A.D. "Pete" Correll, hospital rescuer
Pete Correll didn't have to help Atlanta's Grady Memorial Hospital. Usually in these kinds of Dickensian tales there is a personal hook that leads the wealthy benefactor to help a hospital, such as finding himself being treated there by some odd set of circumstances. Yes, Correll, the former CEO of giant Georgia-Pacific, did have a heart attack a few years back, but he was treated at Emory University Hospital with the rest of the insured crowd.
Correll told the Atlanta-Journal Constitution that he and an inner-circle of Atlanta industry scions were talking about who could save Grady from its decades-long downward spiral of debt, revolving door CEOs, and community distrust. "We decided it would be us," he said.
Correll is now chairman of the Grady Memorial Hospital Corporation. Step one was to wrestle away control of Grady from a public board mired in politics and convert its governance to a community-based nonprofit model. The carrot was a $200 million gift from the Woodruff Foundation that allowed Grady to buy some luxuries like its first new hospital beds in decades.
Step two was to bring in a proven turnaround CEO in Mike Young, who spent his first week on the job looking at any check more than $1,000 to see who was getting paid and who should not be.
Philanthropists carving their names on hospital buildings is nothing new, but to veer away from the tweedy grounds of the academic medical center into a troubled public hospital is a rare leap of community support. Some in Atlanta may still view the move as a takeover by an elite group, with racial overtones aplenty. But as public hospitals start to fail in communities across America, more cities will wish they had rich guys like Correll.
Douglas Shulman, IRS commissioner
He's only been on the job for a little more than eight months, but perhaps no single person has more influence on interpreting those pesky Form 990 and Schedule H revisions than the attorney and former vice chairman of the Financial Industry Regulatory Authority who became the 47th commissioner of the Internal Revenue Service last March.
Douglas Shulman wasn't around for the congressional legislation that drove the Form 990 revisions or the implementation of the Schedule H form that details how hospitals are spending their money. Nevertheless, many hospital chief executives are rightly directing their top lieutenants to make sure nothing embarrassing turns up in these publicly available forms.
The new forms are "by far the biggest change I've seen in the 20 years I've worked in the healthcare tax arena," says Jim Sowar, national healthcare provider tax leader for Deloitte & Touche LLP. Shulman and his lieutenants have broad authority to make changes in the forms, and since the answers hospitals give—ostensibly to make the case that their tax breaks are deserved—are narrative and open to interpretation, it seems natural that Shulman and his leadership team will have broad authority to interpret what those answers mean. Not to mention that they have a legislative mandate to worry about from Congress. Administrators in the government who are tasked with doing Congress' bidding hate being called before that body almost as much as individuals and hospitals dislike being asked questions by the IRS.
So how does Shulman make healthcare better? Some would argue that he doesn't. Surely hospital leaders who feel their organization is doing the right thing don't relish spending the extra dollars that will be required to fill the forms out properly. But making healthcare better isn't always about popularity. The increased focus on transparency that the forms will foster should cut down on the fraud and waste perpetrated by certain organizations that, despite their generous tax breaks, perhaps aren't acting in the best interests of the community.
Gil Mileikowsky, whistleblower
Whistleblowers often pay a high price for exposing flaws in the healthcare system. Like a lot of physicians who have been in his situation, Gil Mileikowsky, MD, essentially lost his livelihood. It started in 2000 when he was approached by a lawyer representing a patient whose Fallopian tubes were removed without consent. He hadn't heard of the case, even though it happened in his own department, and he began to suspect that other patient safety incidents weren't being reviewed through the proper channels. He agreed to serve as an expert witness against Tarzana Regional Medical Center, a joint venture of HCA and Tenet HealthSystem, and four days later the hospital CEO informed him that he would be escorted by security while on hospital grounds. A few months later he was suspended.
That was just the beginning of a long legal battle that is still ongoing. The American Medical Association, the California Medical Association, and other physician and consumer organizations—including a partnership between doctors and trial lawyers spearheaded by attorney Alan Dershowitz—filed amicus briefs on Mileikowsky's behalf. For many of his supporters, the central issue is peer review and whether hospitals should have authority to remove a physician without due process. His case recently led to a new California law that extends whistleblower protection to all physicians, and he has campaigned for similar protections on the federal level.
But in Mileikowsky's eyes, he is locked in a much grander struggle to improve the quality of the healthcare system. He founded the Alliance for Patient Safety to document his case and push for safety reforms, and he has developed what he believes is a solution to poor quality control—a "black box" for physicians. Hospital errors should be reviewed in double-blind studies by randomly selected specialists to remove bias or potential conflict of interest, he argues. Although he never intended to become a whistleblower, he says his goal is now to expose flaws in the entire system, not just one hospital.
Whistleblowers like Mileikowsky play an important role in an industry that is often unsuccessful at policing itself; they now initiate nine out of 10 fraud cases for the Department of Justice. Although in some situations they stand to receive up to 25% of any amount recovered, that wasn't the case for Mileikowsky. "I didn't wake up one day and say, 'I want to become a whistleblower,'" he says. "A whistleblower is just someone who tries to sound the alarm about a wrong situation."