Presidential Outburst at UofL Board Meeting. 

ramsey-may2015•Only Nominally Over Executive Compensation.
•Trustee requests for information and oversight rebuffed.
•Audit called for.

Readers will note that I have not posted anything for over a month.  In truth, I was in Europe for three weeks and am just now getting over a jet-lagged recovery. This was to be an “unplugged” holiday. My long-suffering wife likes to tell the story of how I once almost missed our connection in the Amsterdam Airport waiting to upload a post over the free McDonald’s internet connection. She has other stories too! Indeed, I admit to occasionally feeling guilty of insufficient spousal attention during our travels in these hyper-connected times.

Always something to write about.
I did cheat on this good woman a little by occasionally peeking at the news.  It is not that there was nothing I like to write about!  Several updates of existing hospital quality, safety, and performance ratings were released, as well as a new rating approach by U.S. News & World Report. Flanking these stories were scholarly reports addressing the same issues I have been raising about the reliability and usability of existing rating systems.

There was new data-hacking breach of over a million members at another health insurer. No one should feel safe!  Medicare released a massive database of all outpatient drugs prescribed for those with Part-D drug coverage or in Medicare managed-care plans. The data is broken down by individual drug, healthcare provider, and cost and is already generating a flurry of attention.  For example, it turns out that many of the top prescribers of specific drugs receive monetary payments from the manufacturer. [Naturally this does not influence their professional judgments!] I started looking at the drug database on the flight home– this wasn’t really cheating–  and will have more to say future articles.

New Sunshine Act Data Release.
Entirely by coincidence, the next iteration of the federal database of payments to medical providers by device and drug manufacturers will be released in a month or so and will now list at least some payments to providers for continuing medical education (CME).  These latter payments, previously undisclosed, provide a measure of the degree that manufacturers have taken control of what physicians and other providers think and do.  If transparency and accountability is the goal of the Open Records Program (a.k.a. Sunshine Act), it was a critical error to have initially allowed payments for CME to be hidden. The fact that such payments were exempted from disclosure attests to the lobbying power of both drug companies and the academic medical establishment.

UofL against the world (and its own Board?).
There were other items I filed away in my write-about-later folder, but the big-ticket item for Kentucky was the further unfolding, indeed explosion of nagging concerns over University governance and secrecy, fueled by revelations about executive compensation at the University of Louisville, and triggered by a recent call from a University Trustee and others for an external independent audit by Kentucky’s State Auditor of Public Accounts. The news reports of the Trustees’ meeting used words like “angrily,” “testy,” agitated,” “contentious,” “defiant,” and “lashes out” to describe the behavior or UofL President James Ramsey.  All of this was in response to quite reasonable requests by responsible board members for information that either they or the public is entitled to.  Comments to articles from the public on the three major Louisville markets were solidly against Dr. Ramsey’s positions, except for the reliable fan-boy or contract internet-troll for whom UofL can do no wrong.  I found the reports of the apparent melt-down difficult to believe until, on my return, I had a chance to view a video clip of part of the encounter— it was worse than I thought.  View it yourself. Was this justified indignity or a hissy-fit?  You be the judge.  In any event, it must have been embarrassing for most of the folks present. Continue reading

Medicare Releases New 5-Star Rating System for Acute Care Hospitals.

Not everyone is happy, but Kentucky doing better than the rest!

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released its first iteration of a new and simplified method of presenting the results of the awkwardly named HCAHPS survey that is administered to patients after their discharge.  The survey is intended to capture the patients’ own perceptions of their hospital experience and it is now part of the larger CMS Hospital-Compare initiative. As with previously released quality and safety initiatives, the reaction of individual hospitals is mixed.

The survey of 32 questions is administered to randomly selected adult patients who are between 48 hours to 6 weeks after being discharged alive from acute-care Medicare hospitals.  Unlike most other quality and safety programs managed by CMS, individual patient participants are not limited to the Medicare or Medicaid programs.  Hospitals attempt to reach a target of 300 surveys per year by telephone or mail, but some smaller hospitals struggle to do this.  Additionally, hospitals that are exempt from having to submit the more objective Medicare process and outcome measurements (including Medicare’s Critical Access Hospitals) can participate voluntarily in this patient experience program.

