Archive for Editorial

How can local governments cut expenses?

In a recent editorial in the Enquirer, Mr. Harris, a former city Councilman, contends that in Ohio the operation of local governments is antiquated. He points out that Hamilton County alone has 48 local governments and that each of these has a fully equipped police department. In 2009, Hamilton County taxpayers spent $275 million for these police facilities, some of which provide safety for areas less than 1 square mile.

Let’s focus upon the Mariemont and Fairfax Police Departments within the context of overlapping and duplication of law enforcement services. First, it should be pointed out that the Village of Mariemont occupies .89 square miles and the Village of Fairfax .76 square miles with a combined census of 5,103 citizens.

The Mariemont Police Department has 10 police officers and the Fairfax Police Department has 9 for a total of 19 to cover this total service area of 1.65 square miles. In 2013, Mariemont’s total expenses to maintain their Police Department were $1,248,776 (approximately one-third of the entire budget) whereas Fairfax’s Police Department cost $1,147,240.

I queried a number of friends and our educated guess is that 40 percent of cost to maintain a standalone Mariemont Police Department could be saved by merging Mariemont’s and Fairfax’s Police Departments. If you take 40 percent of Mariemont’s $1,248,776 expenditure on police protection, it comes to a yearly savings of about $499,510. And note that this is just the cost savings referable to the police department.

The next question was whether a merging of the two police departments would compromise safety. The group agreed that it would have a negligible effect upon police services and safety.

Granted, change is always easier said than done when it comes to jurisdictional and power issues, not to mention personalities. At a minimum, if the Mariemont and Fairfax Police shared the night shift coverage, it would equate to roughly $100,000 in yearly cost savings.

Just consider what the Village of Mariemont could do with a half million additional funds a year, or even a hundred thousand. Possibly, hire a part-time Village Administrator, improved street maintenance, free garbage collection (eliminate those stickers), no fee memberships in the swimming and tennis clubs, free land rent for a garden in the South 80, new recreational facilities, rejuvenation of the Historic District and lower taxes could be considered. Longer term, the Village could certainly use better parking facilities, a community center and improvements to the Municipal Building.


–Dick Wendel, MD, MBA

Choosing the Best Doctor

 What is the Best Way to choose your Doctor?

As a physician, many of my friends and acquaintances ask me to comment on the doctoring skills of some of my medical colleagues. Some take it a step farther and ask who the very best doctors are in a given field of medicine. Admittedly, a positive testimonial about the skills, knowledge and abilities from a physician about your private physician or specialist is reassuring.

But even as a physician, it is difficult to judge the competencies of other doctors and how their practices treat patients. Only in my specialty of urology was I confident that I knew with certainty who were the better practitioners. For instance, I knew the number and types of procedures they were performing at the hospital and often took care of some of their complications or patients that were dissatisfied with their care. In addition, I knew them socially and attended the same scientific and medical conferences. As they were competitors, it was unusual for me to refer patients to other urologists.

Judging medical practitioners outside of your medical specialty is very challenging and most often based on subjective and second hand information. Certainly the doctor’s reputation amongst his colleagues is important, but not always accurate because it may relate more to friendship and social skills than ability. However, the opinions voiced by the floor and operating room nurses and staff with whom the doctor works, however, are usually right on target. Other considerations that may or may not influence your decision include malpractice actions and catastrophic medical complications plus any disciplinary actions against the doctor by the State Medical Board or curtailment of privileges by a Hospital.

You might think that primary care physicians and pediatricians (PCPs) would be accurate in their assessments of the quality of medical care rendered by the specialists to whom they refer. But the typical PCP refers only a few patients to any one specialist and rarely has the time to discuss the patient’s experience with that doctor’s practice when he or she returns. Additionally, PCPs today rarely follow their patients when they are admitted to the hospital and in large groups specialty practices the new patients are often assigned a doctor that has openings rather than the doctor the PCP referred the patient to in the first place. Moreover, physicians no longer congregate in the morning in the hospital medical staff lounges to socialize, provide curb stone consults and get to know one another.

Adding to the difficulty in assessing the quality of an individual physician is the very structure of today’s medical marketplace. For starters, insurance plans often change their panel of physicians and enrollees often change health plans. Most physicians are now in large medical groups and when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the numerous partners that happens to be on call. Moreover, the hospital systems are buying medical practices to form large vertically ‘integrated’ healthcare systems and this disrupts traditional referral patterns by the hospital’s insistence that their physicians refer only to other doctors in their system.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practices. In fact, within Obamacare, up to 2 percent of reimbursements will be linked to patient satisfaction in the near future. Many patients have already received the 3 or 4 page satisfaction questionnaire after a medical visit, outpatient surgery or a hospital admission.  Response rates to these extensive surveys are generally low and the majority of patients that complete the survey are either the very satisfied or the very dissatisfied. Thus, from a physician’s point of view, these surveys have limited ability to quantify quality.

