Catholic Church enters 20th century on reproductive health by passively accepting justifiability of contraception and abortion in its institutions.
The Roman Catholic Church, Catholic Health Initiatives (CHI), and KentuckyOne Health (KOH) most certainly had only an incomplete understanding of what they were getting into when they assumed management earlier this year of a secular University of Louisville Hospital and also effective control of the academic medical practices of the University’s faculty and trainees. These religious organizations must now also learn how to deal with contemporary academic research standards. KentuckyOne is promoting its intention to participate in the University’s clinical research enterprise. Indeed, Jewish Hospital has been doing so for many years. Increasing clinical research is also a prominent part of the UofL’s commercial research enterprise.
As Catholic organizations, CHI and KentuckyOne expect University employees, physicians, trainees, and patients to accept its religious tenants with respect to medical care. Indeed, trainees are now required to attest that they have received training about those religious directives. I suspect these faith-based organizations were unaware of the extent to which the Church itself was going to have to, in turn, confront and modify some of its traditional dogma in order to participate in the clinical practices and research of a modern, science-based University and Medical School. By entering the contemporary world of research; CHI, KentuckyOne, and their supervising Catholic Church have tacitly acquiesced to the reality that contraception and abortion are integral to scientific and medical standards of honest and ethical clinical research. Even if unintended, this is a break-through of historic proportions in the history of religion. I congratulate the Catholic Church for allowing its medical mission to enter the 21st Century. Allow me to explain how the Church is being forced to confront and partially alter its previously sacrosanct medieval dogma. Continue reading
Doing not so good? Blame the test.
On May 8, the Leapfrog group released the third iteration of its Hospital Safety Scores. The first appeared in June 2012, and the second in November. I have expressed concerns about the value to curious professionals and consumers alike because of things like volatility of scores over the short term, lack of inclusion of the many small hospitals in the state, and lack of correlation with safety scores proposed by other organizations. Nonetheless, the Leapfrog Group was one of the earliest to push for public disclosure of hospital safety parameters and its evaluation deserves to be taken seriously. I will break out the data underlying the scores and compare it to last November’s in more detail later, but for the time being, here is a raw count of the results for Kentucky hospitals.
Curtis Morrison expanded Kentucky coverage in Insider Louisville of the emerging national scandal of Angioplasty Abuse. Not that this is a new phenomena or anything. The healthcare industry has been riding the gravy train for a long time, taking advantage of our communal willingness to pay for volume rather than necessary and effective medical care. What else should we have expected? What is best for us as patients gets easily rationalized at the altar of economic development, or even ignored. Angioplasty is just the tip of the iceberg! Continue reading
Additional photographs and maps supporting this article can be seen here.
Another place to collect medical dollars. Is the sky the limit?
In a previous posting, I categorized my effort at investigative journalism as a Hardy Boys adventure. I had in mind the young detectives of my boyhood reading, but a friend advised me that modern-day Hardy Boys are members of US military special forces who conduct “dark” operations. Given the nature of the secrecy surrounding healthcare planning in Louisville, perhaps I am on target in either scenario. In any case, to maintain an appropriate image of impartiality, I conducted my next excursion to the east as Nancy Drew.
As the growth of medical facilities in Louisville has evolved, all three major hospital systems have leapfrogged beyond the confines of the Watterson Expressway to the Gene Snyder Freeway (I-265) and beyond. Of course, this is neither unexpected nor unjustifiable. This is where Louisville’s population is settling — especially those with good medical insurance. I might offer my services there too. Indeed, as a patient, unless there was some special reason I needed to go downtown, I too would rather stay closer to home. Inspection of maps, real estate transactions, and observations on the ground make it clear to me that our hospitals are ready, willing, and able to expand their east-county facilities even further. New construction has already begun. What will stay downtown remains to be seen. This article will focus on the developing medical center springing up around the intersection of the Gene Snyder and Old Henry Road. I invite you to share my field trip with me and to add what you can.
New home for UofL Faculty Private Private Practices?
Genealogy hobbyists will tell you that while much information is available on the internet, eventually you have to get your feet dirty and go out into the real world for information. Taking that advice to heart, I played Hardy Boys last weekend and went out to walk the property of the medical facilities at the Jewish Hospital/Norton Suburban medical centers on Dutchman’s Lane and Dupont Circle. There was much to see and insights to gain. It appears to me that KentuckyOne Health already has enough land to build a major new medical facility and/or renovate and construct several smaller ones. A newly acquired office building might house a battalion of KentuckyOne and University of Louisville faculty physicians. A single additional acquisition will give the company a massive piece of contiguous land on which build nearly anything, including possibly another hospital. It is clear to me where KentuckyOne must have its sights set and I am not alone. I prepared a map showing the corporation’s current known holdings. Photographs of the properties can be seen here.
Retained surgical objects: A useful marker of hospital quality and safety?
A few weeks ago, the national newspaper, “USA Today,” reprinted a Courier-Journal exclusive by Andrew Wolfson about the phenomena of “angioplasty-abuse” prompted by a Kentucky lawsuit but increasingly evident nationwide. This week, the C-J returned the favor by running a shorter version of a piece by Peter Eisler of USA Today about “retained surgical items,” that is, the accidental leaving of foreign objects inside the body after surgery- usually in the abdomen or chest. Everyone has heard stories about surgical sponges or instruments left behind– perhaps to be discovered later when symptoms or complications occur. It is a medical mistake that is never supposed to happen, and a red flag that a hospital or surgical center may not have requisite safety procedures in place. Because of this, the frequency of retained items is included in most of the safety and quality evaluations of hospitals. That is what attracted my attention for this blog. Continue reading
The Bishops are coming!
