Category: Health Care Reform

Mandatory Posting of Hospital Charges: Rest In Peace.

I thought that before I signed the death certificate of the Posting Standard Charges Project, that I would place a mirror beneath its nostrils just to make sure it was ready to put in the ground. I was planning to add this confirmatory step as an addendum or comment to my first article, but it was clear that additional details and discussion would be necessary. My first pronouncement was based on a bedside-look at the several chargemaster databases. What did the local hospitals choose to disclose; what must they have intentionally omitted; how easy was it to find anything; and was the information useful to compare different hospitals? I did not even have to feel for a pulse to know the answers. Out of fairness and a desire not to bury the patient alive (but with certainty that my initial diagnosis was correct) I applied a more definitive diagnostic test that might been a valid real-world trial for me had these posted standard charges been available last Fall.

As I pulled away from my cardiac pit stop at Rhode Island Hospital, it was suggested I schedule a cardiac echo stress test back home to evaluate the size and function of my heart. Using all of my wisdom and experience as a physician and Professor, I did what everybody else does– find a cardiologist who would see me as a new patient and do what they suggest! The stress test was normal. I could not have hoped for a better result nor more competent and attentive care. The question for our present exercise is: If posted standard charges were available– and I had time to look at them– what I have found? [Spoiler alert! The effort would have been a waste of time, if not misleading.] Continue reading “Mandatory Posting of Hospital Charges: Rest In Peace.”

Federally Mandated Postings of Standard Charges by Louisville Hospitals Are Unusable for Their Intended Purpose.

(But will reveal the the unacceptable and unjust absurdity of how we pay for medical services.)

Reporter Gilbert Corsey of WDRB was, to my knowledge, first on the block locally to take public look at the implementation of a newly enforced federal law requiring hospitals to publish their Standard Charges online. Originally part of the Affordable Care Act (a.k.a. Obamacared) as turned into regulation last year,, the stated purpose was to allow the public to compare the cost of services and choose wisely among hospitals before they incur responsibility for payment. An overlying expectation (?dream) was to improve quality and decrease costs. Hospitals bitterly protested implementation of this law.

Mr. Corsey’s reporting verified the expectation that charges amoung neighboring hospitals can vary greatly. For example, an uncomplicated birth at one Louisville hospital was priced twice as high as another, and an injection of a drug used for prostatic cancer varied threefold. Corsey’s report also concluded that the published lists are confusing and difficult to decipher. I agree. I will go further and argue these lists are essentially worthless for their intended consumer purpose – surely knowingly so. Their value however for unintentionally making the policy point that, like pricing for pharmaceuticals, hospital pricing and billing exists in a logic-free, Alice-in Wonderland zone to the detriment of the public. Allow me to explain. Continue reading “Federally Mandated Postings of Standard Charges by Louisville Hospitals Are Unusable for Their Intended Purpose.”

Can Jewish Hospital in Louisville be Saved? Perhaps Not.

If not, what then?

Surely the end-game of the years-long efforts of Catholic Health Initiatives and KentuckyOne Health to sell some or all of their hospitals in Louisville must be coming to a climax. Transferring management of University of Louisville Hospital to KentuckyOne– a move that turned out badly for both institutions– was always as much or more about saving Jewish than ULH.  Many outside entities came to kick the tires of what KentuckyOne wanted to sell but walked off the lot.  The last acknowledged potential buyer whose keys KentuckyOne was holding was the tag-team of the private equity firm Blue Mountain and its spinoff for-profit hospital management company, Integrity Healthcare– now majority-owned by for-profit Nantworks Companies and Nantworks owner Dr. Patrick Soon-Shiong.  Sound complicated?  It is!  Casting a very dark curtain over this potential transaction in Louisville is last week’s announcement that Blue Mountain & Co.’s first and only attempt to take over a failing non-profit Catholic hospital chain in California has failed– the hospital system has filed for bankruptcy. These six Verity Hospitals (formerly the Daughters of Charity) might be bought by their communities, taken over by others, liquidated for their assets, or otherwise close.  I cannot avoid concluding that the same result would occur in Louisville and for much the same reasons.

