Tuesday, November 13, 2007

More About Hospital's "A-Lists"

We previously posted about how one well-reputed US state-supported academic medical center allegedly maintained an "A-list" of donors and other VIPs who received additional amenities, and easier access to health care. One of our readers responded to it thus:

The 'A list' idea is a very common practice. I've always found it
offensive, intrusive and detrimental to patient care. Of course it suggests
that the UIP's (unimportant persons) get lower quality treatment

Our hospital has a program that is almost like calling a 'code.' When a
patient on the list is admitted, the administrator on call is paged and the
administration people then proceed to make a nuisance of themselves. I have
actually had the chief of staff of the hospital poking around in the
patient's chart and giving the patient's family his card so that they were
calling the administration about routine issues that should have come to me.
In one case, the VP of nursing was pacing the floor outside the patient's
room watching everything that was going on.

He then asked,

It might be interesting to find out exactly how widespread this practice is.
Perhaps what's needed is a public statement about how inequitable it is and
that it's not in the patient's best interests.

In fact, the Dallas News decided to see if the practice is common at least in Texas. However, it appeared that it is not, at least in the UT Southwestern version. For example, the reporter asked about the Baylor Health Care System,

'What they're doing is unusual. It sounds to me like they have a prospective list rather than people they already know through volunteers, board relations, donors or something like that,' said Jennifer Coleman, senior vice president of Baylor Health Care System.

'Most [hospitals] do keep track of board members and donors, but we do not have a target list,' Ms. Coleman said. 'What they are doing is something I've never heard of.'

At Baylor Health Care System, Ms. Coleman, the senior vice president, said free parking programs and expedited paperwork are available – to anyone who signs up.

Re M. D. Anderson Cancer Center in Houston, also part of the University of Texas system,

M.D. Anderson Cancer Center in Houston, which, like UT Southwestern, is part of the University of Texas system, has a separate development office outside the hospital that deals with fundraising activities.

'What they do is build and cultivate relationships of people who they believe may be potential donors,' said Wendy Gottsegen, director of external communications. 'That's common practice.'

But the fundraising does not cross over into the care that donors and potential contributors would receive at the hospital. 'Absolutely not. I want to be 100 percent clear,' Ms. Gottsegen said.

Re Presbyterian Hospital of Dallas,

Presbyterian Hospital of Dallas is a nonprofit hospital and does track its donors. But that does not translate to any special perks or levels of patient care, said spokesman Stephen O'Brien.

'We do not have a VIP list,' he said. 'Our foundation has a list of members, but it's not a list that is cross-checked with the hospital. We are sometimes made aware if a donor is in the hospital. We will stop by to say hello; that's the extent of it.'

Mr. O'Brien said influential or well-known patients are not flagged by the hospital. 'We're not dismissive of any one class of patients,' he said.

The article reiterated that people on the "A-list" not only get amenities, but enhanced access to physicians and care,

They do get a personal greeting upon arriving at the medical center for an appointment. Most also get an escort to their appointment and free parking.

A more select group receives extensive personal attention and a streamlined process for contacting doctors. The dedicated program acts almost like a concierge service for these people.

People in the program know they are on the list, because they are sent a letter informing them about the special services they can receive. To make appointments, they can use an unlisted phone number to reach the Special Assistance Office. The hotline is also available for reaching a doctor on weekends and after hours.

A UT Southwestern physician will promptly return such calls
, said Dr. McConnell. If necessary, the doctor will also meet the patient at the hospital "and introduce the patient" to the emergency room staff at UT Southwestern's St. Paul building or at Parkland Memorial Hospital, Dr. [John] McConnell [executive vice president for health system affairs] said.

The process is different for those not in the special assistance program. Those who call the medical center's main phone line after hours will be referred to the general answering service, he said. A responding doctor might refer these callers to one of the emergency rooms, but would not automatically meet them there, he said.

So it would seem that other hospitals and medical centers may have "A-lists," but the practice is not universal.

As noted before, the practice does raise troubling questions, especially whether it may violate the organizations' missions. As noted earlier, the University of Texas Southwestern mission statement specifically included the goals of improving "medical care in our community," and "focusing on quality, safety, and service."

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