The Bishops are coming!
The saga of the corporate takeover of the University of Louisville Hospital and most of the clinical operations of the University’s Medical School by Catholic Health Initiatives and KentuckyOne Health has been going on for so long that I have plumb run out of clever tag lines! Today’s report by Laura Unger of the Courier-Journal reminds us that March 1 is the official “integration day” on which KentuckyOne Health formally takes the reins from the University. Continue reading
I have not heard any good news about Jewish Hospital lately. KentuckyOne Health and its partner, the University of Louisville remain characteristically silent about their plans. What I have heard only confirms my perception of ongoing serious problems or even frank chaos. The least troublesome news available to me was that the senior administration of KentuckyOne Health will now be located in downtown Louisville. I was quoted as saying that keeping the headquarters of this state-wide organization in Louisville was not a surprise because running University Hospital and implementing the partnership with UofL was likely to be the major challenge for the company. While keeping headquarters and a few very high-paying jobs downtown must have been appealing to the city fathers who applauded the partnership, it seems to me that everything else points to a major withdrawal of clinical actives from downtown and the southern county in favor of the East End suburbs. Let me explain how this revelation occurred to me and outline the logic of why, in my opinion, such a move is a major priority for KentuckyOne Health and UofL’s joint strategy. For the sake of discussion, I predict that Jewish Hospital will shift a major portion of its clinical activity and even beds from Jewish and St. Mary’s Hospitals to new hospital facilities at its Dutchman’s Lane and Dupont Circle locations, and turn its downtown facility over to University control or even ownership. Continue reading
Bad and getting worse– but not without precedent
The matter of “Angioplasty Abuse” at St. Joseph London Hospital has now truly gained national attention. I have been reporting on the lawsuit against the hospital and some of its physicians and analyzing medical utilization data in this Policy Blog since last December. It was alleged that for several years that doctors at the hospital were performing invasive cardiac procedures on patients who had no need for them, and that the hospital should have known this. On Sunday, Courier-Journal reporter Andrew Wolfson published an in-depth, front-page article that was reprinted by USA Today and further commented upon in Forbes.com. Other news outlets are now also following the story more closely– a story that gets worse as it grows. Continue reading
Region 3 of Kentucky’s Medicaid system, comprising Jefferson and nearby counties, is in the throes of a major reorganization. Beginning January 1, the previous monopoly to provide Medicaid services held by a consortium of providers organized by the University of Louisville was withdrawn. State contracts were offered to three additional Medicaid Managed Care Organizations (MCOs). The timing of this major change was not the most felicitous, given that the statewide Medicaid managed care system newly put in place January 2012, could be said sympathetically to be in chaos. Medicaid managed care has been operational in Region 3 for several years and was providing acceptable clinical services, albeit under a cloud of abusive if not illegal management by its UofL-controlled financial administration. (One might say it was used as a slush fund. No one went to jail, but people lost their jobs and a major reorganization was demanded by the state.)
Given that the new contracts and procedures in Region 3 are essentially the same as those now used statewide, it is instructive to see how things have been going in the rest of the state. Alas, the precedents are not rosy. “Medicaid-Meltdown” is a term that is frequently being used. The rocky start may be one of the reasons the state is withholding its approval of expanding the Medicaid program under the new federal Accountability and Affordability Act to provide more Kentucky individuals health insurance coverage. In that regard, an interim report funded by the Foundation for a Healthy Kentucky and prepared by the Urban Institute and the University of Kentucky is receiving much attention nationally and is relevant to Region 3′s future. (Click the “Medicaid” category link in the left column of the Blog home page for available earlier comments.) Continue reading
Too many, too few, or just right?
Although it is St. Joseph London Hospital that is taking the heat in Kentucky over accusations of performing medically unnecessary cardiac catheterizations and other invasive cardiac procedures, it is certainly not alone nationally in this regard. I examined publicly available health data from the Kentucky Hospital Association (KHA) website which confirmed that St. Joseph London was performing a lot of cardiac catheterizations and other invasive cardiac procedures for such a small hospital in a rural part of our state. The hospital today claims to perform over 3000 heart catheterizations a year, although not all are angioplasties. Of course, absolute numbers alone do not indicate that anything improper occurred, However, given the nature of the accusations, the precedents elsewhere, and in the best interests of both the hospital and the patients it serves; it is my belief that a careful and transparent review is in order. Continue reading
Back in the days when I was a hospital lobbyist, my colleagues voiced the generally accepted fact that Medicare and other insurers overpaid for cardiology services. As a medical student, I was taught the Willie Sutton Law of Medicine– “When looking for a diagnosis, think of common things first.” [When Willie Sutton was asked why he robbed banks, his answer was, "Because that's where the money is."] While I by no means wish to imply that all hospitals are stealing our tax and premium dollars, an increasing parade of nationwide criminal investigations, indictments, and convictions make it clear that some hospitals and their doctors are shaking the cardiology piggy bank too hard. Continue reading