10 years ago the planning agencies were crying "crisis" over the bed shortage in New Orleans, with full sections in our newspapers carrying the stories. Now health planners say "we have too many beds". 20 years ago planners said we need more 08 beds - today, that we need to "close 08" because the planners did not foresee "the birth control pill". "Iron lungs" wards recommended by planners were closed by the polio vaccine - but may be needed for the federal planners' Guillian Barré paralysis from their swine flu vaccine fiasco. "Those who say 'restrict progress to the health center' are regressing 30 years, leading us to a bankrupt system of anticompetitive socialized. monopoly medicine, as in foreign countries. But the Carter, Califano, Kennedy policy is to ration and deny care - so they may be able to 'afford' NHI. NHI will be National Health Rationing," said the PDA spokesman, "and we'll all be like England or Russia: 5 years wait for your hernia operation for the worker, or for the hip surgery for the senior citizen, or tonsillectomy for the child. Let's close the HSAS instead as was recently done in Los Angeles and Puerto Rico. Let the goal of the American medical system be: let every hospital share in our miracles of technology, and make available the best surgery and medicine in hospitals close to where our patients live. Duplication, competition and availability is the key to higher standards of health Care. High Health By The Associated Press Higher medical costs and lower qual ity care are two potential problems in New Orleans hospitals that have duplicated equipment and such services as open heart surgery, neonatal care, certain cancer treatment and dianostic procedures for heart disease The conclusion was contained in a report by the New Orleans Area BayouRiver Health Systems Agency, a regional health planning group under the state Department of Health. Education and Welfare. The planning agency serves 11 parishes. In its report, the agency said only Ochsner Foundation Hospital meets the minimum number of 200 open heart surgeries annually, which is the medical standard of proper use. The other area hospitals which perform open heart surgery are Charity, Southern Baptist, Touro Infirmary and Tulane Medical Center An agency spokesman said all five hospitals also perform pediatric open-heart surgery. but at a rate lower than the accepted annual number for such operations. The report said infrequent performance of a surgical procedure may mean that medical skills do not stay honed Expensive equipment may stand idle or be used when not medically necessary It recommended that hospitals which perform less than a standard number of procedures in a specific field within three years after such services have begun - should stop the prac tices The report is a series of proposed additions to the agency's 1978 health plan covering problems and priorities n the 11 parish area Times Picayune, New Orleans, January 21, 1979 Times Picayune, New Orleans, January 22, 1979 Doctors Dispute By THERESE L. MITCHELL Private Doctors of America Sunday challenged the local health systems agency's conclusion that duplication of hospital services is driving up medical costs. "It is a hoax to tell people that duplication is expensive and rationing will lower costs," Dr Jose L. Garcia Oller, president of the national organization, said of the New Orleans Area-Bayou River Health Systems Agency report "The HSA is using their federal power to turn the clock back 30 years by creating monopolies on health care," Dr. Oller said in an interview with The Times-Picayune. "This will cause a massive increase in health costs, not a decrease," he added. The report, which was released last week, concluded that local hospitals are overly equipped for the needs of the patients. It also recommended that hospitals which perform less than a standard number of procedures in a specific field within three years after such services have begun should stop the practices. Because a specific number of procedures are not performed, the report concluded, the medical skills of the physicians do not stay honed. Dr. Oller said for the HSA to conclude that "quality depends on the number of procedures done is ridiculous. " He added that the HSA recommenda tion for the development of health care centers would probably mean the surgery patient would be cared for by interns and residents who "have to be trained every few months. "In private hosptials, surgery is done by trained, experienced specialists with proven skills. It is the doctor that counts, not the hospital numbers game," Dr. Oller said. Dr. Oller, representing 42,000 doctors from 48 states, also took issue with the HSA's charge that duplication of such equipment as the CAT scanner or Co balt X-ray is driving up costs. "The CAT scanner cost has dropped from $500,000 in 1976 to $85,000 in 1978," he said "The money spent by the local HSA alone is enough to buy a CAT scanner for six hospitals, a Cobalt X-ray, or a kidney dialysis unit every year. "By duplication, the cost has lowered and the CAT scanner service is available to patients in eight local hospitals." Dr. Oller claims that "bureaucratic overregulation is strangling our hospitals, adding $40 a day to costs. Planning agencies are applying a defunct. unworkable, expensive and crystal ball process to medicine." The New Orleans Area-Bayou River HSA is a regional health planning group under the aegis of the state Department of Health, Education and Welfare. It serves an 11-parish area TR 2 STATEMENT BY THE AMERICAN COUNCIL OF MEDICAL STAFFS FR 42, no. 185, 9-23-77 FR 42, no. 225, 11-22-77 Dear Mr. Secretary: I. December 8, 1977 There appears to be no such thing as a failure of a Federal program in Washington. When a program does not work, we change its name, we double the personnel and double the budget. Such is the history of the failure of Health Planning. A. B. In 1946, Congress decided we needed to build more hospitals. The Hill-Burton program for hospital construction was instituted and hundreds of hospitals built. The Congress now finds that we have "too many hospital beds". Never mind that The Congress found, in 1970, a doctor shortage. Today we are told we have too many doctors. Government planners said we had a postwar baby boom, we needed to build more obstetrics and pediatrics wards. Planners and social engineers did not foresee the development of "the pill". Today the Secretary of HEW decrees we must close OB and Pediatric wards. Planners didn't visualize the medical breakthrough of the polio vaccine, and demanded more "iron lungs" and rehabilitation centers. Today, polio is nearly a disease of the past, the centers closed. The point, Mr. Secretary, is that interventional Health Planners have been an expensive failure, because bureaucracy's solutions come too late, and are soon made obsolete by medical progress by doctors working for a cure of the problem. If a "voluntary" government program fails, we tend to make it compulsory and to override the power of the states. 