I had a couple of exciting moments. First, there was the website I was sent to edit which turned out to be entirely stolen. Yep, the client had snitched whole paragraphs of content from a variety of competitors. Fortunately it’s agency work, so I don’t have to deal with the client directly, but I’m making a mental note not to trust those guys with my money.
The question is unlikely to arise, I know. Right now, I’m waiting for payments to come in so I can pay #2 son’s tuition. I don’t expect to need a financial advisor any time soon.
The next bit of excitement was a contact through my website from a major educational product company. I had to restrain myself from gushing about how I used to sell their stuff! That exclamation point is to show how I would have gushed, not to emphasize my restraint. I totally can fix their web site, too, and I really hope they choose me.
I did also have a call from another agency yesterday, and we got as far as “How do we proceed now?” and “You’ll be hearing from me soon.” And then this morning I had a request to interview from a new agency that describes itself as “a disruptive force.” I think I’d quite like to work for a disruptive force.
But perhaps the most exciting bit was one of the topics I wrote about. Really, I like all the topics I was writing about. I wrote someone a very nice website yesterday, and I love the process of coming up with ways to say what they want to say that really fit their goals, and the character of their business, and their target audience. It’s a great pleasure.
But I’m working right now on 2500 words about a political issue, something I don’t get to do very often, and it turns out to be very interesting.
It’s about physician-owned hospitals, or POHs. Some of the POHs have come about because inner-city hospitals were being torn down by cash-strapped cities, so the doctors who worked there banded together to save the hospital. You could make a movie out of that. Some have been built by doctors who were frustrated with the level of care they were able to give at corporate-owned hospitals, and making their own hospitals allowed them to provide the kind of health care they thought their patients deserved.
Some, no doubt, were built by groups of doctors who felt that they could make more money if they got not only their fees, but also some of the profits of the hospital itself. And it it this capitalist attitude that has — perhaps — led to a bill which is designed to run PHOs out of business.
There are two main arguments against PHOs. The first is that the level of care they provide is inadequate, that they are out to make a quick buck and therefore they push expensive procedures onto patients who don’t need them, that they put profits first, etc.
Consumer Reports, an organization I trust, just brought out a report ranking hospitals throughout the U.S. In 19 states, the top-ranked hospital is a POH. In my state, the top two are PHOs, and four of the top seven are. Since there are only about 225 PHOs in the nation, this is not the kind of result you’d expect. The PHO in our capital city, which doesn’t even have a million residents, is not just #1 in the state, but is ranked in the top 5% of the nation by Health Grades, an independent organization.
And, since much of this first argument is about for-profit vs. nonprofit hospitals, it’s worth noting that relatively few hospitals nowadays are nonprofits. We have some charity hospitals in our state, run by religious organizations, but most belong to corporate chains. Even many of our city hospitals are managed by corporate chains on a for-profit basis. In Sacramento, a city which looked into this question, 95% of the hospital beds belong to six corporations. So the PHOs aren’t in competition with government hospitals.
That, however, is the second concern. PHOs, the story goes, will cherry-pick (or skim the cream — pick your favorite metaphor) the healthier, wealthier patients, leaving the charity cases and the Medicare patients for the public hospitals. This is of course the same argument we’ve heard for years about public vs. private schools.
The Congressional Budget Office, however, was quite frank about their thinking on this. In areas with PHOs, they noticed, it was more common for people to have orthopedic and cardiac surgery. By closing down PHOs, forbidding their expansion, or limiting their ability to accept Medicare, they hope to avoid paying for such expensive treatments for Medicare patients. That is the source of the savings they’re predicting: Medicare patients won’t get expensive procedures.
I don’t see why they didn’t just say that they’ll no longer pay for cardiac and orthopedic surgery (it’s a long list, actually, but those were the examples in the letter) for Medicare patients. Possibly they felt that such a law might make them look heartless.
It’s interesting, though.