Level Funding for Quality Community Care Trust (QCCT)

Last night the Louisville Metro Council passed a budget for 2012-2013 with very few and relatively minor changes from the proposed budget they and the Mayor had put together over the past few weeks. For the purposes of this Policy Blog, the controversial QCCT fund for inpatient care of the underserved  at University of Louisville Hospital received funding of $7.00 million. This is the same net amount the University has received in recent years but which the University claims is a decrease. The Courier-Journal’s report today states that a clause was added that if city income projections are better than projected next year, that additional funding would be considered. [The official published budget is not yet available to me. When it is, I will quote the language of the clause, the final numbers, and comment further.] Below are the figures from the proposed budget. A neater tabulated copy is available.

Proposed 2012-13 Budget
Health Expenditures By Activity (Dollars)

Administration & Support Division: $1,537,100 to $1,140,700
Population & Personal Health Services: $12,979,300  to $12,513,100
ARRA Health: $4,007,600  to  $0 (Federal Stimulus Funding)
Health Equity Programs: $1,460,000 to $ 2,146,800
Environmental Health Services Division: $4,022,500  to  $3,689,200
Public Health Preparedness: $554,500  to $643,800
Communicable Disease Prevention: $3,868,400  to $3,576,400
Family Health Center: $1,983,300  to $1,884,100
Quality Care Charitable Trust: $9,643,200 (net $7 million)  to $7,000,000
Total Expenditure: $40,055,900  to $32,594,100

Comment.
Working from the Mayor’s Recommended budget, this was a tough year for the Department of Public Health and Wellness whose recommended overall budget took an 18.6% hit, decreasing from $40.06 last year to $32.54 million next year. In fact, funding for every activity in the budget except Health Equity Programs and Public Health Preparedness was decreased. When Mayor Fischer told us about tight budget constraints, he was not understating the matter!  Even the Family Health Center was subject to a 5% decrease, and they didn’t get very much in the first place! (Something to talk about as we revisit how we provide indigent health care within our community.)

The critical importance of public health.
No matter what happens in the Supreme Court this summer, or whether the University of Louisville gets its trophy partner, or despite any of the other predictable major changes that will occur in our continuously evolving healthcare system; our Department of Public Health, by whatever name it is called, is going to play an increasingly important role. The leadership of the Department of Public Health and Wellness must be perceived as the champion of the people and none other. The voice of that entity must be perceived as impartial, evidence-based, and as having no conflicts of interest.

Who should speak for the poor?
Even before the scandals and the highly critical independent evaluations of the way the University of Louisville does business, I raised concerns that the fact that the new Director of Public Health and Wellness in Louisville was a half-time employee of the University of Louisville represented a potential conflict of interest, and that such a relationship must inevitably diminish the role she could play as hospital mergers and healthcare reform of the underserved and disadvantaged was being considered. I raise those concerns again. In fact, if revenue projections for the City are better than projected, and if it has not already done so, I recommend that Louisville buy back her time from the University. By all accounts, Dr. LaQuandra S. Nesbitt, MD, MPH is a great catch for our city and I admire her. However, we should be as uncomfortable with the fact that the University is paying half her salary and benefits, as we would be if tobacco companies were funding University research. She should not be on the list of University insiders the University President urges to lobby on its behalf.   Dr. Nesbitt was recently asked to lobby for a line-item on her own departmental budget and for who knows what in the past.  Even if Dr. Nesbitt is completely independent of the University in every other way, as I believe she is, perception is all.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor, UofL
June 22, 2012