April 2000
Volume 64 |
Number 4
|
| |
VENTILATIONS
|
| Executives, Admirals
and Other Obstreperous People |
America is certainly a wonderful country! Our life styles are
considered by many to be the best in the world. Conveniences abound
and the transfer of knowledge, both business and medical, flows
freely. This country must also be blessed with an inordinately
high number of geniuses who rapidly accumulate knowledge, evidently
through speed-reading and osmosis. These enlightened beings often
rise to the top of the executive, military leader and policy-maker
echelon. They are all capable of assimilating enough medical knowledge
in a few years to change the course of physician/patient interactions
that have existed for centuries.
Recently, one of our colleagues sent an article to me from the
Hartford Courant titled, "Aetna Under Siege: Whack on
Wall Street Only Latest in a Series of Assaults on Insurers"1
(I think the word "backlash" could have been used in place of
"assault"). This article is a heartwarming story for physicians
and expounds on the travails of Aetna's CEO, Richard Huber, who
personally lost $12.8 million (800,000 shares) in the first week
of February when Aetna stock dropped by 28 percent. In 1996, the
company's value dropped by 33 percent from its purchase price
of $8.9 billion to $5.8 billion. What a fabulous example of executive
stewardship! As Aetna is being attacked by attorneys with class
action suits regarding their "practice of medicine without a license"
(my quotes), a series of brilliant statements from Aetna executives
and analysts spew out like lava from a volcano: "... the company
seems to be making the right moves, but they have completely lost
the confidence of the investment community," stated analyst T.B.
Richter. This quote is the exemplification of a contradiction
(i.e., the team made all the right moves but lost the game by
33 points).
When a company stinks that bad, like a fish, one looks to the
head first. Huber has been under intense assault for "questionable"
leadership ability. In predictable fashion, he blamed investors,
the corporate organizational structure and the rise in their spending
for medical claims. It was also pointed out that Aetna's inflated
purchase of U.S. Healthcare (a mere $1 billion) changed its interaction
with physicians. They also turned against Aetna when it increased
the "hassle factor" for reimbursement and forced capitation on
some physicians ($12 per month per patient for primary care).
Aetna countered by saying that it was trying to keep costs down!?
Providers and hospitals are snubbing Aetna, which prompted Huber
to insist that they "have gone a long way to repair those relations
[with providers], and we're going to continue to work on it"
(my emphasis). In defending his company's reputation for being
a bully when contracting with its 400,000 providers, Huber compassionately
responds, "That's sort of what America is all about. That's a
free-market system." He also said that there will always be "constructive
tension" with the providers. In his next statement, Huber reveals
the brilliance that earned him the CEO moniker by declaring that
physicians "...want to get as much money as they can for doing
as little as possible. That's what we all want in life. But our
job is to try to pay them a fair fee for doing services that are
medically necessary." Reports that Huber actually stepped out
of his golf cart to utter this "principle of business" have been
unsubstantiated. Subsequently, Aetna's subscribers have dropped
by 12 percent due to claims disputes. Huber responds by saying
that if their claims problems were only 1 percent, they would
have 10,000 disputes each day.
As Aetna realigns to make the company friendlier, Huber's leadership
has come to an end when he was ousted in late February. However,
before you feel too sorry for him, bear in mind that his 800,000
shares alone are still worth $36.8 million, or $92 for every one
of the 400,000 providers who contract with Aetna. Why not start
to repair relations by giving these health care workers two shares
each from his stock holdings?
The rhetoric in Washington continues to be contradictory when
following Institute of Medicine, Health Care Financing Administration
and the Navy's activities. Recently IOM stated that medical errors
in hospitals kill more people than highway accidents (see March
"Ventilations"). Our specialty was cited as being the leader in
reducing deaths from anesthesia to a very low level (about three
or four per 1 million cases). The U.S. government can be expected
to spend billions of dollars to investigate and correct this epidemic
in hospitals by improving the quality (regulations?) of care.
Current U.S. policies on health care operate like a Venus flytrap.
On one hand doctors are lured into improving the quality of care,
a universal concept. On the other hand, once a specialty such
as anesthesiology ultimately makes outcomes safer, it is snared
by HCFA and the U.S. Navy who want to replace physicians with
nurse anesthetists. Both agencies believe that costs and the safety
threshold can now be lowered by replacing physicians with these
nonphysician anesthesia providers. The HCFA administrators and
the Navy brass fail to acknowledge that there is a cost for maintaining
safety.
Rear Admiral Bonnie Potter, then Commander at the National Naval
Medical Center, was in my opinion, administratively and professionally
irresponsible to establish a two-tiered health care standard for
naval personnel. By mandating that all healthy personnel (ASA
I or II) except VIPs (there was a box on the surgical form to
check off if the patient was a dignitary) can have anesthesia
administered by a nonphysician is akin to providing more "effective"
bulletproof vests to noncombat officers instead of ground forces.
However, those who served in the military are very familiar with
"RHIP" (Rank Has Its Privileges).
To say that organized medicine is in transition understates
the extensive metamorphosis that is presently occurring. To presume
that lesser qualified personnel can maintain high safety standards
is akin to letting the flight attendant fly the plane. To imagine
that recruitment and retention of some of the brightest medical
professionals in the nation will be maintained is folly. Wake
up before you go "under the knife" America, because in the future
you may not wake up again!
A Call to Action This is NOT a Drill!
Nancy-Ann Min DeParle, Administrator of the Health Care Financing
Administration (HCFA) notified Senator Arlen Spector (R-PA) that
the conditions for participation in Medicare will drop the requirement
that nurse anesthetists be supervised by anesthesiologists or
surgeons. These changes will appear in the Federal Register
in June. This announcement is being used by nurse anesthetists
to change state requirements because if the federal government
"believes they are safe, why shouldn't the states conform?"
In the next few weeks, you must write to your senator and
congressperson telling them that you are opposed to this HCFA
regulation change, and you must contribute to the ASAPAC.
(Please consider giving at least $100.) If you know anesthesiologists
who are not part of ASA, please let them read the last few issues
of ASA NEWSLETTER and encourage them to join ASA and contribute
to ASAPAC.
We have been woefully outspent because 70 percent of the nurse
anesthetists want this change while only 11 percent of the anesthesiologists
wish to prevent it! You may disagree with these percentages but
based on PAC contributions, which is like casting a ballot, these
numbers are known in Washington. Not voting means that one is
content with those who vote others into office. It goes the same
way when PAC monies are distributed. Apparently 89 percent of
ASA members are disinterested or apathetic regarding this critical
issue based on our poor PAC donation response.
Giving to PACs is similar to brushing your teeth. You must do
both on a regular basis and sustain it for a long time. Failure
to do both results in decay and other adverse outcomes. We haven't
been brushing our teeth well enough for the past few years!
Reference:
1. Levick D. "Aetna Under Seige: Whack on Wall
Street Only Latest in a Series of Assaults on Insurers." Hartford
Courant. Sunday, February 13, 2000
return to top
|