Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection. We will edit for space, and we require full names.
In recent weeks, readers have reacted to stories about climbing death rates at critical access hospitals, the readmissions penalties being imposed on some hospitals and Walgreens' move to become the first retail chain to diagnose and treat chronic conditions. Other coverage that drew responses included a story about angry doctors as well as coverage of decisions made both by physicians and consumers that impact the cost of care.
Here's a sampling of comments we received about Death Rates Rise At Geographically Isolated Hospitals, Study Finds (Rau, 4/2):
Farrell A. Turner, health care consultant, Anniston, Ala.
The article regarding the mortality rates of Critical Access Hospitals (CAHs) seems to miss some very key points. They reviewed only those patients who were admitted as inpatients to CAHs. ... As a former CAH CEO, most patients who came to the hospital with a heart attack were never admitted as inpatients. Such patients were stabilized in the emergency room. Some were treated with clot busters. But all were typically transported as soon as possible to the larger hospital. … Since they are only looking at hospital admissions, those patients who were successfully stabilized and transported are not counted. … One last point: I wonder if the publishers of the article have any data on the mortality rate in communities that have lost their CAH and have no emergency care. We used to say that if our hospital weren't there to stabilize those in need, they likely would die at the county line on the way to the large medical center.
Susan Leif, RN, Osceola, Neb.
Have you totally overlooked the 96-hour rule and the entire premise and function of the rural hospital? They are called "Critical Access" for that very reason! We do not have the case numbers to warrant or support "cardiac cath labs" and the other expensive equipment of "acute care" facilities. That is why we stabilize [patients] and transfer them to the higher level of care on a routine basis. I think your "study" needs to know the CAH system before you throw out numbers that skew the reality of a system that functions quite well in the rural environment. … Do you even have a clue what life is like in a rural state where the average population of the towns served by the CAH is less than 1,000?
Another reader offered this comment about Medicare Revises Readmissions Penalties – Again (Rau, 3/14):
Beth M. Buzzell, Maryville, Tenn.
I read the article about readmission penalties with interest, as I am interviewing for a quality management position at a 375-bed county hospital that serves a varied population, including many in poverty. Having most of my experience in ER, it is evident that some readmissions stem from poor education upon discharge, and many patients cannot afford the prescriptions given them. Of course, they will not necessarily admit this. Elderly patients are usually dependent on adult children for transportation, which may be undependable, and the medications don't get started until a week or so after issuing, or not at all. Without knowing what resources our patients have at home, we are only scratching the surface when we discharge them.
KHN's story, Walgreens Becomes 1st Retail Chain To Diagnose, Treat Chronic Conditions (Appleby, 4/4), triggered this response:
Daniel Elden Milbridge, Virginia, Minn.
This [idea] takes the "9-5" easy stuff and leaves the difficult, more complex care and after hours care to the hardest-to-recruit health care providers. Contrary to Walgreens' community do-gooder marketing campaign, it couldn't be more harmful to the clinics and hospitals which rely on a balance of medicine to attract and retain primary care physicians and advanced practice clinicians. The health care providers at Walgreens have no commitment to the community after their daily clinic hours.
Meanwhile, readers also reacted to the story Hospitals Crack Down On Tirades By Angry Doctors (3/5). Here's a sampling:
Catherine Egan, New York, N.Y.
A long-overdue response to unacceptable and abusive physician behavior! However, I must comment about the choice of a female surgeon as your example. … I can count on one hand the number of abusive exchanges I've had with female physicians over a thirty-year career while the list of men who hurled nasty, abusive comments and behaved outrageously would stretch far behind me. Women are by no means exempt from bad behavior, but the scale weighs much more heavily on the male side. Ask any nurse.
Lauren Powell, Charlottesville, Va.
In the story about doctors and their bad behavior, there is a statement in there that I don't believe to be accurate. The article stated that nurses' bad behavior is less likely to affect patients. In the majority of health care offices, nurses spend a considerable amount of time with patients in comparison to doctors who spend much less time with the patients. Nurses with bad attitudes or disputes are going to be interacting with other nurses and patients much more frequently.
The following comment came in response to Slow Progress On Efforts To Pay Docs, Hospitals For 'Value,' Not Volume (Mitchell, 3/26):
David G. Greer, M.D., The Clinic for Neurology, Huntsville, Ala.
Has no one ever thought that the reason tests are over ordered and too many referrals are made is the fear of litigation. Any doctor who says this is not in the back of their minds is lying. There is also a perception that if a doctor does not order a test, say for a headache, there is a lack of concern on the doctor's part. This takes education for the patient which takes time, for which physicians are currently being reimbursed poorly. Therefore, the easy out for many physicians is to see patients quickly, listen and nod their heads, while (over) ordering tests to cover all possible, not the most reasonable, diagnoses. Tort reform. An elephant in the room of the physician-patient interaction.
Another reader commented on the "Insuring Your Health" column Consumers Don't View Curbing Costs As Their Job When Choosing Treatments, Study Finds (Andrews, 3/12):
Thomas Bowman Maple Grove, Minn.
Most hospitals and many clinics simply do not have "price lists." They want to know what you HAVE to know what they will CHARGE. I had … multiple insurances -- so was often told that certain procedures would be "covered," but not told much about if the [procedures] really were needed or [about the] risks. After an infection due to a biopsy that didn't seem to offer much value (key question is "what difference will this lead to for treatment?"), I began to assess cost, risk and the value of various procedures. Having REALLY good insurance may get one referred for unneeded, invasive tests. It's not all about the customer.