1. The Comprehensive Health Planning Program (CHP) of 1966 was a failure. The money misspent in planning could have paid for the expensive technology it purported to ration, enough money to buy all the Cobalt machines, instead of denying those services. In our own experience in the New Orleans Area Health Planning Council since 1968, nothing was accomplished in eight years other than an astronomical waste of physicians' and community leaders' time. We know of no accomplishment during those years, except "to comply" in order to obtain more "federal dollars". AMERICAN COUNCIL OF MEDICAL STAFFS 3422 BIENVILLE STREET, NEW ORLEANS, LA 70119 504-486-5891 3 HSA STATEMENT C. 2. The Regional Medical Program of 1965 was designed to create Regional Centers for Heart Disease, Cancer and Stroke. With few worthwhile exceptions (stimulating availability of intensive care and dialysis units, etc.) the RMP failed. 3. Because CHP and RMP failed, Congress created a compulsory, huge health rationing device which overrides the proper regulatory powers and authority of states, and eliminates the power and authority of hospital boards in our communities: "The National Health Planning and Resources Development Act of 1975", Public Law 93-641, which was enacted against the unanimous opposition of the medical profession. The National Guidelines provide for Rationing of Hospitals and Medical Services. The Health Planning Act gives HEW the power to ration and dismantle the best hospital system in the world, and to deny access to quality medical care to those most in need, the poor and the rural areas. In the opinion of the Council of Medical Staffs, the proposed National Guidelines would not only deny services, but are incompatible with high quality and compassionate care delivered at the point of need. There are four forms of rationing now used, requisite for political imposition of socialized medicine (national health insurance): 1. 2. 3. Close Hospital Beds no more hospitals to be built. No more beds added. This system is exemplified by the British National Health Service. The public suffers by a long waiting line for care: 2 1/2 years for a hip operation in a senior citizen, years for a tonsillectomy in a child, or a hernia in a worker. We do save "excess beds" "money is saved" but the patients suffer denial of services. Empty beds, Mr. Secretary, are essential for prompt, quality medical care. If the firemen in the Firehouse are idle most of the day, do we then fire the firemen, to call them only when there's a fire? Government planners "foresee" a swine flu epidemic, yet want to close hospitals. Where are we going to admit the patients in an epidemic, in a disaster? No hospital can function efficiently at 80% occupancy - it's simply overloaded, and quality suffers. Deny services as "unnecessary", by creating the artificial Deny equipment: the "reduplication" rationing. This country's 46-585 0-79-40 HSA STATEMENT 4. to "reduplicate". Expensive technology becomes cheap only when The intensive care unit, once esoteric technology, is now What is expensive and is not fruitful is the reduplication of the planning agencies and bureaucrats, which stultify progress in technology and in delivery of care. What we need is a law and guidelines to prohibit reduplication of bureaucratic failWe also need guidelines for the accountability for the cover-ups of the planners. ures. Geographical Rationing: "Regionalized care" which takes doc- individual The CMS recommends, therefore, that the current proposed Guidelines be withdrawn, and a new set of guidelines be issued on the concept of patient and the family as the geographical center of planning and the benchmark of access and quality not the convenience of the "health center" or of the health bureaucrat. That should be the basic reference standard against which to issue the guidelines as required by S. 1501 (b)(1) of P.L. 93-641, "standards respecting the appropriate supply, distribution and organization of health resources". The proposed Guidelines, Mr. Secretary, are further subject to the following criticisms. 1. 2. 3. 4. 5. They set raw numbers as the answer to problems. A central computer can now do the entire national planning, relocate all hospitals and services. State planning and Health Service Agencies are rendered obsolete by the guidelines. The Guidelines give HSA's and the federal government the power to regu- Rural services by doctors and hospitals will be seriously diminished. 5 HSA STATEMENT 6. 7. 8. 9. ally changed by federal edict, instead of by evolutionary response to the needs of the sick. Federal hospitals, public health service hospitals should be the primary testing areas for all "health planning". Only if they work in "federal" hospitals, should the experiment be cautiously expanded. The Guidelines represent a clear incentive for overutilization. "Heart units" will obviously strive to attain their "200 operations" "to stay alive". Patients will be shuttled accordingly, for the convenience of the quota. When the quota of "200" is reached, the patients' operation may then be conveniently postponed to the following year's quota. Is this, we ask you, quality - producing guidelines? The "quota" system for babies, for children, and for technology, etc. If we are to encourage medical services to small communities the CMS a. b. exempt doctors from income tax for three years if they work in encourage, not restrict, full availability of services: OB, pedi- 10. An "80%" average occupancy rate standard will increase costs, not lower them. It becomes an incentive to the hospitals to: a. Keep patients longer just like the Public Health Service hospitals, whose attention to their bed occupancy leads to lengths of stay up to 15 years (see CMS monograph on the New Orleans PHS Hospital). b. Admit patients who may be treated as outpatients as the PHS hospitals and Veterans hospitals admit patients just for "Barium Enemas", just to keep up their occupancy rates and justify their existence. 11. These Guidelines, by eliminating the smaller and the rural hospitals, will create a Health Monopoly under the Secretary of HEW Health Czar. The majority of this country's hospitals have 100 beds or less, yet give excellent care. The guidelines would have many of these fine hospitals eliminated or taken over by large hospitals. 6 |