UofL’s Ramsey Urges Board Members and Officers to Lobby over QCCT Fund

My advice to the Mayor and Metro Council.

I received a copy of a message University of Louisville President Jim Ramsey sent today to a star-studded list of politically connected board members, University executives, at least one employee of Louisville Metro government, and other folks of the sort that regularly get invited to UofL events.  It urges these high-profile individuals to use whatever political influence they have to lobby decision-makers over Derby Week with a goal of convincing the Louisville Metro Council and Mayor’s office to fully fund the QCCT fund that supports some of the non-compensated care provided by University Hospital. Here it is.

To: University of Louisville Boards
Colleagues:

As we enter Derby weekend and you engage in conversations with civic and business leaders in our community, we hope you would offer support for the Quality Care and Charity Trust (QCCT) agreement among University Hospital, the City and the State. These funds support the most vulnerable populations in our community and state, as well as enhance the opportunity for our Health Sciences Center to achieve excellence in a teaching hospital. Metro Council will be making decisions on the budget in the next several weeks, so there is a short window to influence its decision.

The QCCT agreement is a partnership of the state and the City of Louisville to provide $34.8 million for the uninsured and underinsured in our community. The Great Recession’s impact on our economy has increased these populations’ need for help from the QCCT more than ever. Even though University Hospital has as its mission to care for all regardless of their ability to pay, reduced levels of QCCT funding threaten to make this mission unsustainable. That means Louisvillians and Kentuckians will postpone care, become sicker, and endure more expensive episodes of care ultimately. Our neighboring cities, e.g., Indianapolis, Cincinnati, and Nashville, have safety nets of compassionate care similar to our QCCT agreement. Our City, too, needs to remain a leader in compassionate care.

University Hospital/James Graham Brown Cancer Center is asking the Mayor to restore full funding of the QCCT in his budget. Failure to do so will result in additional cuts matched dollar-for-dollar by the state due to language contained in the recently enacted state budget.

If you have the opportunity to discuss QCCT over the upcoming weekend with any of those involved in the decision, please lend your strong support.

Jim
James R. Ramsey, Ph.D.
President, University of Louisville

Comment

There is no acknowledgement (did we really expect one?) that UofL has largely brought its current difficulties upon itself. Before I get into that, let me say straight away, that I strongly assert that UofL Hospital deserves financial and other assistance to provide care to the medically indigent and underinsured that enter its doors seeking help. To the extent that other so-called non-profit hospitals in town provide more than their fair share of such medical care, they should receive our help also. In fact, we need a lot more discussion about just what such a fair share should be to justify their non-profit status as charities.

What is a public hospital?

The most common result of an internet search for the definition of a public hospital is a hospital that receives state or local funding for all or part of its budget. One can reasonably argue that there might be some threshold for how much public support is needed to cross that threshold, but the mega-millions UofL receives into its various buckets certainly qualifies it. Kentucky’s Attorney General and other legal and public officials also agree the UofL Hospital is a public hospital. For reasons that it chooses not to reveal, UofL’s leadership has resolutely clung to its fantasy that it is a private entity and therefore not accountable to the public, including its use of public funds.  As I have argued earlier, this issue will plague all further efforts by the University to further its missions of education, research, patient care, and community service.

Why the Metro Council and Mayor need to take a close look.

It is not like UofL has acted consistently in a manner that inspires confidence: quite the contrary. Senior officers were fired because UofL misused Medicaid money. The Board of the QCCT fund did not meet its obligations to oversee the money entrusted to it. I heard with my own ears the Metro Council scold UofL for not providing information it requested about how the QCCT money was used. The Kentucky State Auditor was compelled to audit the University’s use of its clinical money. UofL receives several hundred million dollars of such money yearly but is unwilling to account for how it is spent. We know that huge amounts of such money go into research and faculty accounts at a time when the University cries poor and threatens, oh so subtly, to limit future care to the poor unless it gets exactly what it wants. For these and many other reasons discussed in these pages over the past few months, our elected government officials have every reason to force the University to come clean. These officials would be derelict in their fiduciary duty if they did not. Those of us citizens not lucky enough to attend the Derby in person will be equally guilty if we allow ourselves to be bullied into putting more money into a structure that is obviously not working.

What should be required of UofL.

My recommendations to policy makers would include the following.
Unless UofL abandons once and for all its arrogant claim to being a private hospital, it should receive no special treatment or financial support from the state or city unless such assistance is also offered to other hospitals.

UofL and its hospital needs to come clean on how it has used money provided from local, state, and federal sources in the past. This will be embarrassing for the University but this painful step must be taken. If additional individuals must lose their positions because of any inappropriate revelations, so be it. Tough love from state and local officials is needed. If all is well, UofL will have taken a major step forwards in recapturing the trust of the public which it has squandered, and its true needs will have been documented.

State Auditor’s Investigation.

There are several initiatives already underway that would provide a good start towards this goal of accountability for the public trust. The University must open all its books to the State Auditor’s office. There is no other way to determine how the University launders shifts its money around. There is a good reason the University has maintained its peripheral corporations and faculty businesses. For example, I always have to laugh when Kentucky newspapers purport to list university salaries on their websites. Because of multiple accounts and miscible funds, the public has no idea what our clinical faculty are paid, and no way make a judgment of appropriateness.

UofL’s Ad Hoc Operations Review Committee.

In what appeared to me to be largely a public relations defense to the Auditor’s investigation, UofL itself hired a consultant to look at its books and practices in an Ad Hoc Review of its operations. Although originally promised to be conducted in full view of the public, in actuality, very little information has been revealed and it was stated that the committee’s final report may not contain any supporting financial or operations data. Such a report would be useless to the public and our elected officials. The University must open the books of its hospital. If things are as bad as is claimed, we deserve to know why before more public money is pumped into a black box. At the very least, all information considered by the committee must be made public. What proprietary information is the University afraid of revealing? Is it fearful that other hospitals will try to steal away their poor or poorly-paying patients?

UofL’s REQUEST for a bailout partner.

In the middle of all this, the University of Louisville has been conducting an ill-fated search to find a partner that can help it out of the hole it has dug for itself. To all accounts, this search has collapsed. The University has demonstrated that it is willing to sell out its clinical, academic, and administrative independence in its search for research money and other non-clinical support. How can the University ask for public money when it had been or is seeking to turn its hospital over to another controlling entity?   Surely the current state of affairs of this debacle and its true and complete motives must be made public. The University is admitting that it is failing in  its major missions, except perhaps sports. Before it is allowed to merge with a private entity, the public must be allowed to know why.

Other requirements.

State and local officials should also consider additional recommendations that were presented earlier in these pages related to how the University of Louisville provides medical care to the underserved of our community.  These include continuing marginalization of a segregated facility and addressing the quality of clinical care and education provided,

What do you think? What advice would you give our state and local elected officials? Lend your strong support, one way or the other, to the Metro Council Members and Mayor.

Peter Hasselbacher, MD
May 2, 2012