The board of Central Health, a taxing authority that oversees health care programs for low-income Travis County (TX) residents, weighed in as a group Saturday and embraced the idea of rebuilding University Medical Center Brackenridge, Austin's public hospital, which is owned by Central Health. Board members, attending a 5½-hour retreat to build consensus on their vision for a medical school, said they support a premier teaching facility and trauma center for training doctors in primary and specialty care, as well as teaching them to work in clinics that serve the poor. The board also said, among other goals, it wants to play an influential role in developing the medical school concept so doctors gain experience in its clinics and stay in the community, alleviating a shortage of physicians. The board said it placed a high priority on seeing that its patients are treated like others in the community, regardless of income.
As the Walgreen Company pushes its army of pharmacists into the role of medical care provider, it is bringing them out from their decades-old post behind the pharmacy counter and onto the sales floor. The pharmacy chain, based in Deerfield, Ill., and the nation's largest, has renovated 20 stores in the Chicago area and is converting more than 40 in Indianapolis to get the pharmacist closer to patients. Pharmacists in the revamped stores are being kept away from the telephone, where dealing with insurance coverage questions and other administrative tasks occupy 25 percent of their time, Walgreen says. "What we are seeing now is pharmacists should be using their knowledge to help consumers manage their medications appropriately," said Nimesh Jhaveri, executive director of pharmacy and health care experience at Walgreen.
Whatever directions are taken to reduce the federal budget deficit, we in healthcare must show what we can do, individually and in collaboration with others, to live within those parameters and help our country live within its means. That is demonstrating true value.
In healthcare, economic and fiscal circumstances make it clear that hospitals and other healthcare providers serving as true "safety nets" are increasingly endangered under the weight of community service demands from uninsured and low-income patients. Does anyone really believe that all of the coverage expansions provided for in the federal healthcare reform law will be implemented or sustainable given the current state of federal and state government finances?
In order to demonstrate true leadership in community benefit, those hospitals doing relatively less should do more by reaching out to their community's safety net providers, offering monetary and/or in-kind support (e.g., managerial, clinical) to enable the safety nets to carry out their vital missions.
If the "haves" don't help the "have nots," then the "haves" will ultimately bear the burden, one way or another, that the "have nots" are carrying. It may not happen today, but it will happen.
Tax Exemptions
One possible scenario, which does not seem out of the realm of possibility, is that policymakers will seek to use hospital tax-exemption requirements to leverage greater support by the "haves" to the safety nets. Here's the progression:
First, as federal, state, and local governments obtain more community benefit investment data from hospital filings of Form 990 Schedule H (as well as from separate reporting in many states) government analysts could find significant variations across hospitals in the percentage of total net revenues or costs being devoted to community benefit—by any definition. Can anyone doubt that such variations will be found?
Next, that finding could lead to legislative proposals to establish a quantitative threshold of hospital community benefit as a condition for federal income-tax exemption. With government looking in every nook and cranny for ways to reduce their budget deficits and/or help fund other services, can anyone doubt the attractiveness of such proposals?
Look at what is happening in Illinois. Gov. Pat Quinn (D) has put a hold on further denials of property tax exemptions for nonprofit hospitals, but only in exchange for cooperation by the state hospital association in establishing a more definitive legislative standard for community benefit that is fair to both hospitals and taxpayers.
Next, those legislative proposals could be amended so that in measuring compliance with such a threshold, "extra credits" would be given for monetary and/or in-kind support provided to safety-net healthcare providers. Other amendments might call for tax credits to be given to those nonprofit hospitals whose community benefits significantly exceed the threshold (typically the safety-net hospitals). Does this sound too outlandish?
Voluntary Leadership
The right answer is voluntary leadership at the community level, with those providing less community benefits proactively reaching out a hand--individually or collectively--to help protect the safety nets.
In that vein, although he can be criticized for thinking in too narrow terms about community benefits, U.S. Rep. Dennis Kucinich, D-Ohio, has just called on all of the major hospitals in the Cleveland area to cooperate in providing care to the poor. Doesn't collaboration on community benefit at the community level make sense?
To borrow a phrase from Benjamin Franklin, as a group of nonprofit healthcare providers and health plans, we must all hang together or surely we shall all hang separately.
Howard Berman is chairman of the Alliance for Advancing Nonprofit Healthcare and a retired president and CEO of The Lifetime Healthcare Cos., based in Rochester, NY. Bruce McPherson is president and CEO of the Alliance, based in Washington, DC.
State residents insured by Blue Cross Blue Shield of Massachusetts have started receiving refunds stemming from the health plan's decision to distribute a total of about $4.2 million to its members, an amount equivalent to the severance paid to its former chief executive, Cleve L. Killingsworth. But if policyholders expected to be taking a vacation with the money saved from their "premium credits," they may want to set their sights on a latte, instead. "You will see this one-time credit of approximately $3 per policy on the enclosed invoice,'' Blue Cross, the state's largest health insurer, wrote in notes sent with premium invoices this month to about 38,000 individual policyholders. Blue Cross disclosed in July that it would issue the refunds to close the books on its widely criticized $11 million exit package for Killingsworth, who resigned abruptly last year. The decision to refund the severance pay portion came after talks with Attorney General Martha Coakley's office, which conducted a four-month investigation. The office concluded that while Killingsworth was entitled to the money under his contract, the generous severance did not serve the purposes of a nonprofit insurer.
Amid makeshift exam rooms and rows of dental chairs, the L.A. Sports Arena has been transformed into an enormous health fair. While waiting for treatment, patients watch videos about how to brush their teeth and learn about the amount of sugar in soda. They receive vaccinations and read fliers about healthy eating and exercise. The event, organized by the L.A.-based nonprofit CareNow, will run through Sunday and expects to treat 5,000 patients for high blood pressure, tooth decay and diabetes. President Don Manelli said his goal was to meet the immediate needs of the patients but also to have an "enduring impact" on their health to keep them from returning next year. Much of that, he said, is done through education. "A lot of what we see out here is preventable," Manelli said. In addition to adding counselors and exhibits on prevention, CareNow is also working to connect patients with local providers for follow-up treatment. As patients left, representatives of local clinics took down their contact information.
Eye surgeons in Tennessee have begun a pre-emptive offensive against legislation to allow optometrists the right to do laser surgeries—even though optometrists say they aren't seeking any law change. Lasers are replacing scalpels in eye surgery with procedures that range from saving a patient's sight to freeing them from eyeglasses. Computer programs make some of those procedures seem as easy as pushing a button, but a laser is just as dangerous as a knife, said Rebecca J. Taylor, MD, a Nashville ophthalmologist. "You laser the wrong area and in an instant you render someone blind and it's not retrievable," said Taylor, a medical doctor who completed a surgical residency at Vanderbilt University to become an ophthalmologist. She and other leaders with the Tennessee Academy of Ophthalmology—the organization that represents the surgeons—worry legislators here will follow Kentucky's example. That state passed a law this year allowing optometrists to do surgical procedures, including some using lasers, that were previously limited to ophthalmologists. Optometrists already have an ally in the legislature. Rep. Gary Odom, D-Nashville, is the executive director of their organization.