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On the surface, adverse drug events or reactions appear to pose primarily a clinical challenge. But scratch the top layer and you discover that a bad mix or an inappropriate [...]

The forces of virtue are lining up to attack the uninsured problem. With an estimated 43 million Americans lacking medical coverage during a time of unparalleled economic prosperity, there is [...]

George Veliotes, M.D., has trained, practiced, taught and managed for 25 years in the world's largest inpatient facility, 3,205-bed Chris Hani Baragwanath Hospital in Johannesburg. "Those of us who have [...]

International Hospital Federation (IHF) director general Errol Pickering is expected to retire in February 1998 from the position he has held for 11 years. Pickering, 59, says that he will leave IHF headquarters in London and head home to Sydney, Australia, where he will operate his new restaurant, consult and write. Pickering will be succeeded by Per-Gunnar Svensson of Sweden., The 30th International Hospital Federation Congress, set for Nov. 17-21 at Australia's Melbourne Convention Center, carries the theme "Sharing Ideas for Better Health." The conference will cover such topics as [...]

Putting out a magazine like 'Modern Healthcare' requires teamwork and the energy and expertise by the staff of 28. Crain Communications, which acquired the magazine in 1976, targets 'Modern Healthcare' at the senior executives of healthcare companies. Modern Healthcare' has covered the major changes that have transformed the industry in the last 20 years., Over the years, I've been asked by many readers how Modern Healthcare stays up on all the news. First, it takes planning, consistency and a clear understanding of each person's [...]

Larry Teuber, M.D., is a physician executive and has the calling card to prove it. Teuber helped spearhead the 1997 opening of the Black Hills Surgery Center, one of the [...]

It's time to alter the way physicians are reimbursed by insurers. They are paid for treating medical conditions, which has fueled evolution of a 'sick care' system that focuses more [...]

Analysts warn that hospitals face a credit crunch, further underscoring the importance of raising funds and investing the money wisely. It seems the bankruptcy of Allegheny Health, Education and Research [...]

It's time for patient advocates, healthcare providers, insurers and the government to reach a historic compromise on the privacy of medical records. And the clock is ticking. As part of [...]

Managers of hospitals and health systems should prepare for the day when HCFA selects providers based on the providers' costs and the quality of care their Medicare patients receive. In [...]

Those tireless medical researchers, managers and clinicians devoted to improving the quality of healthcare are tired of getting no respect. According to J. Duncan Moore Jr.'s recent report from the [...]

No one denies that the creeping growth in the number of Americans without medical insurance is a major flaw in the healthcare system. An estimated 44 million people are uninsured; [...]

It's going from bad to worse. As the national economy continues to flourish, the number of uninsured is spiraling upward. In my 12 years as editor of MODERN HEALTHCARE, the [...]

They're at it again in Pittsburgh, where the four remaining acute-care hospitals in the once-mighty Allegheny Health, Education and Research Foundation empire are being sold to the only bidder. Yet [...]

Notice the new look as you read this week's issue of MODERN HEALTHCARE. From an updated logo to cleaner page design, we've unveiled a series of graphic changes intended to [...]

A Cape Town-based investment firm managed by anti-apartheid activists is banking on growth opportunities within South Africa's healthcare system. Iqbal Surve, M.D., who serves as chief executive officer of the [...]

Health care executives should place particularly importance on customer service in their plans for 1997. A strong commitment, according to authors Roger Dow and Susan Cook, would involve building a strong foundation for customer relationships, making sure that every customer feels specially treated, simplify, use the power of people, and taking risks in setting bold goals, among other things., The holiday season finally allows some time to tidy the office, collect thoughts, reflect on the hectic year and plan for a rip-snorting 1997. The pause to refresh also provides [...]

Boston University Medical Center (BMC) Pres and CEO Elaine Ullian will be under pressure to prove the BMC's merger with Boston City Hospital a success. Ullian was the key executive behind the deal and took the brunt of the protests against it. BMC has already had to close its Boston Speciality and Rehabilitation Hospital, and Ullian further announced in Nov 1996 that she will cut the center's $400 million budget by 10%. Other potential mergers could be with New England Medical Center, which is said to be eyed by Columbia/HCA Healthcare Corp., Popular Boston Mayor Thomas Menino may have been the architect behind the merger of Boston City Hospital and Boston University Medical Center, which formed the new Boston Medical Center, but [...]

The same funds given to the defense industry to make smooth corporate mergers and subsequent downsizings are not offered to the healthcare industry. Merging healthcare companies should either also be able to receive funds for severance packages for laid-off workers and employee retraining or should show the Pentagon and Congress that taxpayers do not need to pay for what the free market will take care of on its own., You may want to clip and save this one. First, let me set the scene. Hospitals continue to merge, consolidate and affiliate in record numbers. The reasons for such business [...]

Imatron's Ultrafast Computed Tomography offers cardiac medicine an advanced imaging technology that scans coronary arteries electronically. Ultrafast Computed Tomography scans the pumping heart 20 times faster than conventional CT technology and detects heart conditions associated with the coronary disease. Presence of calcium in coronary arteries indicates plaque buildup inside arteries which can cause stroke, angina or heart attack., In healthcare, as in baseball, you gotta have heart...miles and miles and miles of heart. And that's why imaging technology that electronically scans coronary arteries has marketers, hospitals and physicians [...]