CHI has played this one very close to its corporate chest. Fanned by anxiety about the future, rumors have been flying in increasingly disparate and desperate directions ranging from “Blue Mountain” has taken a second look and will sign on soon; or Blue Mountain has walked away for good; or that Nantworks and Dr. Soon-Shiong will move forward with the deal without Blue Mountain; or that CHI will give Jewish to the University for a song; and even that one or both of the sister Jewish & Sts. Mary Hospitals will soon shut its doors.  None of the potential players is in a strong place right now as I will outline below.  The one thing I am sure of is that the ground under the downtown hospital complex is going to quake hard, and that secondary seismic activity will be felt out in the county and beyond.  The Louisville Community is going to have to make some public health decisions that are both difficult and expensive. Continue reading “Can Jewish Hospital in Louisville be Saved? Perhaps Not.”

City Air Makes You Free. A Public Health Case for Sanctuary Cities.

The following is extracted (with permission) from an article first published in hasselbloger.com.

In the printed edition of the Courier-Journal on January 25, a letter-writer contributed the following:

‘Dignity of Labor’ to get healthcare is wrong.
According to your report of Jan/ 13, Gov. Bevin wants to change Medicaid requirements to enable the “able bodied” poor to learn the “dignity of labor.” It was a teaching of the Nazis that “Arbeit macht frei.”  The similarity between these two simplistic positions is too dangerous to ignore.  Stephen Schuster, Louisville.

Based on reflection over the past two years, I do not deem Mr. Schuster’s reaction to be overblown.  I submitted my own letter in response, but it appears that it was not accepted. Having my own “barrel of ink,” I publish it below.

Dear Courier Journal.
A recent correspondent to these letters drew uncomfortable attention to a similarity of phrasing used by Gov. Matthew Bevin and the German Nazis.  To obscure an ultimate goal of decreasing Medicaid enrollment, he and other governors would require “able-bodied” beneficiaries to either work or provide compulsory volunteerism [an oxymoron?] under the dissembling cover of gifting the poor with the ability to learn “the dignity of labor.”  Mr. Schuster and I were both reminded of the phrase Arbeit macht frei (Work sets you free) posted by the Nazis at the entrances to their Arbeitslager (labor camps) which evolved into the death camps of Europe.

A much older German phrase entered my mind as President Trump and his acolytes scold and sue cities like Louisville for protecting their inhabitants born under other suns.  Stadtluft macht frei  (City air makes you free.) expresses a centuries-old common law concept of medieval Europe whereby slaves, serfs, or peasants who entered a self-governing city were protected against involuntary repatriation to the rural countryside or servitude by their owners or landlords.  Remaining in such a city for a defined period ruptured the physical and economic bondage of structural rural poverty. Those so sheltered could become Bürger, or citizens.  Cities were places of opportunity!  The concept of a path to citizenship in a sanctuary city has a long and honorable history.

In the late 19th century, the abstraction of Stadtluft was still being used to summarize the motivation of rural Germans wishing to escape the tyranny of their birthplace, their legitimacy, their institutionalized poverty, or limits imposed on their occupations and ability to make a living.  I am proud of the leadership in Louisville and similar cities which protects those living in their jurisdiction against the unleashing of the most ignoble of nationalistic urges.  Louisville should not reopen its workhouse of the early 20th century.

Peter Hasselbacher
Louisville
29 January 2018

Addendum:
I take the liberty of reposting this larger part of my other article in this health policy blog because I believe it is relevant.  Individuals who in the current climate of immigration stings and deportation may be justifiably afraid to respond to demands of “show me your papers,” will correspondingly  be much less likely to seek medical care when they are sick.  This is not good for anyone!  As a people, we are no healthier than the sickest among us– regardless of place of birth.