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.
A recent story, Washington's $10 Billion Search For Health Care's Next Big Ideas (Hancock, 8/11), drew various reader responses:
Tony Hausner, independent health policy consultant; Silver Spring, Md.
I worked at Centers for Medicare & Medicaid Services Office of Research and Demostrations for many years. The model we used of carefully designed demonstration projects with well-designed comparison models and evaluation research paid off extremely well. It resulted in many major successes implemented into legislation, with incredible savings and extremely important advances in the programs. Some of the advances included prospective payment for hospitals, home health, managed care programs, hospices, and prenatal care programs, just to name a few. Much more of this is needed at CMS.
Michael A. Rie, MD, associate professor of anesthesiology at the University of Kentucky College of Medicine; Lexington, Ky.
You … indicate that Premier Group Purchasing, a buying group, is pursuing innovation in efficiency and pricing in the drugs or equipment arena. Indeed, the American Society of Anesthesiologists and Premier are recent partners in a quality improvement project, and all ASA members are asked to [voluntarily contribute] their hospital drug quality issues to a database. There are legitimate reasons to be ethically concerned with a group purchasing organization (GPO) creating and owning such a database as the business model of GPOs under existing rule of law places the GPO at variance with the economic causation of chronic and increasing generic injectable drug shortages for all hospitalized patients and ambulatory patients and those requiring basic cancer chemotherapy.
Another KHN article, Patients Seeking Cheaper Care Are Soliciting Bids From Doctors Online (Boodman, 8/5), drew the following reader reaction:
William Prentice, CEO, Ambulatory Surgery Center Association; Alexandria, Va.
In her article about the online medical site, Medibid, Sandra Boodman correctly observes that ambulatory surgery centers (ASCs) often provide a more affordable alternative to their hospital counterparts. Unfortunately, she also erroneously implies that ASCs adhere to lower safety standards than other health care providers. Today, there are approximately 5,300 Medicare-certified ASCs in the country. Each of these centers meets or exceeds the rigorous health and safety standards set by the Centers for Medicare & Medicaid Services. In addition, most of these ASCs also meet additional state and federal regulatory and licensing requirements, and are accredited by the very same organizations that accredit hospitals. ASCs also maintain extensive anti-infection programs based on protocols established by the Centers for Disease Control and Prevention, and other nationally and internationally recognized infection-control guidelines. Numerous medical experts have recognized ASCs as integral to improving quality in our health care system.
Readers shared a variety of thoughts regarding Expert Panel Recommends Sweeping Changes To Doctor Training System (Rovner, 7/29). Here's one example that focuses on rural health care:
Jean R. Sumner, MD, Georgia Rural Medical Scholar Program; Wrightsville, Ga.
Excellent article and so true. As a rural physician you see bright capable students leave the area and never return here to practice. The present system trains physicians in urban areas, in large institutions and often fails to provide the unique skills needed to be successful in a rural practice.
Readers also responded to stories about Medicare issues relating to hospice and to observation care. Here's a comment regarding Medicare Experiment Could Signal Sea Change For Hospice (Andrews, 7/29).
Patrice Nerone; Painesville Township, Ohio
I am greatly encouraged by the direction hospice and palliative medicine seem to be going, and hope to see it become a reality. I used to work in hospice and am very heartened that patients may not have to make a choice to end treatment while pursuing comfort measures at the end of life. I don't believe it ever should have been a one-or-the-other situation to begin with. What most patients and families seemed to hear because of that policy was: "That's it, throw in the towel, life is over" and many of them emotionally, spiritually, and physically did just that.
And here's a response regarding FAQ: Hospital Observation Care Can Be Costly For Medicare Patients (Jaffe, 6/18).
Bob Olsen; Helena, Mont.
The description of "observation care" is okay, but overlooks that for years Medicare attempted to limit that care only to those cases in which diagnostic tests and active medical monitoring were required. This all changed specifically due to Medicare audit decisions that denied coverage for short hospital stays, and instead argued for observation care. The "2-midnight rule" is also contrived to overcome the confusion of when admission is reasonable. [But] there was no confusion before the Medicare program itself created the problem.
Another reader offered this comment in regard to Appeals Courts Split On Legality Of Subsidies For Affordable Care Act (Rovner, 7/22).
Dawn Prevete; Atlanta, Ga.
The confusion over who is entitled to subsidies is another example of the Affordable Care Act's failings -- an overly complicated construct that made a mess of what should have been a simple expansion of health care to all Americans. We could have gone with single-payer plan -- think of Canada or France or Great Britain. Or, a heavily government-regulated nationwide private insurance option like the Swiss enjoy. In Switzerland, there are no narrow networks -- every insured citizen can go to any doctor or hospital or specialist in their canon (equivalent to our states). Instead, we still have insurance risk pools -- state by state and even county by county -- leading to tremendous differences in cost, tiny networks of doctors and hospitals, and [other] complaints … and headaches.
Readers also shared their ideas regarding recent stories about employer health plans. For instance, one reader had this response to More Employers Limit Health Plan Networks But Seek To Preserve Quality, Says Adviser (Carey, 8/13).
Budd N. Shenkin, MD, affiliated faculty at the Philip R. Lee Institute for Health Policy Studies; University of California, San Francisco
In supporting high-deductible health plans, Dr. Robert Galvin is simply mouthing the line of those who don't care a fig about the ordinary person. These plans discriminate against the ordinary worker in favor of higher income people, as though health care were an ordinary [commodity] like a TV set. HDHPs ration by income. These plans are also anti-primary care. Primary care physicians should be the "health coaches" he talks about, yet patients are dissuaded from accessing them, which is directly against decided national health policy to strengthen primary care.
And here's a comment regarding 16% Of Large Employers Plan To Offer Low-Benefit 'Skinny' Plans Despite ACA: Survey (Hancock, 8/13).
Joel R. Stegner; Edina, Minn.
[It's] not surprising that [skinny plans] are popular in Las Vegas, where so many people make bets hoping for good luck and lose their shirts. Bet on a skinny plan, and if things don't go your way, you lose your health, all your money and your life. Your employer is happy to let you do something so stupid, as the house always wins.