Effective communication is the key to improving public understanding about medical issues. Confusing terminology and endless acronyms should be replaced with language which can be understood by patients, media and politicians. Emerson College and Tufts University School of Medicine have created a joint master's degree program in health communications., As a veteran journalist, I've done a lot of thinking about the communication process and its role in improving the quality of life. After spending 10 years as editor of [...]

Not-for-profit health systems and hospitals undertake voluntary disclosure to ensure their credibility at a time when concerned citizens, politicians and the media are very interested in such things as executive compensation and commitment to charity care. As many healthcare providers increasingly function like quasi-insurance firms, they must be prepared to accept the risks associated with such a shift, as their tax-exempt status are closely examined by government tax collectors., For tax-exempt healthcare organizations, disclosure can be the better part of valor. Few organizations face as bright a spotlight as community hospitals. Participation in the Medicare and Medicaid programs, for [...]

After spending 11 years in healthcare administration, Elizabeth Martin now works with the Atlanta Committee for the Olympic Games and supervises a staff of 35 and 4,000 medical volunteers. martin's duties include providing medical services for officials, volunteers, media, spectators and athletes at attending the games. Her staff also facilitates research projects on the biomechanics and physiology of sports, among other things., Elizabeth Martin believes her 11 years of experience in healthcare administration provided ideal training for her current position as director of medical services for the Atlanta Committee for the Olympic [...]

The guidelines issued by the Labor Dept on how to prevent workplace violence for social service and healthcare workers could be the starting point for healthcare managers to ensure the safety of their personnel. This is particularly crucial because as Labor Sec Robert Reich notes, healthcare and social service industries experience more assaults than any other. The guidelines include the establishment violence prevention programs and the use of closed-circuit video recording to monitor high-risk areas., So it's come down to this. Healthcare workers are so vulnerable to violence that the Occupational Health and Safety Administration believes many cases go unreported because of"a persistent perception that [...]

Other countries are looking to the US for solutions to their healthcare delivery problems. The growth of managed care in the US intrigues the healthcare professionals of other countries who are looking for cost containment devices. The interest of foreign parties is so high that some US managed care companies are going global. Employers, insurers and healthcare providers in many countries increasingly are sending patients to the US for low-cost healthcare, and some US providers are seeking to directly enter foreign markets., Today capitation, tomorrow the world. While most providers are preoccupied with the rigors of managed care, network formation and declining reimbursement, a growing number are turning their attention to international [...]

Actor Christopher Reeve's lobbying efforts on behalf of legislation that would keep insurance companies from setting lifetime insurance benefit caps at under $10 million could be harmful to an important bipartisan health reform bill. The actor, who suffered a paralyzing neck injury after an equestrian accident in May 1995, has medical care expenses amounting to $400,000 a year and a policy for catastrophic injuries with a $1.2 million cap. However, the focus of Reeve's political agenda could derail passage of the health reform bill sponsored by Sens Nancy Kassebaum and Edward Kennedy that will be up for vote after April 15, 1996.

Economic factors such as financial risk and cost-containment concerns motivate hospitals and physicians to make wiser decisions on the managed care services they will provide. A careful analysis of each medical case will efficiently aid healthcare providers' decisions to rationalize medical services, increase their profitability and reduce their operating costs. Healthcare providers also should consider that medical care capitated payment systems and contracting with provider-sponsored networks and hospital-based health maintenance organizations would help them better address the healthcare cost-effectiveness issue.

Opening Doors is a $5.5 billion program focused on reducing social and cultural barriers to maternal, child and reproductive healthcare. The organization, funded by the Robert Wood Johnson Foundation and the Henry J. Kaiser Family Foundation, finances several programs around the US which encourage Native Americans, Asians, inner city poor and other groups to use healthcare programs they may feel don't welcome them. Cultural and language barriers are two main reasons the groups discussed do not use the care offered. Several programs are outlined and public policy discussed.

The Institute for Diversity in Health Management is an Atlanta-based organization dedicated to increasing the representation of minorities in healthcare administration. Formed in 1994 by retired Brigadier General Walter F. Johnson III, the institute has put about 95 minority college students through a 12-week health services training program at leading US hospitals. It is also developing a $10 million endowment fund.

The lucrative healthcare industry is attracting the eye not only of potential investors but also of financial service firms wanting to draw attention to themselves by holding seminars on the subject. Robinson-Humphrey Co held a healthcare conference in Atlanta, GA, that attracted 426 people and had House Speaker Newt Gingrich among its speakers. According to Runnington, there are 33 major conferences on healthcare investment planned for June 1995-Jan 1996.

The government should minimize its involvement in the healthcare business, which is already beset by excess capacity and disgruntled taxpayers. It should confine itself to providing healthcare for the poor instead of spending billions on acute care. Some counties and municipalities have gotten the message. Walworth County, WI, Maricopa County, AZ, and New York City number among these. Others, like Cook County, IL, have not.

