Today’s Courier-Journal reported on a legislative hearing in Frankfort concerning the struggling implementation of our new Medicaid Managed Care companies in Kentucky. The focus was on slow payments to providers and difficulties arising from having to interact with the systems of three different providers, although there were apparently also problems in obtaining timely authorizations for treatment or prescriptions. None of this should have been completely unexpected given the relative speed at which rather drastic changes were made to the Medicaid program of Kentucky. Most of the state just went from unbridled fee-for-service care to the more closely supervised system we call managed care. I am certainly not surprised! What is more important is how this vital healthcare system reacts and repairs itself. Time will tell.
What did surprise and more-than-disappoint me was the report of the behavior of an unnamed psychiatrist in Kentucky who is said to have refused to continue to treat two of his current patients who are children because “he has not been paid since Nov 1.” Why is this not abandonment and a cause for disciplinary action by the Medical Licensure Board, or if there are any damages, in a civil court? My friends in the Medical Licensure Board, what does it take for you to investigate this accusation? You may consider this a complaint. The safety of two children is in jeopardy, or the good image of physicians has been sacrificed to make a better story for our legislators. Either alternative begs for clarification and resolution. Reports like this, when true, make me ashamed on behalf of my profession. Continue reading “Exaggeration, Unethical, or Just Plain Despicable?”
How do we provide the best health care to the underserved?
A few days after this Policy Blog, County Attorney Mike O’Connell, the Courier-Journal and others called for an audit of the Quality & Community Care Trust (QCCT) that funds indigent care at University Hospital, President Ramsey responded in acquiescence. He had no other reasonable choice. Given increasing criticism over its habit of secrecy, any dragging of feet would have had a devastating effect on the University’s tarnishing reputation. The “Unsubstantiated C**p Defense” is no longer feasible. A better course for the University would have been to be out in front with such an offer weeks ago when it was becoming clear that the Louisville Metro Council and others were having concerns about how this particular package of public money was being used. Now we know that there was a good reason for that concern. Nonetheless, better late to the table than never.
To their credit, the University is not using its “Private Organization” defense to limit scrutiny, despite the fact that the initial results of outside scrutiny were not good. Board meetings have not been held for several years, and required records were not kept even as the University complained that it needed more money. The University of Louisville has given away its best defense against criticisms of acting secretly or even irresponsibly. The fact that this University-led Board was so careless in its management of such an important public function adds urgency to the many other calls for the University of Louisville to stop the secret internal shell game it plays with its many component foundations, corporations, institutes, and other entities. Continue reading “UofL President Ramsey Calls for Evaluation of Indigent Care Fund”
It is often said facetiously that the true measure of the success of an advertising campaign is that it compels its target to buy something that is not needed. By this measure, the pharmaceutical industry is the true master of the craft. What else explains the high proportion of the industry’s budget that goes to advertising and marketing spending more for ads than research! But that is a subject for some future blog or comment below. What I will highlight today is the stunningly successful campaign of the industry to induce us to pay $billions for overpriced brand-name drugs when the exact same drug (or one that is as or more safe and effective) is available for a small fraction of the price as a generic product.
What got me going today is the latest of a long series of full page ads in my local newspaper urging me to apply for Pfizer’s $4-CoPay Card that allows me to begin or continue to take brand-name Lipitor® to lower my cholesterol. The CoPay Card promises an out-of-pocket cost to me of from $4 to $50 per month for perhaps one year. The savings depends on whether or not I have prescription drug coverage as part of my health insurance, and how low my co-pays are. As usual, those without any health insurance pay the highest prices. Those of our neighbors do not have anyone negotiating discounts for them are stuck being billed for the full amount of whatever the healthcare industry thinks it can get away with. Continue reading “Not One Public Penny More for Lipitor®”
One of my favorite lines from old movies is: “The Devil can quote scripture to his own purpose.” So have various parties seen different things in the Dranove opinion of the recent partially released documents related to the acquisition that would have included the University of Louisville Hospital. The University itself focused on a line forecasting “dire effects” if the University was not permitted to proceed with its plans to hand over control of its clinical activities to another organization. My attention was focused on the lack of specific detail in the report. One of the items that must have captured the attention of County Attorney O’Connell who commissioned the report, was the suggestion that a body independent of the University oversee any future use of the Quality and Community Care Trust (QCCT) through which millions of state and local government funds are funneled to the University.
When the County Attorney asked for minutes of the University Board supposedly overseeing the funds, he was astonished to find that the legally required documents were not available, or worse, that there was no official documentation that the Board had met since 2007. Such a failure echoes the recent complaint of the Louisville Metro Council that the University had not produced information requested of it by the Council. Notwithstanding, the Council voted to continue the QCCT funding anyway. The University has now shared a little of its own increasingly tarnished reputation with an overly tolerant Council.
County Attorney O’Connell has called for a new Board, completely independent of the University, to oversee any future use of a public QCCT funding mechanism. He wanted to insure that “money did not come before mission” with respect to the University. I recently called for a State Audit of the QCCT, and questioned whether this almost 30-year-old partial solution to funding indigent care in Louisville is still appropriate. After all, Louisville’s governance has merged, the needs of the pubic have evolved, the health care system of Jefferson County has been drastically reorganized, and alas, the University of Louisville has also changed.
Would a lack of the required accountability from the QCCT Board simply represent a failure of University management? Is this part of a pattern of the University attempting to circumnavigate the law? I cannot help but be reminded of the recent Passport Scandal in which the University and its internal organizations harvested money intended for medical care of the needy and used it for other purposes. In my opinion, what we have been seeing unfold is a failure of leadership at the highest levels of the University of Louisville. The University of Louisville has lost its way. It needs our help now, not enabling responses from the public to which it is accountable.
Peter Hasselbacher, MD
A PDF version of this entry can be obtained here.