Hospitals across the region are cutting staff, elected officials are considering slashing Medicaid and Medicare funding and medical bills are driving an increasing number of Georgians into bankruptcy. But the six- to seven-digit compensation packages for the chief executives who lead metro Atlanta's taxpayer-subsidized hospitals remain untouched and in most cases are growing. Five of these CEOs made more than $1 million in the fiscal year ending in 2009, the last tax records available. Edward Bonn of Southern Regional Health System, which operates Southern Regional Medical Center and two affiliated facilities, made $2,610,175 in fiscal 2009. Bonn left the system that year and received his pay of $421,822 plus $2.2 million from a retirement plan. Hospital CEOs commonly receive extra pay from retirement plans when they leave.
Wellness screenings emerged as one of the signature benefits of the big federal health overhaul that Congress passed last year -- an effort to catch problems early, keep patients healthier and cut future Medicare costs. Some doctors, however, are having second thoughts. To get paid by Medicare, a physician and nurse must complete 15 steps during a 30- to 45-minute exam, including brief screenings for dementia and depression, an eye exam, a medical history and personalized health advice. They must also check weight, height and blood pressure -- the only time the patient must be touched. Although much touted in letters to the 46 million aged or disabled people on Medicare, the wellness visits haven't caught fire with patients either. Since Jan. 1, about 780,000 patients have received the new service, Medicare officials say.
Despite decades of research, doctors have few tools to measure pain objectively. Generally, they ask patients to rate it themselves from one to 10, or point to the cartoon face on the wall chart whose expression best matches how they feel. "We don't have a pain-o-meter," says Joel Saper, MD, director of the Michigan Head Pain and Neurological Institute in Ann Arbor, which draws about 10,000 patients a year, including some of the nation's toughest migraine cases. Saper estimates that 15% to 20% of them are faking—or at least, aren't as incapacitated as they say. Some are dependent on painkillers or seeking to resell them, he says. Some want a doctor to certify that they'll never be able to work again and deserve disability payments. Some, he thinks, don't really want to get well because they subconsciously find power in their pain.
Miami-Dade taxpayers know how much they pay for street lights, school buses and sidewalks, but they don't know how much they pay for pacemakers and defibrillators purchased by their public hospitals in Jackson Health System —a form of pricing secrecy that drives up healthcare costs for everyone, experts say. Jackson spokesmen say the financially strapped system can't reveal how much it pays because it has signed contracts with vendors that include clauses that call the prices "trade secrets." Such clauses are standard in the medical world and exempt from public records laws, they say. But the secrecy means that Jackson can't compare its prices to what many other hospitals pay. That's like a consumer going to buy a flat-screen TV and not knowing what others are paying for the same brand, said Curtis Rooney, president of the Health Industry Group Purchasing Association. "We call them gag clauses. People can't find out the best price."
Given that the average adult over age 55 juggles six to eight medications daily, the ability to consolidate pill-popping is no minor matter. "I'm more likely to be able to sustain a medication regimen if I only have to take it three or four times a day," said Michael Wolf, an associate professor of medicine at Northwestern University who studies drug safety. "Seven or eight times a day is complicated to fit into your daily schedule." His sister, who has lupus, sometimes takes up to 16 different drugs, he noted. "Why can't we standardize prescriptions?" Why indeed? The idea has been kicked around for years. Nearly three years ago, the Institute of Medicine proposed that pharmaceutical manufacturers adopt a universal dosing schedule that would make it possible for people to take medications at just four times of day: morning, noon, evening and bedtime. Virtually all drugs could be formulated to fit into this framework, Dr. Wolf said: "It's ridiculously simple, an incredibly basic idea."
Major employers across the country, eager to curb fast-rising healthcare costs, are opening their own state-of-the-art health centers where doctors and nurses provide medical care to workers often just steps from their desks. The cost-cutting strategy has been embraced by dozens of companies—typically large employers that are self-insured and pay their own medical claims, including Walt Disney Co., Qualcomm Inc. and American Express Co. Many of the health centers are full-service medical offices equipped with exam rooms, X-ray machines and pharmacies. Some provide on-site appointments with dentists, dermatologists, psychiatrists and other specialists who treat life-threatening illnesses. Executives say providing in-house medical care keeps workers healthy and productive. But the clinics also help the bottom line by reducing absenteeism and slashing employers' medical bills for outside doctors and emergency rooms.