A House bill that would bundle Medicare hospital and acute-care payments and force hospitals to offer outpatient care or contract it out might save $19.3 billion over seven years. Hospitals are ambivalent about the proposal because they fear losing control over quality and service. But they acknowledge that few hospitals are sufficiently integrated to handle bundling. The plan will speed integration while assuring entrepreneurs a role in healthcare.

Speakers at Picker Institute's conference on patient-centered care emphasized the need to implement the concept in fact. One said that, while patient-centered care is directly responsible for much of the reengineering taking place at hospitals, its original meaning has been lost. Another pointed out that patients' perception of care is becoming more important to hospitals' survival as they reach technological parity.

Approximately 3.9 million baby boomers will turn 65 in the year 2020. This will eventually cost Medicare around $210 billion, about twice the amount needed to care for the 2.1 million who turned 65 in 1990. These figures are calculated in 1990 dollars and ignore inflation. Managers need to emphasize to Congress that hospital rates grew only 4.1% in 1994 and 1995 and Medicare finances and demographics are important considerations.

Congress' plans to eliminate the federal budget deficit by 2002 will require significant cuts in public expenditures that could affect healthcare financing. Annual reductions in Medicare and Medicaid payments to hospitals will impact the quality of medical care and encourage medical personnel layoffs. Not-for-profit and investor-owned hospitals must be united in their efforts to fight irrational budget cuts.

Hospitals are beginning to behave like insurance companies as they adopt managed care, with frightening results. Limiting medical care in the pursuit of profits is not good cost control; forcing physicians to observe protocols and managing resources efficiently is. In managed care and capitation there is the need, more than ever, to carefully train hospital staff in patient relations.

The untimely death of Jordan Hospital (Plymouth, MA) Pres Peter Chapman from a heart attack is a warning sign that healthcare executives might be working too hard. Chapman's rigorous 70- to 80-hour-a-week schedule is not uncommon in the industry. Colleagues lauded Chapman for his diplomacy and fairmindedness. He took charge of what was a moribund hospital in 1985 and by 1994 had returned it to profitability.

Some hospitals and their suppliers are establishing ground rules to achieve a closer working relationship, one that reflects the new, managed-care environment. The fee-for-service environment was characterized by commission-hungry sales representatives and wasteful hospital inventory practices, both of which generated resentment. Partnership principles established by the Society for Cardiovascular Management are presented.

Federal health care reform will be shifted from democratic party to republican party hands in 1995, but will proceed at a slower pace than indicated by House Speaker Newt Gingrich. Gingrich has announced that he will completely rethink the Medicare system and give states block grants to deal with acute Medicaid problems, but drastic reform is virtually impossible within one year. Healthcare providers should stake out their positions on the 1996 budget and simultaneously concentrate on their local markets.

The New England Healthcare Assembly and the Innovation Associates group from the Massachusetts Institute of Technology will meet to develop computer simulation models for the design of an integrated healthcare delivery system. Hospital executives and healthcare industry observers hope that the project can present executives with new ways to imagine and manage healthcare dilemmas in the coming decade and beyond.

Some 40% of hospitals plan to downsize their workforces, but there are methods by which hospitals can ease the pain and disruption caused by layoffs. Johns Hopkins Hospital will jointly administer, along with the Service Employees International Union, a $250,000 retraining fund for laid-off workers. It is important for managers to listen closely to workers being laid off, according to University of Oklahoma professor Howard Stein.

Healthcare executives, as they attempt to deal with reform, should remember a few basic points. The government will overestimate savings and underestimate spending. Fee caps could lower hospitals' and physicians' revenues. Providers must become more efficient and further cut costs. An antitrust exemption for healthcare providers is unlikely.

The media is only doing a fair job of presenting information about healthcare reform to the public, but since the debate will be continuing over a long period, there is time for improvement. The media should focus on the impact the proposed changes will have on communities and individuals. A survey funded by the Henry J. Kaiser Family Foundation found that many media stories emphasized political ramifications and structural changes and neglected concerns, such as provider choice and quality of care. Consumers lack knowledge about the basics of healthcare reform, and the media could help to fill this gap.

Special interest groups will spend up to $100 million to lobby politicians and sway public opinion on healthcare-reform issues. This marketing battle could frighten and confuse many Americans. Individuals should keep in mind that every interest group involved in the reform debate, including the Democratic and Republican parties, has a hidden agenda.

The Clinton healthcare reform plan has now moved into the public arena, but a lot more discussion and planning is needed before it becomes practical. The Clintons' dedication to healthcare reform has already influenced many providers to reassess how they deliver healthcare and has raised public awareness of medical care financing. Clinton should focus on the 37 million people in the US with no healthcare insurance. So far, the plan puts more emphasis on management and not enough on competition. Suggestions are given for politicians who are planning healthcare reform.

Healthcare reform, in the final analysis, is a matter of making difficult resource-allocation choices. The case of conjoined twins Angela and Amy Lakeberg provides a foreshadowing of the profound impact that reform could have on payers and providers. The case raises the question of whether all patients have a right to unlimited healthcare funds. Healthcare funds could perhaps be better spent on primary care and preventive medicine.