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Tue Nov 27 14:53:28 GMT 2007

Oh Pret, my dear friend Pret.  Why does it always come back to that one issue - the WAR - which you have decided is the root of all financial evils in our profession (and all others, I presume).  Why not mention tort reform and its effect on malpractice insurance costs?  Why not mention the multi-million dollar malpractice awards given out by juries "of our peers" that keep the costs going up?  Why not mention the gobs of hostage money that our hospitals are now forced to pay to our sub-sub-sub-specialty physicians who will not take call in the EDs unless they get paid more just to take call then our family practice colleagues earn in one year?  Why not mention the uninsured and their effect on the inner city hospital's ability to pay the ever-increasing cost of doing business.  Why not mention the obscene cost of prescription medications , allegedly that high to pay for R&D of new and better medications.  Why not mention what this new mandate from the feds that will deny payment to hospitals for patients in those hospitals who will suffer complications that are, in fact, well known and almost unavoidable consequences of our incredible advanced medical capabilities, without which these folks would have simply died from their diseases at the get-go.

In short, what in hell's name does any of that have to do with OIF (Operation Iraqi Freedom, just in case you haven't kept up on the lingo).  And yes, I know the cost of the war is billions per year (50 billion in the last request, as I remember it).  But just what does that have to do with any of the things I mentioned above.

I am glad to see that you are as zealous on one side of the coin as i am on the other........ain't America great??

Take care,
Ron

>>> "Bjorn, Pret" <pbjorn at emh.org> 11/27/2007 9:24 AM >>>
Sad that all this red ink comes to a small fraction of one per cent of
Georgia's share of federal healthcare reimbursement slashed by the
current administration.

Fifty million dollar budget shortfall?  End the Iraq war six hours early
and let Grady keep the change.

Pret Bjorn
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith
Sent: Tuesday, November 27, 2007 7:52 AM
To: rockmd at aol.com; 'faran bokhari'
Cc: 'Trauma &amp; Critical Care mailing list'
Subject: Grady

Atlanta Hospital Moves to Unburden Itself of Debt 

By KEVIN SACK
<http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack 
/ind
ex.html?inline=nyt-per>  and SHAILA DEWAN
<http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew 
an/i
ndex.html?inline=nyt-per> 

ATLANTA, Nov. 26 - The politically appointed board of Atlanta's troubled
charity hospital effectively voted itself out of business Monday, the
first
step in at least a short-term escape from the insolvency that had
threatened
the region's only top-level trauma center.

Without the financial bailout made possible by the vote, the hospital,
Grady
Memorial, was at risk of not meeting its payroll, perhaps by the end of
the
year, hospital officials had warned. Though Grady, like most public
hospitals
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto 
pics
/hospitals/index.html?inline=nyt-classifier> , has faced intermittent
financial crises in the past, this one has generated real anxiety
<http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove 
rvie
w.html?inline=nyt-classifier>  because of its roots in a collision of
national forces, including the unchecked growth of uncompensated care
and
deep cuts in government reimbursements. 

Political leaders and medical officials have worried that Grady, woven
into
Atlanta's social fabric since 1892, might follow Martin Luther King
Jr.-Harbor Hospital in Los Angeles County as a casualty in 2007. If so,
the
consequence would be a "patient tsunami" at other area hospitals, the
Metropolitan Atlanta Chamber of Commerce said in a report earlier this
year.

Grady - which supplies the region with its only 24-hour trauma center as
well as poison control and burn units and large clinics for AIDS
<http://health.nytimes.com/health/guides/disease/aids/overview.html?inli 
ne=n
yt-classifier>  and sickle
<http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over 
view
.html?inline=nyt-classifier>  cell anemia - has operated in the red for
10
of the last 11 years. It is expected to run a deficit of $50 million to
$55
million in this year's $730 million budget. 

The hospital owes an accumulated $63 million to its biggest creditors,
the
medical school at Emory University
<http://topics.nytimes.com/top/reference/timestopics/organizations/e/emo 
ry_u
niversity/index.html?inline=nyt-org>  and the Morehouse School of
Medicine,
which provide its doctors and have threatened to train residents
elsewhere.
Republican state legislators had threatened a state takeover if local
officials did not reconstitute the hospital's governance structure.

Following a raucous meeting marked by chants and protest, the 10-member
Fulton-DeKalb Hospital Authority voted unanimously to hand daily control
of
Grady and its affiliated clinics and services to a nonprofit corporation
to
be formed for that purpose.

A Chamber of Commerce task force had advised earlier this year that a
governance change was needed to remove the hospital from the control of
the
elected commissioners of Fulton and DeKalb Counties and to restore the
confidence of lenders, foundations and Georgia's Republican leaders. 

Advocates for patients have warned that the hospital would become less
responsive to community needs if it was operated by a less political
board.
But with few other options and Grady's fiscal condition worsening, the
authority felt it had little choice.

"In three weeks, our cash position would have been zero," the
authority's
vice chairman, Dr. Chris Edwards, said at the meeting Monday.

In its resolution, the hospital authority, which would continue to own
Grady's buildings and land, made explicit that its willingness to hand
over
control depended on substantial financial commitments from both the
public
and private sectors.

Before the lease, to be executed by Dec. 31, becomes effective, the
hospital
must receive written commitments for a capital infusion of $200 million
from
businesses and philanthropies.

In addition, the resolution demands that state leaders provide written
support for $30 million in new state aid.

A. D. Correll, a former chairman of the Georgia-Pacific Corporation and
the
co-chairman of the task force, said he considered the vote a critical
first
step, though with provisos attached. "They were a surprise, a lot of
them,"
Mr. Correll said of the conditions, "and they require action on a whole
lot
of people's parts." 

Mr. Correll said a single anonymous donor had agreed to give the
hospital
$200 million if the donor approved of the governance system changes. He
said
he was confident that the private sector could raise an additional $100
million in two or three years.

The fate of the hospital has become a keenly watched civic drama,
overlaid
with issues of race and class. 

Some black activists and elected officials had warned that the
governance
change would shift control of the hospital from black political leaders
to
white business leaders. The hospital's problems, they said, are
financial
and not political.

Chamber of Commerce officials, white and black, have responded that the
only
color that matters in the campaign to save Grady is green. And
justifiably
or not, they say, business leaders and state officials were willing to
participate in a rescue only if they saw a real departure from past
practice, when the hospital's board was perceived to lack technical
expertise and the will to block corruption and cronyism.

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