Not the county's problem

Jefferson County, Alabama has plenty of problems! That's a fact. But The Cooper Green Mercy Hospital is not, I repeat, IS NOT one of her problems.

Recent (and not so recent) events have led the county to where she is. A staggering sewer debt layered in back door deals and kick backs that have led to the conviction and incarceration of a line of public officials longer than my wind, coupled with the repeal of the county's occupational tax has left this county of Jefferson in a financial tail spin. But now, trouble is on the horizon for the county's residents. A threat looms. And that threat comes in the form of legislators (mostly Republican) who wish to close Cooper Green Hospital.

Cooper Green was established to assist with the provision of health care for the residents of Jefferson County. Most importantly it serves as a life saving service for the uninsured and under-insured residents of the county. Thousands of residents depend on the vital and life saving services provided by the fine physicians, nurses and staff of Cooper Green. And almost since its very establishment the hospital has been forced to fight off attacks by outside forces who for one reason or the other disagree with its existence. The most recent attack against this saint of hospitals is being led by Republicans in the state legislature who wish to 'cut funding' to Cooper Green.

Opponents of Cooper Green blame some of the current fiscal distress on Cooper Green by claiming that the hospital 'duplicates services' provided there and at the county's health department. To be sure, the doctor's at the Jefferson County Department of Health do a fine job caring for the disadvantaged of the county but they are not duplicating services that are performed at Cooper Green. The Cooper Green patient tends to be one with more medical problems, more medicines, more hospitalizations, require more procedures and more referrals than the average patient at the health department. To be plain, the Cooper Green patient is sicker. If you so happen to be one of the wonderful patients requiring care provided by the health department and you develop a complication or need a surgery you will be promoted too...... You guessed it! Cooper Green. Also, the health department has no hospital beds. So if you require an overnight stay in the hospital guess where you will be going? To Cooper Green. Doesn't sound like duplication of services to me.

The next thing is Cooper Green's fiscal status. A recent article written by The Birmingham News' Barnett Wright alleges that Cooper Green needs "$75 Million over the next five years from the general fund of Jefferson county to cover a current operating deficit and capital needs" according to a consultant hired to examine the county's finances. The problem is this. Cooper Green operates on an accrual basis and not a cash basis. In other words, monies that are designated to go to Cooper Green from the sales tax that feeds the indigent care fund don't go directly to Cooper Green. They first go to the county and then Cooper Green must request the funds from the county and wait on the county to disperse those funds. Why does that matter? Let's say that on your job instead of a check being given directly to you or being direct deposited into your bank account it went to some other 'holding service' that held your money. When the first of the month rolls around and it's time to pay the mortgage or the auto loan instead of picking up your check book and mailing a check to the mortgage company you had to wait on the holding service to give you your money. What if the holding services was slow and held your money for months? Wouldn't that make your debt compound? That's what the county does to Cooper Green on a regular basis and it often makes it appear as if the hospital is operating in a deficit. That is, at least, until the end of the year and the hospital gets the money it's owed and they then operate in the black because they are able to pay all of their bills. The Barnett Wright article makes it seem like the county is rescuing or helping the hospital when in fact the county is giving the hospital the money it owes to them. Are you surprised that the county doesn't pay its debts on time?

Don't be fooled by the political gaming we are seeing from those who wish to exterminate Cooper Green and the services it provides to the residents of this county. It's the same song we have heard for decades, just a different verse. And I assure you as long as those in this county and state continue to do business the way they have been doing it, the county will be broke if there is or is not a Cooper Green Mercy Hospital.