New Statistical Ways to Choose a Doctor

In a recent USA TODAY article they talk of a revamped website as a new tool to research doctors. This site uses about 500 million claims from federal and private sources to rate and rank doctors. It claims to factor in experience, complication rates and patient satisfaction. Problems arise with selecting a physician in this way because:

  1. Some physicians treat sicker patients than other doctors and accordingly might have higher complication rates. No severity of disease adjustment of patient populations is possible.
  2. Medical treatment still lacks broad standardized parameters of medical care for all but a few common clinical conditions such coronary artery bypass surgery, diabetes, asthma and pneumonia.
  3. The collection of electronic data covering large populations of patients is still in its infancy and the current statistical data is insufficient to evaluate individual physician performance.
  4. The geographic, insurance and technical barriers to properly match patient and physician are many.
  5. Patient satisfaction statistics may be the only valid indicator because patient satisfaction does correlate with quality and outcomes.

Both Cincinnati and Cincy Magazines rate the ‘best doctors’ in Cincinnati based upon surveys sent to all or some of the 5000 physicians practicing in Hamilton County. The surveys are quite simple, “who would you send your relatives to for care?” With large group practices dotting the medical landscape and hospitals owning a large swath of medical practices, this type survey causes business interests to surface rather than objectivity in physician evaluation. There are few independent physicians in solo practice who ever make the list of best doctors. Moreover, the survey response rates tend to be less than 20 percent and, at best, this exercise becomes a ‘popularity contest.’ In my review spanning many years of these ratings, I have been unable to see any correlation between the survey results and the quality of care administered by those selected.

Lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, medical testing facilities and so on must sell magazines and attract viewers because the numbers of lists in all media just proliferate. In Cincinnati, virtually all major heart, orthopedic and neurosurgical clinics claim to have high national ranking. You must ask how and by whom or just chalk it off to the hospital’s or practice’s aggressive marketing efforts.

In the medical field, physicians and physician specialists all read the same scientific journals, attend the same medical society meetings and, as a consequence, no one has ‘special’ knowledge or revolutionary techniques. Some efficient hospital systems such as the Mayo and Cleveland Clinics have perfected their processes to expedite medical care and achieve a reputation through exemplary patient satisfaction. Additionally, if a surgeon or hospital does 500 open hearts a year, they usually are more proficient than if they do 50-100 per year.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match.. At the end of the day, you, the patient, are the best custodian of your health. A healthy lifestyle has greater survival benefit than selecting the best of the best doctors.


– Dick Wendel MD, MBA

Ohio Community Governments Struggle

An opinion piece in the Enquirer on January 9th cut to the crux of the financial problems facing local governments in Ohio. Dusty Rhodes, the Hamilton County Auditor, and Greg Harris, a former Cincinnati councilman, provided the insightful commentary. Both agreed that the State of Ohio has a budget surplus at the expense of local governments.

Mr. Rhodes feels that the current State Administration and a compliant Legislature is encouraging local governments to “tighten our belts” with “shared services” and “conservative government.” He goes on to say, however, that the vast majority of local governments are operating conservatively and have already tightening their belts and sharing services whenever positive.

Mr. Harris contends that in Ohio the operation of local governments is antiquated pointing out that Hamilton County alone has 48 local governments. In 2009, he notes that Hamilton County taxpayers spent $275 million on 48 fully equipped police departments, some of which cover areas less than 1 square mile.  He goes on to say that this overlap of services creates self-defeating jurisdictional issues that are reinforced by the political clout of entrenched power that holds tremendous sway over local elections.

The elimination of estate taxes and certain property taxes will dramatically shrink the revenue streams of all local governments in Ohio. As was pointed out in a November editorial on the blog, the Village of Mariemont during the past ten years collected $3,370,347 in estate taxes and that if there had been no estate tax, the Village would be $2,054,243 in debt at the end of 2012 rather than having $1,316,104 in reserves.

These figures provide a look into the magnitude of the problem and a recent article in the Eastern Hills Journal revealed that recently the Mariemont Council had to approve a $390,000 appropriation to cover its budgetary shortfall in 2013. These numbers bring into stark focus the squandered opportunity to form a JEDZ with Columbia Township and the need for our leaders to become proactive in producing a balanced budget. Shared and consolidated services may become the only option other than higher taxes, which in Mariemont are already some of the highest in Hamilton County.

Saying 'No'

How Difficult is it to just say ‘no’ when you are asked by a cashier or other unfamiliar person for a small charitable donation for an organization with which you

are unfamiliar?

For instance, before totaling your bill the clerk asks “would you like to contribute $1 toward helping breast cancer victims or those with muscular dystrophy?” This type of solicitation occurs with some regularity and, if you decide to give, the small donations may go toward worthwhile causes but how do you know the organization that receives the money will put it to good work. It is a pure leap of faith. I prefer give larger donations to just a few organizations whose mission and range of charitable services I fully understand. What are your thoughts about these ‘blind-siding’ requests and do you have suggestion about how to suppress any guilt you might feel by refusing to give?