Kentucky to the World Presents Louisville Native, Dr. Sander Florman.

Noted transplant surgeon to speak March 12.sander-florman

Dr. Florman, a graduate of St. Francis School and University of Louisville Medical School, will share the fascinating story of his journey from growing up in Louisville, to rebuilding the transplant program in post-Katrina New Orleans, and to leading the Recanati/Miller Transplantation Institute at The Mount Sinai Medical Center in New York City.

Kentucky to the World (KTW) showcases highly successful individuals with strong Kentucky connections who are seldom seen or heard here.  Dr. Florman’s work as the Director of the Transplant Institute at Tulane University in New Orleans earned him recognition as one of New Orleans Magazine’s “People to Watch”. He was twice named “Health Care Hero” by New Orleans CityBusiness and was chosen as one of Gambit Weekly’s “40 Under 40.” He was recognized by Louisiana Life magazine as one of Louisiana’s “Top Doctors” and “Best Doctors” in 2007-2009. Florman is the author of nine book chapters and more than 75 publications.


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Who Pays for Human Organ Transplantation?

In response to a recent article in these pages about human organ transplantation in Kentucky, it was alleged that the University of Kentucky Hospital accepted Medicaid as payment for solid organ transplantation but that the Jewish Hospital program did not. I interviewed a number of individuals with first-hand knowledge but was unable to dispute the assertion that the source (or lack thereof) of a patient’s health insurance makes a difference in who receives an organ— not only here in Kentucky but nationwide. I recently obtained comprehensive payer-specific information from the United Network for Organ Sharing (UNOS)– the government-sponsored organization that regulates and oversees virtually all organ transplants performed in the U.S. The short answer is that there is a considerable difference in the payer-mix for solid-organ transplantation between Jewish Hospital and the University of Kentucky (UK). In 2013– the last year for which a full 12 months of reporting is available– Medicaid beneficiaries made up 6.4% of all transplant recipients at Jewish and 15.9% at UK. These figures can be compared to the national proportion of 8.7% Medicaid beneficiaries. It cannot be said that the Jewish Hospital program does not accept Medicaid beneficiaries altogether. Additional details and commentary concerning local and national transplant programs are presented below. Frankly, I had not encountered such data before and I think it will be of general interest to many. Continue reading

All But 2 Kentucky Hospitals Receive Medicare Penalties for Quality.

Some Hospitals Get the Triple Whammy.

It can’t be easy to be a hospital administrator nowadays. It probably never was. It has always been a delicate balance to juggle dealing with the feelings and physical needs of the sick and their families, courting professional staff members, the business priorities of the community, the never ending march of new technologies, the ever-present possibility of malpractice suits, labor and staffing issues, competition from other hospitals, the spiraling costs of healthcare, and more recently the expanding expectation of transparency and measurable outcomes. There are few industries are now subject to as much regulation and oversight than the hospital industry. With the authority of the federal government behind it, Medicare– whose lead is followed by much of the private-payer world– is arguably the regulator-in-chief and is increasingly more willing to use its control of the purse strings to advance public health policy priorities. Highly visible in the last three years are Medicare programs that seek to change the metric for payment of hospitals from paying for volume and procedures to quality, value, and desirable health outcomes. Measurement of these latter is now being tied to Medicare hospital payments. Continue reading

The Best Doctors are in the Czech Republic!

A sign said so!sign-photo

Last Fall I got way behind on my writing and have still not caught up. The proximate reason was a road trip, or rather a riverboat cruise behind the former Iron Curtain down the Elbe River from Prague to Berlin. On the 100th anniversary of the outbreak of World War I, and the 25th anniversary of the fall of the Berlin Wall, the trip was informational as well as enjoyable. Although I (and my spouse) was looking forward to a holiday from my writing, it proved impossible to avoid thinking about health policy. Allow me to share two examples of how I was hit over the head by medical advertising.

America abroad.
Imagine my surprise as I rounded a corner in the small riverside town of Litomerice— whose name I could not pronounce, let alone spell— to be confronted by the sign below. I was stunned to the point that during the subsequent arranged tasting of truly excellent Czech beer, rather than enjoying the moment, I pressed our English-speaking host for information about the sign. Continue reading

Kosair Charities of Louisville Breaking Ties With Its Hospital.

Elvis has already left the building!elvis-closeup-150

Andy Wolfson of the Courier-Journal updated us on the status of Kosair Charities Foundation’s lawsuit with a peek at Norton Healthcare’s countersuit. It is amazing how different things can look when both sides of the story have been heard. I won’t go into additional details here as I have not yet seen the full brief myself. As was also the case in the tag-team lawsuit stemming from the University of Louisville’s attempt to evict Norton from its Children’s Hospital, attempts by the court and encouragement from the Commonwealth to have the matters settled by mediation failed. Frankly, this was not a surprise to me. It was made clear to anyone who can read that UofL wants to present a children’s hospital to its new clinical partner, Kentucky One Health. It is also obvious that the University has already wooed Kosair Charities away from Norton. Mediation only works when both sides are willing to compromise. All I see is scorched-earth tactics. In my opinion, UofL has been burning its bridges to Norton for years. In partnering with KentuckyOne, it put alligators in the moats. Continue reading

KHPI Expands Into Social Media

I recently wrote about improvements to the KHPI website and summarized our progress over the past few years.  I announced that KHPI had a new Facebook Page, and that I was trying to learn how to use Twitter.  Amazingly, for as much as I love the digital life, I had virtually no prior experience with either platform. Today’s January 1 post can be considered my New Year’s resolution to try harder!

Here are links to KHPI’s pages on:

Facebook, and

I am still tweaking the various buttons that let readers interact with KHPI and their own social media accounts. I am learning by doing.  You can help me. Note that you can now receive an email notice of new entries on this policy blog. Use the Subscribe form in the sidebar.


Behind the Acquired Hospital Condition Data Curtain.

1-percentHAC Reduction Program: How valid is the evaluation construct?
Perhaps not so much.

An increasing number of private organizations attempt to measure the quality and safety of hospital care. I have already expressed my growing concern about the validity and utility of such ratings which seem to have lives of their own. Hospitals are spending a fortune to collect and report on a variety of ever-changing indicators and to improve their ratings. When the scores are good, hospitals use them to market their services. When scores are not-so-good, hospitals either make no public comment, criticize the system, or offer putative explanations why their hospitals face greater challenges than others. This selective use of quality scores in advertising has always seemed a little hypocritical to me. Is it immaterial that a hospital can be ranked as both worst and the best of something at the same time? Things are not that compartmentalized within hospitals. Continue reading

Hospitals Penalized by Medicare for Excessive Hospital-Acquired Conditions.

I have been interested in attempts to measure the quality and safety of healthcare since my year of fellowship on the Senate Finance Committee which oversees the Medicare program. In the run-up to what would become Medicare’s Hospital Compare program, a long list of things that might be measured was proposed. Most were set aside because of concerns about utility, comparability, reliability, difficulty of collection, or ability to be gamed. The shorter list evolved into the current iteration of Medicare’s own Hospital Compare database that is incorporated into virtually every proprietary hospital rating system. The quality measurements are part of a new payment structure that hopes to pay for quality and value instead of volume alone. Continue reading