Exaggeration, Unethical, or Just Plain Despicable?

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?”

UofL President Ramsey Calls for Evaluation of Indigent Care Fund

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”

Not One Public Penny More for Lipitor®

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®”

More Bad Press For the University of Louisville. A QCCT Scandal?

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.

My Way or the Highway! UofL Takes Hostages.

Governor Beshear, with consultation from the Attorney General’s office, again rejected “suggestions” offered by James Ramsey and Jim Tayor that were intended to make more acceptable the addition of the University of Louisville and its Hospital to the newly merged Catholic Health Care Initiatives entity in Kentucky.  The Governor thought not!

The substance of the suggestions was not initially made public.  Even the Governor’s office curiously called them “private and proprietary.”  However, President Ramsey has given his version of them to the UofL community in a broadside that continues this matter with some open threats.  (Read his message here.)  In fact, President Ramsey seems openly  to have picked a fight with the Governor and Attorney General by claiming an alternate version of reality. “We began our in depth merger conversations with the governor 18 months ago.  He has never expressed any concerns to us about the governance structure of the proposed merged entity.”  I do not have a feeling that this is going to end well for Dr. Ramsey and the University!

I am surprised at the continuing secrecy, especially since this whole merger-matter has been widely criticized for inappropriate secrecy and private dealings.  Dr. Taylor did not initially reveal this new Plan-B,  telling us that the University wanted the Governor to have a chance to reflect on it.  I maintain because now that President Ramsey has released his own obviously self-serving version of the suggestions, we of the public have a right to hear it all.  I believe the University has already waived its “privacy” with regard to its amended merger propositions, if indeed it was ever entitled to such special treatment. Continue reading “My Way or the Highway! UofL Takes Hostages.”

Jewish & St Mary’s Merges with St. Joseph’s. University out of deal, but very profitable indeed.

On Friday January 6, the relationship between Catholic Health Initiatives and its Louisville hospitals was reshuffled as Jewish Hospital and St.Mary’s Healthcare joined the rest of CHI’s Kentucky hospitals without the University of Louisville Hospital. The University still has hopes that it will be able to join the new entity at a later time. The announcement gives us some insight into what the earlier acquisition would have looked like: the New CHI-directed system will be called KentuckyOne Health, and it already has a logo.

This is a logical move for these institutions. The formerly independent Jewish Hospital was already under the effective control of CHI having merged with the former Caritas Hospital (now St. Mary’s). By all accounts, Jewish Hospital (and St. Mary’s?) were already in a desperate financial situation as their clinical services continued to unwind. The new merger has been backdated to January 1. There was probably lot of scrambling over the past week to rearrange the former deal. Somehow the phrase “having a gun to your head” pops into my mind. I have no knowledge what other offers have been made to Jewish. Obviously CHI wanted to keep the institution in its fold.

What has not been spoken of at all is what role St. Mary’s Hospital has in this new future. It was not one of the premier hospitals in Louisville before, and has lost even more of its luster since. I am being told by people who’s contacts are better than mine that the plan is to close St. Mary’s and transfer its beds to Jewish Medical Center East, much as Norton closed Southwest Hospital and opened Brownsboro East. (The plan from its construction was to turn Jewish Medical Center East into a hospital.) The new Jewish Hospital East will become a woman’s hospital to compete with Norton and Baptist just up the street and around the corner. Indeed, we are already seeing the advertisements for the new Jewish Hospital Women’s Center. Perhaps University Hospital will reduce the size or even close its obstetrics service as it sends more of its patients to the East End or even to a Jewish Hospital Downtown: certainly it will now have more competition for patients. If it had still been in the deal, my wager at even odds would have been that University Hospital would have transformed itself, or at least part of itself, into a stand-alone cancer hospital. The above predictions and speculation fit well with the facts as they are emerging. I suspected they were coming weeks ago.  I understand now why the proponents of the old deal were not willing to say that jobs in Louisville would not be lost in their new entity. I suspect we will find out in short order much of what was hidden in the prior two or more years of sub rosa planning. Continue reading “Jewish & St Mary’s Merges with St. Joseph’s. University out of deal, but very profitable indeed.”

Where Were the Faculty Voices?

Since the failed initial attempt by the University of Louisville to force its own acquisition by Catholic Health Initiatives, a number of current University faculty members have approached me privately to thank me for my small roll in bringing the secret agreements into public view. They told me many of their colleagues were also very unhappy with the plans.

