopping a stroke is what counts.

Dozens of generic blood pressure medicines reduce the risk of stroke, heart attack and death, but Tekturna had no such research evidence.

A FULLER PICTURE

In the past, there have been many instances of drugs that move numbers (like blood pressure), but that can worsen clinical outcomes. Alpha-blockers, for example, were shown decades ago to cause increased numbers of deaths in heart failure patients despite powerfully lowering blood pressures.

Last month, a clinical trial of Tekturna (the ALTITUDE trial) was stopped before it was completed. In trying to measure if Tekturna reduced the risk for heart attack and stroke, researchers discovered that Tekturna significantly increased the risk of stroke, kidney complications and problems with blood potassium levels.

The drug actually caused patients harm in comparison with generic alternatives, so the manufacturer recently stopped marketing it.

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President Obama Announces Accomodation on Birth Control – NYTimes.com

President Obama Announces Accomodation on Birth Control – NYTimes.com:

Just had to get this great Antonin Scalia quote up here…

It’s a law of politics that when you’re losing the debate, you change it. So with the economy improving and President Obama rising in polls against his likely general election opponent, Mitt Romney, it’s not surprising that the Republicans went looking for an inflammatory social issue. They came up with contraception, which apparently is really controversial even though 99 percent of women rely on it at some point in their lives.

I’m referring, of course, to the ridiculous brouhaha over the new health care rule mandating that businesses provide insurance coverage for birth control. The original version exempted religious institutions, like Catholic churches, but not religiously affiliated ones, like Catholic universities, that cater to the general public.

That concession wasn’t good enough for the U.S. Conference of Catholic Bishops. Along with such opportunists as House Speaker John Boehner and Rick Santorum, they claimed the president was disregarding the First Amendment and assaulting religious freedom. The idea was to paint Mr. Obama as irreligious, and to chip away at the health care reform law in the process. I guess they were unaware of the 1990 Supreme Court decision Employment Division v. Smith, which established that religious liberty doesn’t trump an otherwise neutral law. As Justice Antonin Scalia, that notorious atheist, wrote: “To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself.”

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Are Conservatives More Fearful Than Liberals? | Tea Party and the Right | AlterNet

Are Conservatives More Fearful Than Liberals? | Tea Party and the Right | AlterNet:

Their political advisers must understand a psychological phenomenon that researchers have been studying for some time now: conservatives appear to be motivated by fear in a way that liberals are not. An expanding body of research suggests that Republicans and Democrats differ on some fundamental level in how they respond to positive and negative stimuli. A new study, published in the journal Philosophical Transactions of the Royal Society B, adds even more evidence to the theory that these two groups quite literally see the world differently.

Researchers at the University of Nebraska at Lincoln showed people a series of photos — some endearing, some disgusting — and then measured their physiological and cognitive reactions. Conservatives, in keeping with past literature, reacted more strongly to the negative images, and liberals strongly to the positive ones.

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Fair Enough? Inviting Inequities in State Health Benefits — NEJM

Fair Enough? Inviting Inequities in State Health Benefits — NEJM:

How much leeway should HHS allow in benefits programs?

I believe that the HHS proposal reflects an inadequate view of equality. A better approach would be to establish uniform standards so that all Americans would have access to the same high-quality goods and services.5 Such a policy could mean the difference between life and death, and it has been well tested and long debated. Indeed, this solution is grounded in the Aristotelian principles of vertical and horizontal equity. Vertical equity calls for different quantities and intensities of goods and services for persons with different needs. For example, patients with conjunctivitis and those with glaucoma need different treatments to restore normal ocular function. Horizontal equity demands that persons with the same needs receive the same treatment. Providing such persons disparate care — as might well happen under the flexible system established by HHS — represents horizontal inequity.

Those who object to the uniform-standards solution will counter that it idealistically and naively seeks, as measures of fairness, the same health outcomes and the same amounts of care for everyone. In fact, however, it is based on the principle of proportionality — the notion that similar cases should be treated similarly and different cases differently, in proportion to their differences. Medical cases in which the health needs are the same are deemed alike; those in which the health needs are different are considered unalike. Such a solution would also require that health care be provided in keeping with medical necessity and medical appropriateness and that patients and their doctors — not state insurance exchanges, state governments, or private health plans — be the ones to make such assessments, within the scope of national standards.

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Is the White Working Class Coming Apart?—David Frum – The Daily Beast

Is the White Working Class Coming Apart?—David Frum – The Daily Beast: :

A piece by my favorite conservative, David Frum, taking apart a book by Charles Murray

1) It’s historically wrong to describe the “founders’ conception of limited government” as if there existed some group called “the founders” who broadly agreed a vision of government that more or less corresponded to contemporary libertarianism.

2) As a matter of fact, if you announce that there can exist no possible information that might change your mind about abortion, the death penalty, marijuana, same-sex marriage, and the inheritance tax, then yes you are an unreasonable person—or anyway, an unreasoning one. I’ve changed my mind about same-sex marriage as experience has dispelled my fears of the harms from same-sex marriage. If somebody could prove to me that marijuana was harmless or that legalization would not lead to an increase in marijuana use, I’d change my mind about marijuana legalization. And so on through the list.

3) But here’s the most important point of all. I tramped through a lot of the same research that Charles Murray presents here when I wrote my history of the 1970s, How We Got Here.

As I looked backward and forward in time, however, I had to face this awkward fact: America became more culturally stable between 1910 and 1960 as it became less economically and socially libertarian. As it became more economically and socially libertarian after 1970, America became culturally less stable:

“The greatest generation was also the statist generation. Like them or loathe them, the middle decades of the twentieth century were an entirely anomalous period in American history. Never had the state been so strong, never had people submitted as uncomplainingly, never had the country been more economically equal, never had it been more ethnically homogeneous, seldom was its political consensus more overpowering.”

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