One of the positives of the digital evolution of media is the immediate feedback we get from you, our loyal readers. Whether your responses are critical or complimentary, we value your comments. We want to know what is on your mind. Often, your thoughts help shape our future coverage and content. After all, most of you are living delivery system transformation every day, while we are merely witnesses to this historic time.

So, as we do every month, here's a sample of letters we received in response to H&HN Daily articles and blogs.

Last week, Marty Stempniak and I reported live from the ACHE leadership congress. In one blog, Marty wrote about the need for hospitals to find clinical leaders during this time of rapid change. He noted that Witt/Kieffer's Carson Dye urged hospital leaders to seek out physicians who have "a 'calling' to leadership … MBAs are fine and dandy, but they don't automatically turn MDs and DOs into top-notch leaders."

Stephen Loebs at The Ohio State University, offered this critique of Dye's assessment:

Carson Dye apparently overlooked the skills and leadership background provided by Master's in Health Administration (MHA) graduate programs. These programs combine emphases on management skills, population health management and working relationships with physicians. An appropriate educational foundation offered by MHA programs is most helpful for future leaders, including physician leaders.

Regular H&HN Daily contributor Ian Morrison penned a column in which he put on his futurist hat and looked at Obamacare several years out.

M.S. Russo argued that patient responsibility shouldn't be overlooked:

The inability to hold the client/patient responsible/accountable is the same problem that teachers face with students. Anyone working in either of these professions can make the case that the clients (patients and students) who don't follow the advice of the professional (physician, health care professional, teacher, instructor) actually pay no consequences. The fact is both parties do — students don't learn, patients don't recover as quickly or as fully. What might be the best course would be to graphically describe the best-case and worst-case reality — complete with real (not re-created or acted) human examples who "look and act" like the person the professional is addressing.

Writing under the ghost name Soontobeextinct, another reader offered a stark assessment of the ACA:

Anything as complex as this law, and with the literal stacks of implementing regulations that it will spawn, is almost always doomed to failure. Best intentions are usually overcome by unintended consequences in huge government-sponsored entitlements such as this. Also, I've noticed a primary failure in the structure of accountable care organizations. Everyone and everything is held accountable for the care of the patient EXCEPT for the patient his or herself! Well, the one most important in the care of the patient is usually the patient him or herself. A noncompliant patient is today's scourge of medicine, but there's no mention of this in the ACO. How can the "system" be accountable for the misbehavior of the patient? The patient also has no accountability for cost either. Amazingly shortsighted. It indicates the law is more interested in so-called "social justice" than in actual efficient delivery of health care with ALL parties held accountable.

Commenting on John Glaser's column, More Time Needed for Meaningful Use, Rebecca Morehead said:

It is important that as practices, we begin to utilize the reporting capabilities in the EHRs chosen to track for auditing requirements and also to benchmark where we want to go with the outcomes. It will also help us to catch those aspects of the system that are not being utilized. Some of the EMRs out there today are very robust powerhouse engines and many practices have a jet that they are using like a Yugo!

AHA President and CEO Rich Umbdenstock responded to Time magazine's cover story, "Bitter Pill." Readers agreed with Umbdenstock's assessment that the article seemed to miss the mark.

Art Sutherland, M.D., Tennessee coordinator and national board member, Physicians for a National Health Program, wrote:

Mr. Umbdenstock made a good point that health care institutions are complex and barely manageable. That's because we have a supply-driven medical market in America that is not a free market. There are many distortions in this market as pointed out in "Bitter Pill". What we need in the USA is a national single-payer insurance system that would lead to meaningful health care reform that would hold down long-term cost, improve delivery of care, and provide universal access to everyone (the goal of the Triple Aim). Why can't we do this? All other developed nations have national programs of some type that cost less than half of what our market system costs, and do indeed have better population health than the USA. It's time to think out of the box and seriously study what an expanded and improved Medicare for All program would do to reform our outdated "non-system" of health care financing.

Submitting under the apropos pseudonym Bitter Pill, another reader took aim at Brill's research:

Time should have researched the subject in a bit more detail. No one pays the charges in the charge master file or on the patient's statement or bill. Medicare mandates that all patients are "charged" the same price. However they never pay that price. One should look carefully at what is actually paid by Medicaid, Medicare, and many other insurers. Medicaid pays between 50 and 70 percent of the costs ( not the price) incurred in many states and Medicare pays substantially below the costs of serving the patient in most hospitals. Other large insurers with clout — market power — base their payments on percentages of what Medicare pays. Many physicians won't see Medicaid patients because their payments are so far below the costs of treating the Medicaid patients. Soon they will choose not to see Medicare patients for similar reasons.

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