Curtis Morrison expanded Kentucky coverage in Insider Louisville of the emerging national scandal of Angioplasty Abuse. Not that this is a new phenomena or anything. The healthcare industry has been riding the gravy train for a long time, taking advantage of our communal willingness to pay for volume rather than necessary and effective medical care. What else should we have expected? What is best for us as patients gets easily rationalized at the altar of economic development, or even ignored. Angioplasty is just the tip of the iceberg!
So it is that another Kentucky hospital is under the spotlight. We are told that plaintiff’s attorneys are recruiting cardiac patients from King’s Daughter Medical Center in Ashland. I have no specific knowledge that anything improper was done there, but based on my investigation of Kentucky utilization data, this would have been an obvious place to look. King’s Daughter is one of the top three hospitals in the state for the number of circulatory discharges. In 2008 when I analyzed the data, it was number one for the most common angioplasty stenting procedure (MSDRG 247) placing almost triple the number done at Jewish Hospital in Louisville! Angioplasty has become a growth industry for Kentucky.
I have not written much about it, but I am no great fan of the current medical malpractice system for fairly or even honestly adjudicating medical outcomes. Indeed, the industrial-scale nature of out-of-state actors sweeping into Kentucky is distasteful for me. It reminds me of my brief involvement in the Fen/Phen scandals. Those were not the finest hours for medical or legal professional integrity. Doctors, including myself, have long complained of the shortcomings of the medical malpractice system. However, we bear some responsibility for failing to watch over our own house adequately in the public interest. That failure allows the default situation of medical practice being judged by non-medical professionals.
Two Kentucky hospitals are currently being scrutinized in this arena and I suspect others are now nervous. If they have been doing their jobs responsibly, I hope all are fully exonerated– but it is likely to be messy. What I fear most is that settlements will be reached, fines paid as the cost of doing business, bad doctors will go elsewhere, and it will be back to the profitable status quo. We deserve better if for no other reason than to allow us confidence in the healthcare system we are currently stuck with. I say: Shine the light as brightly as possible. Sunlight disinfects.
Not just a problem for Eastern Kentucky.
I speculated earlier that the financial burden of these lawsuits has the potential to bring St. Joseph London Hospital to its knees. I feared that the University of Louisville Hospital would suffer collateral damage if KentuckyOne Health was able to contractually withhold its payments due to insufficient state-wide profitability. I neglected to mention the more obvious threat to Louisville’s default safety net hospital. UofL Hospital is now formally a member of the insurance risk pool of KentuckyOne and its parent organization. If I read the partnership documents correctly, our Louisville Hospitals will have to pay part of any settlement! In its quest for support of its commercial research initiative, UofL appears to have made itself vulnerable to the behaviors of the weakest members of a system over which it has no control!
If I have not read the documents correctly, or if any of the items above are incorrect, I invite any involved party to help me make appropriate corrections or offer rebuttal. How can we make a better system?
Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
April 8, 2013
In 2010, King’s Daughter’s Medical Center released a detailed document prepared in support of its $108 million bond offering underwritten by the Commonwealth of Kentucky and the City of Ashland. Over the fiscal years 2007 through 2009, net patient revenue increased 43%. Noteworthy contributors to this impressive surge in revenue were a 22% increase in angioplasty procedures, an 18.6% increase in diagnostic cardiac catheterization, and a 30% increase in MRI procedures– all of this despite the downturn in the economy. To the financial community, such numbers are good.
It was also announced that in the prior year the hospital purchased the medical practices of the Medical Center’s two largest cardiology groups, its cardiac surgeons, and other physicians. I and others have previously raised policy concerns that hospital employment of its referring and practicing physicians has the potential to encourage over-utilization of medical services. I do not say this is happening at King’s Daughters. I do not know one way or the other. However, since hospital employment of physicians is becoming the new normative model, policymakers and the public must feel confident that an unhealthy conflict of interest is not intrinsic to these new business relationships. I believe that unencumbered outside independent review must be an essential part of this changing medical playing field. I regret that such review seems so often to be initiated by medical malpractice suits.
Peter Hasselbacher, M.D.