I confess that over the last month I had begun to feel like the old dinosaur I am, witnessing the apparent extinction of traditional academic principles. The question I had for my former colleagues was, “if there were so many of you, where were your voices when the public needed to hear them?” Of course I already knew the answer: they were afraid of losing their offices or their jobs. “How could that happen” you might ask? The fact is that bullying is not just a phenomena of grade schools. Of the few faculty letters to the Courier-Journal these past months, the only three that spoke against the acquisition were from retired faculty like myself. A few administrative faculty wrote in support, but I felt as sorry for them as I did for the young (she looked young to me!) new Chairperson of the Department of Obstetrics and Gynecology who had to begin her Louisville career arguing for the University that nothing was going to change and everything would be all right.

I have not had any feedback after reprinting a critical letter allegedly sent from many senior faculty and faculty administrators to President Ramsey and Provost Willihnganz last summer. I for one am assuming it is not a forgery! In any event, we already know it was essentially ignored.   Is there anyone from the University who is willing to at least tell us how many faculty finally signed the letter? (Use the confidential “Contact Us” link on the right.)   I will not ask anyone to personally identify themselves or any other faculty member, nor will I do so. I know your concerns about retaliation are real. Isn’t that sad?

Peter Hasselbacher, MD

An Outside Perspective on Recently Failed Merger Attempt.

A Review by David Dranove,
Consultant to Jefferson County Attorney O’Connell.

In mid-December, The University of Louisville and its proposed partners, under an order from Jefferson County Attorney Mike O’Connell, released some of the previously secret documents underlying the proposed acquisition of University Hospital by Catholic Health Initiatives (CHI). Mr. O’Connell asked Professor David Dranove, a respected faculty member at Northwestern University’s Kellogg School of Management to review at least some of the materials. On December 28, two days before the Governor rejected the proposal, a four-page “Perspective” from Professor Dranove was released to the public. I am unaware if the opinion was circulated in enough time to be considered by the Governor’s or Attorney General’s Offices, but at least one phrase from the report has been seized upon by the University and its partners as a justification to soldier on.

I do not know which documents Professor Dranove looked at nor what aspects of the deal he was asked to consider. In fact, it is not obvious to me that Professor Dranove read the most important documents at all. He seems unaware that the proposed merger also involves St. Joseph’s Hospital System and invents a new name for the merged system: “CHI-Kentucky” instead of “Network-Entity” which is used throughout the documents. He admits that he was not asked to consider church-state issues. There is no mention of any specific financial details, no comment on any of the proposed organizational or administrative structures, and no possible alternatives to merger. The report discusses the current national wave of consolidations as hospitals and their captive employed physician practices face increasing competition with each other. The report seems to assume that the new Patient Protection and Affordable Care Act (Obama-Care) will favor large organizations that can serve as Accountable Care Organizations (ACOs) and be eligible for higher Medicare payments for quality. (Of course it is equally likely that such an organization would receive less money for lesser quality!) Continue reading “An Outside Perspective on Recently Failed Merger Attempt.”

Thank You Governor Beshear.

What Comes Next?

Today I sent the following letter thanking Gov. Beshear for his careful approach to the Commonwealth’s consideration of the proposed acquisition of University Hospital by CHI. (PDF version here.)  I sent appropriate versions of the same thanks to Attorney General Conway and State Auditor Luallen for their roles in preparing an objective analysis for the Governor. The University of Louisville has chosen to press ahead with a modified configuration of its current plan.  The community also needs to press for an explanation of how this run-away-train of an agreement was allowed to proceed so far out of the eye of the Commonwealth and the public.  In my view, the answer lies in a fundamental shift in the priorities of the University over the past two decades.  It is time for the community to reevaluate if we are in agreement.
Peter Hasselbacher, MD Continue reading “Thank You Governor Beshear.”

Governor Beshear Rejects Proposed Louisville Hospital Merger

On Dec 29,  the last business day of 2011, Kentucky’s Governor Steve Beshear rejected the acquisition of University of Louisville Hospital by the Catholic Health Initiatives hospital chain of Colorado. If you have read any of my recent entries in this Policy Blog it will be clear that I agree wholeheartedly with his decision. I confess to being more than a little surprised, given the enormous expenditure of money, marketing, and political pressure that drove this steamroller of a business deal.

The Governor acknowledged much input from a wide range of community actors both for and against the acquisition. In his statement (reprinted here) he referred largely to the legal and policy advice of Attorney General Jack Conway’s office, which was assisted in its analysis by State Auditor Crit Luallen. I am immensely proud of these three state officers. They deserve our thanks for protecting the interests of all Kentuckians. I urge you to write to them and thank them, as I will. (Addresses available here.)

A sufficient objection to the acquisition/merger hinged on the fact that an important state and public treasure was being sold unilaterally to a private entity by the University and its hospital subsidiary, University Medical Center (UMC). The University claims that UMC is itself a private company and therefore beyond control by the state. This obviously fallacious argument was soundly and logically rejected by the Attorney General. Continue reading “Governor Beshear Rejects Proposed Louisville Hospital Merger”