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President's
Message
Michael J. Mirro, MD, FACC
I attended the specialty
hospital roundtable meeting, which was hosted by the
Indiana Hospital and Health Association (IHHA). The
primary purpose of this meeting was to listen to the
concerns of two key Indiana legislators: Representative
William Crawford, chairman of the House Ways and Means
Committee; and Senator Pat Miller, chairman of the
Senate Health and Provider Services Committee.
Rep. Crawford introduced
a bill last session that would prohibit physician
ownership of ambulatory surgical centers as well as
specialty hospitals. This bill died in Commerce
Committee, and Rep. Crawford agreed to participate in a
roundtable meeting with various interest groups. Sen.
Miller also has specific concerns regarding the
evolution of specialty hospitals in Indiana.
The meeting included
participants from the IHHA and their legislative
counsel, legislators, large business (HR manager from
Daimler Chrysler and GM), labor, providers and payers.
Different
Hospital Care Models
The IHHA and their counsel made the
point that heart hospitals avoid providing core
essential services and thus cannibalize profitable
revenue streams that the general community hospitals
maintain for community service. An extensive discussion
regarding a competitive model versus a regulated model
of hospital care was discussed.
Rep. Crawford's major concern is the treatment of the
medically underserved areas in his district where he
represents an urban inner city hospital, Wishard
Hospital. Sen. Miller was concerned about the regulatory
environment versus allowing the market to regulate the
flow of patients. In the past, she has been against the
certificate of need. However, she is reconsidering her
position on this issue in light of the current
environment in Indianapolis where four heart hospitals
are being built.
Points
Made by Labor & Large Business
Labor and large business were aligned and made the
following points:
* Indiana has the second highest health care costs of
the states in which they conduct business.
* Hospital costs have risen 20% in the past year.
* There is frustration regarding the lack of public
information relating to quality and outcomes.
* They aggressively support the certificate of need
(CON) program since states with CON programs in place
have lower mortality rates and lower costs.
* GM particularly would like to focus on feedback
relating to provider efficiency and quality.
* The Indiana Manufacturers Association was present and
pointed out that a number of key manufacturers have left
the state due to the non-competitive nature of the cost
structure for employee benefits due to health care
issues.
I spoke directly to the
issue regarding physician ownership of ambulatory
surgical centers and pointed out the data on improved
quality of care and lower cost. There are currently 114
ambulatory surgical centers in Indiana. I commented
about the market dynamics that have led us to the
current environment of specialty hospitals.
Specifically, physicians have seen dramatic reductions
in Medicaid and Medicare reimbursement while hospitals
traditionally are able to preserve their revenue
streams. Rep. Crawford and Sen. Miller took note as they
now understand to a larger degree the reasons for the
evolution and the need for physician ownership.
Overall the meeting was
successful. I am certain that there will be some
legislative efforts in the upcoming session but our
input will be sought.
ACC
Legislative Conference Postponed
The ACC postponed its annual legislative conference in
Washington, DC, because Hurricane Isabel hit. Both Dr.
Mary Norine Walsh and I will attend when it is
re-scheduled and will meet with our Indiana legislators
in Washington to represent Indiana cardiovascular
physicians.
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