Hospitals have been submitting this information voluntarily since 2006, it has been mandatory since 2007, and the results have been reported publically since 2008.  A similar program for nursing homes and a few other healthcare providers already exists.  Future plans are to include these patient experience scores with the other more blood-and-guts process and outcome measures to provide a single global star-score for all Medicare hospitals. Proprietary quality and safety organizations are already doing this. Continue reading

Catholic Health Initiative 2d Quarter Report Showing Better Numbers.

chi-2d-quarter-2015-200pxCHI’s report shows immediate favorable impact of acquisitions on current financials. Productivity and sustainability of existing operations harder to ascertain.
Catholic Health Initiatives (CHI), the parent company of KentuckyOne Health, released its most recent quarterly financial report earlier this month covering the three months ending December 31, 2014.  The company’s press release stressed “improved second-quarter financial results as the organization continues a comprehensive program of operational improvement, revenue enhancements and strategic expansion in key markets.”  Raw earnings in this second quarter were $290.5 million compared to $132.1 million in the same quarter a year earlier. Operating income moved into the black following the losses of the first quarter.  These gains were attributed to “additional business acquisitions, clinical and operational improvements as well as other internal cost-saving programs to reduce expenses.”  However, these “turnaround” earnings are entered before being reduced by a variety of adjustments including interest, depreciation, amortization, business combination gains, and “restructuring.”  This makes it difficult for the uninitiated such as myself to judge whether this apparent reversal of fortune represents on-the-ground improvement in existing competitive markets, or the untested effects of an expanding acquisition bubble. The bond market that supports the considerable debt of the organization, and CHI’s continuing success in a rapidly changing healthcare environment will provide a more definitive judgment. The full report is available here. Continue reading

Faculty Senate Meeting Updates— Or Lack Thereof!

I attended the April 1 meeting of the University of Louisville’s Faculty Senate hoping for updates in a number of areas of both faculty and community concern that we have been following. These included the politically motivated grants to the Business School, compensation packages for senior UofL executives, and Board of Trustee concerns about University governance.  In all honesty, I came away disappointed.

Koch/Schnatter Foundation Grants.
Last month, Pres. James Ramsey signed linked contracts on behalf of the University and the University of Louisville Foundation accepting a potential $6.3 million dollars but which carries with them tight restrictions on the kind of thoughts allowable in the minds of recipients.  Others and I found the restrictions impermissible in the academic setting but I expressed my opinion why University Administration would have no objection, indeed, no option except to accept both the money and the outside control.  In accepting the grant, the University violated its own rules about requiring faculty approval before new centers or programs were applied for.  In the faculty Senate meeting of March, representatives of the relevant faculty Academic Program Committee pointed out that no such approval had been requested.  The Provost made much of the great value the administration placed on the input of its faculty but what else could she say?  The fact is, that as of the April 1 Senate meeting, the Committee had not met to consider the matter and there was no further discussion offered from the assembly. In contrast, in his March newsletter to the community, President Ramsey makes acceptance of the grant sound like the done-deal that skeptics in the community like myself believe has occurred.  Certainly there was no mention in the update of any contingency upon faculty approval. No doubt faculty other than myself are feeling steamrolled. Continue reading

Why UofL Can’t Say No to the Kochs or Papa John.

A Former UofL Lobbyist’s Perspective.

A few months ago, someone anonymously sent me preliminary news reports about the University of Louisville’s engagement with politically conservative donors over the establishment of a new University Center.  A fair amount has been written since about the UofL’s willingness, if not eagerness, to accept a grant from the John H. Schnatter Family to fund a new John. H. Schnatter Center for Free Enterprise within, but effectively independent of the School of Business.  Insider Louisville and the Kentucky Center for Investigative Reporting have followed the matter closely.  The grant itself is contingent on the University’s also accepting a grant from and sharing controlling interest with the Charles Koch Foundation.  Most community concern stems from attached strings that restrict the academic viewpoints that can be addressed by the funding, and which give inordinate and inappropriate academic control to outside political and business interests. Read the Grant Contract yourself (6MB).  As I lifetime member of the Academy, it made me shudder— and I am not alone. Alas, I do not think the University felt it was in a position to say no.  Even as a non-University person, would you have agreed to all the provisions in this contract?  If so, tell us why in your own name in the comments section. What parts of the contract do you believe are inappropriate? I don’t have enough room to do so here. Continue reading

Another Major Data Breach for a Health Insurer.

