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Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

June 16, 1998

The Honorable Nancy-Ann Min Deperle
Department of Health & Human Services
200 Independence Avenue
Washington, DC 20201


Dear Ms. Deperle:

I am writing concerning the issue of possible private contracting with hospitals.

I am on the Ethics Committee of my local hospital, and we have had various concerns about quality of care issues under the current fiscal constraints of the medical care environment. There is some concern that nurses are somewhat overworked and the patient/nurse ratio has increased beyond what is reasonable.

In the interest of quality care we are thinking of possibly establishing a special floor on the hospital where patients who wish to obtain better nursing ratios and other potential amenities could pay an extra sum to the hospital per diem to obtain improved quality of care. The exact amount would depend upon the details of the specific benefits.

My concern is that would it be possible for Medicare patients to pay the hospital extra to obtain this improved quality of care. I am aware that doctors who sign "private contracts" are forced to forego any Medicare payments for 2 years from the time of private contract. I am wondering whether or not a hospital would be in this similar circumstance or whether the hospital could arrange to improve the quality of service for some additional "extra" reimbursement.

I thank you for your time and effort in dealing with this issue for me. I would appreciate your reply at your earliest convenience.


James P. Weaver, M.D.