Hernando Carter, MD

Birmingham, AL

How the Speech Spoke to Me and What it Said

How the Speech Spoke to Me and What It Said Tonight, President Obama delivered his long awaited address to congress and in my opinion it was a home run. I have stated that it was a historic and awesome speech and there have been some to disagree. Some have even insinuated that I love all things "Obama" and believe that our President Walks on water. Admittedly, I supported the President vehemently during his primary campaign and during the general election. I donated money and volunteered time by canvassing neighborhoods, making phone calls and organizing. The obvious motivation that some allude to is the similarity in skin color between he and I. Some say that I love all things Democrat. They are mistaken in both instances. I supported the President because I was moved and motivated by his vision and supported his platform, particularly in the area of health care. In that arena I consider myself a moderate health care reformist. Several weeks ago, I sat in front of my television and watched our President flounder and stumble in an attempt to address the American people and share his vision of health reform. It was very "un-Obama" to say the least. And as I screeched in pain I watched him self destruct and answer a question regarding racial profiling by police in a very inappropriate manner and at an inappropriate time. He totally missed it. In the coming weeks, we would witness a fury unleashed by those who oppose reform like no other. Town halls, assault rifles, death panels, yada yada yada. But not tonight. Tonight President Obama was back. I was waiting for the call and response of "Yes We Can". He was specific, direct, confident and forceful. He was, well, the President. What did I like about the speech? What did it say? I was starving for his vision of health reform since he took office. I received the first course of the meal. First to what it will look like. Private insurance will remain. I like this because I am not a fan of single payer health insurance. As a physician, I like having options and multiple revenue sources. I don't believe physicians should be forced to participate in a public plan (although I think ethically they should. I believe as physicians we are called to be altruistic) and a single payer system will give no options. Private insurance does need reform though. And I liked what I heard from the President on this. Pre-existing conditions as a grounds for exclusion from a health plan will be illegal. Yippee. Great! I think it's unethical to deny those who need coverage the most just because they need coverage. Also, if you're healthy now and pay your premiums and develop a serious condition (God forbid) it would be illegal for your insurance company to drop you or not pay when you need them the most. The idea of an exchange is appealing as well. An exchange will work for all involved. For the patient, it will provide for more availability and choice in insurance plans. Hence, more competition. In most states currently, one or two insurance companies dominate the market and you either take it or leave it. They carry the big stick and write the rules. That's not true capitalism. It works for the insurance company because it opens up the market for them too and makes more customers available to them. And as a primary care physician, more individuals with coverage means more people will seek a physician and hence more volume. A large percentage of revenue into my practice comes from Medicare currently. More patients with a public plan will come, but also more patients with private insurance by way of the exchange will come as well. How will it be paid for? The President says he will not sign legislation that adds to the deficit. I have to take him at his word, however I am admittedly a bit skeptical. He stated that there are cost savings within medicare and medicaid that can help pay for a public option. A new development, at least in my mind, is that the public option will be limited in scope to only those who cannot acquire affordable coverage via the private market. That to me sounds manageable. Cost savings in medicare and medicaid are likely to look like more roll outs of "never events". CMS listed things known as never events that if they occur during hospitalization, they will not pay. These include deep venous thrombosis (blood clots) that develop while a patient is in the hospital, catheter associated UTIs, ventilator associated pneumonia's, pressure ulcers and etc, etc. While the term never is not very practical, the fact the CMS (medicare and medicaid) will not pay for these events, makes hospitals vigilant to avoid these as much as possible and I think has improved patient safety. There are likely to be more never events to come. Hopefully, reimbursements to physicians will not drop. It will make it very difficult for a majority of docs to participate and would hence expand the access issue. Hopefully, there will be provisions to negotiate down the cost of prescription drugs with the pharmas. This unregulated cost adds to the expense significantly. He also stated he will reform medical malpractice suits. Awesome! This WILL help cost. A few weeks ago Chuck Hobbs interviewed me for his blog and asked about cost and paying for health care and I stated that this has to be addressed. Fear of frivolous law suits does force docs to practice defensive medicine. This increases cost. If I do an additional test not because our best medical evidence says it should be done but to cover my butt that raises costs. I felt as if the President googled by comments and plagiarized them. He also stated the premiums of those in the exchange would pay for the exchange. Just as it works now. The difference is costs should be better regulated which makes it more affordable for you and I. Also, there will be tax credits for some. Some citizens will see higher taxes. Most of this will come as a repeal of the Bush tax cuts. Ouch. But a sacrifice I am personally willing to make. What else did I hear? Finally he "manned up". He addressed the lies that have been propagated. He also took charge of this discussion. I have been very critical of what I perceived as his passiveness. Not tonight. Not any more. This issue is one of the most important and historic of our generation's time. And I believe he made a generational speech. Not to his left liberal base, but to the American people as their American president. -- Hernando Carter, M.D. "Just because it looks like you're losing, doesn't mean that you are"- Pastor Mike Moore