Hackers breached whatever firewalls and security measures were present at Premera Blue Cross based in Washington state.   The personal, financial, and now even medical information of some 11 million past- and present customers were accessed. The breach may have occurred last May, was detected on January 29, but not disclosed to either the public or regulators until a few days ago.  Nice job on the accountability front.

I recently wrote about an even larger breach of security at Anthem where the personal information of almost 80 million people was penetrated.  It was not thought that medical information was compromised then, but how can one know for sure?    I predicted we would be seeing more attacks on medical record and insurance databases but it is disappointing to see them coming on so rapidly.  There are at least two driving forces or enablers.  The first follows from Willie Sutton’s law explaining his reason for robbing banks—because that is where the money is.  Some 18% of our gross national product fuels the healthcare industry— that is where the real money is.  Medical fraud is part of that big business. Continue reading

Was Kentucky Spared from CHI Layoffs?

Is there still a nursing shortage in Kentucky?

Earlier this year, and following a disappointing report for the first quarter of FY 2015, Catholic Health Initiatives announced that it would cut 1500 jobs nationally by the end of January.  The positions targeted were administrative and support staff representing some 1.7% of CHI’s total 90,500-person workforce.  KentuckyOne Health (CHI’s operation in the Commonwealth) had already absorbed an previous layoff of 500 employees one year ago but remains the weakest sister financially among CHI’s regions.  Locally, concerns were shared that we might take another hit this round. Has that happened?

To be fair, CHI is not the only big system to be laying off people.  A nationwide shift from inpatient to outpatient services has even the prestigious Cleveland and Mayo clinics trimming their staffs.  Frankly, I have not heard much of anything about layoffs in Kentucky– at least in the Louisville market. Even a usually productive Google search did not reveal much for me.  The most notable activity is in Omaha where CHI’s hospital and clinical system have no current network contract with Blue Cross/Blue Shield.  The drop in patient volume there is said to have sparked layoffs of at least 156 people including physicians! Additional job cuts were anticipated through attrition and by not filling open positions.  There have been layoffs reported in Oregon too. Otherwise things seem to be quiet. Is that what happens when administrative jobs get cut?

In fact, in the usual on-line places, KentuckyOne is advertising to fill quite a few clinical positions in Louisville. I am informed that some modest hiring of clinical-support people is also occurring. I do not know what is happening in the rest of the state.  Good! Lets face it– you can’t run a hospital or medical office without doctors, nurses, and technicians.  If you terminate too many of these, people tend to notice, including accreditors and regulators.  I asked KentuckyOne how much and in what way Kentucky might have shared in CHI’s nationwide job-reduction program but did not receive a reply. Continue reading

You Can’t Always Get [What You Pay For]

But if you try real hard— you might do better than Venezuela!

Providing healthcare to [some] Americans is the best economic development bonanza going. Alas, here in the exceptional USA, many people do not have access to mainstream healthcare.  Worse however, as pointed out in today’s Wall Street Journal [yes, I do subscribe], nearly all Venezuelans needing even standard medical or surgical care are plum out of luck— unless they can find and then afford to buy their own medical supplies from insulin to heart valves.  It sounds awful. Hyperinflation makes already overpriced medical devices and drugs impossible to afford. An exodus of physicians, including those whom were loaned by Cuba, makes matters worse. The situation is beyond frustrating for both patients and physicians alike.  At least our feared but imaginary American death panels would have actual choices to make!   Venezuelans are in very real death-spirals of the flesh, not the death-spirals health insurance companies face when they are left holding the bag for sick people when healthy and less ill people fail to enroll in their plans.

The disheartening article included the following graphic showing Venezuela at the bottom of the list of Latin American countries, spending in 2012 only 1.6% of its gross national product on healthcare (and that was 2 years ago). The numbers from the World Bank are only slightly different.  If fact, according to that source, its healthcare spending in 2012 puts Venezuela at the bottom of the list of every other ranked country in the world, occupying a healthcare category all of its own.  That country is suffering the melt-down that apocalyptic American alarmists either warn of, or alternatively fantasize about as a starting point from which to rebuild from the ashes. Continue reading