University of Louisville Provides RFP Documents. Better slow than never!

ALL Public UofL RFP Documents Available Here

On March 20, ten days after I requested them, and with 3 days left before responses to its RFP are due, the University of Louisville provided the Schedules and Exhibits that are part of its Affiliation Agreement with University hospital and University Medical Center, Inc.  I had requested these under the Freedom of Information Laws.  The set of documents can be found on the Purchasing Department website of UofL.  For convenience, I have broken the document down into its components. Continue reading “University of Louisville Provides RFP Documents. Better slow than never!”

University of Louisville Runs Out the Clock on its RFP.

Release of a supplemental response to one question about UofL’s partner search, and possible foot dragging on another.

The University of Louisville has published an addendum to one of the questions posed by those interested in learning more about their Request for Proposal to find a new partner for their Health Science Center Activities. I wonder why? Their initial answer was not very helpful at all. It is emphasized that responses are still due on March 23, one week from the release of the following supplemental response.

Original question and answer:

Q36 Section 5.3 of the Request for Proposal references a Joint Operating Agreement structure. What additional structures would be acceptable? Please elaborate on the preference for one structure over another.

Response: This issue was suggested to allow respondent to propose one or more approaches to operating structures.

Additional UL/ULH Response to Q36 released March 16, 2012

The University and UMC will consider any and all transaction types and operating structures, including mergers, joint ventures, and/or joint operating agreements. Any selected arrangement must sufficiently protect the University’s right to control its interest in University of Louisville Hospital.

I am beginning to have a feeling that the University is purposely slow in releasing requested material. Continue reading “University of Louisville Runs Out the Clock on its RFP.”

I Love My Socialized Medicine.

I am less happy with private-sector managed confusion.

As I may have mentioned in these pages before, I am the beneficiary of socialized medicine in America. Yes, your tax dollars, supplemented by my lifetime of Medicare premiums (already spent on someone else) have been paying for my health care for the past year. Fortunately for you, I am in pretty good shape at the present time. Even better for me, the Supplemental Premiums paid into the kitty by my fellow United Healthcare Seniors are now paying my monthly gym fee through the Silver Sneakers program. That’s $30 or more a month I can spend on gin. I for one am in love with government-run socialized medicine.

Regular Medicare was easy for me. Uncle Sam signed me up automatically for the classic plan. It’s the private sector part of Medicare that is giving me fits. Picking a private Medicare supplement to cover copays and deductibles was relatively easy because UofL (my former employer) partially subsidizes only a single program for its retirees, and because of their feud with Humana, does not provide any support for Medicare Managed Care that might provide drug coverage. The University had earlier abandoned their promise to retirees that they would contribute to drug insurance coverage. (Ironic for an institution that aspires to be a drug company itself– or perhaps very smart.) We are on our own for drugs. Continue reading “I Love My Socialized Medicine.”

Second Organizational Meeting of the UMC Ad Hoc Hospital Review Committee.

Not the promising start I had hoped for. Secrecy and control still in abundant evidence.

The Ad Hoc Operations Review Committee of University Medical Center, Inc. (UMC) met yesterday, March 12, 2012, for the second time. [Read about the history of this committee herehere, and here.]  I counted six of the 10 members present, three of whom were outside Committee members. There had been some “briefing” beforehand that I suspect will not show up in the minutes of the meeting. (TC #1) [Minutes of last meeting here.]

A new potential partner!

Perhaps the most interesting piece of news was that the healthcare strategy firm that had been updating the 2008 report of UMC’s financial future just notified the hospital that they had been hired to represent another hospital system that intended to respond to UMC’s request for proposal (RFP) for a new system-wide partner! (I had suspected as much from the content of some of the questions proposed in writing following the Pre-Proposal Conference.) The potential responder (not KentuckyOne Health) appears to be serious, although the opportunity to gather business intelligence as a motive cannot be dismissed by me at this point. Continue reading “Second Organizational Meeting of the UMC Ad Hoc Hospital Review Committee.”

Review of UofL Hospital by Kentucky Auditor of State Accounts.

An Open Letter to State Auditor Adam Edelen.

Re: An appeal to make broad your audit of UofL Hospital.

Dear Mr. Edelen,

Although it is like pulling teeth, small amounts of information about the financing of the University of Louisville and its University Hospital are slowly becoming public. The public is aware that your office is looking at the University’s handling of its QCCT funding for indigent care in its hospital. I am writing to try to convince your office that examination of QCCT funding alone is insufficient and that to fully judge whether the state and local components of that fund are truly being used to the best advantage of the public, other aspects of University accounts must also be examined.

For example, in last week’s release of information in response to questions submitted by potential responders to the University’s RFP for a new partner, the amounts of transfers from University Hospital funds to the University were outlined to the tune of $74 million of the $430 million of hospital clinical revenues. More than 17% of hospital revenues go directly to the University! Some of this is Medicare money designated to pay the salaries of Residents, but under its ongoing veil of secrecy the University does not detail where its money came from, nor how it is spent.

Given that the University has a long history of pooling its state money and using it as it sees fit, and in the wake of the Passport and other scandals, the public is entitled to a fully justified explanation. How else can we know whether the $34.4 million of current QCCT funding is too much, too little, or just right. A dollar of money drawn from the QCCT means another dollar that might legitimately be used to support indigent care can be spent elsewhere. Indeed, I believe the whole concept of the QCCT fund needs to be revisited. Why, for example, should not state indigent dollars follow the indigent, no matter where that service is provided? Why shackle the indigent to a place they may not care to go? Does the current QCCT reimbursement formula lead to artificially higher charges to all patients at the hospital? Does having a captive patient population blunt faculty motivation to make University Hospital the most desirable and highest quality hospital in town? To make such determinations, the public needs a full audit of the University of Louisville, its Foundations and Hospital. Continue reading “Review of UofL Hospital by Kentucky Auditor of State Accounts.”

Ongoing Planning Between UofL and KentuckyOne Health.

Does all Kentucky business happen at basketball games?

I made an interesting field trip to New York City last Friday. By accident, I discovered that the University of Louisville’s Department of continuing medical education was offering a seminar in the Big Apple entitled, “What We Can Learn about Hospital Mergers, Capital Investment and Construction in a Landlocked Urban Environment.” This topic sounded familiar! Given all the excitement about religious intermarriages of hospitals, I thought it would be interesting to hear what some of the players would have to say off the battlefield. It took a few phone calls, but eventually I got my name on the list. As I learned later, this meeting was part of an annual affair for University officials and faculty going to the Big East basketball tournament. Physician members can get some of continuing medical education credits necessary for licensure. The trip also gives University representatives a chance to visit other medical schools and teaching hospitals and to talk about things like technology transfer and mergers. This year’s field trip included a visit to Mount Sinai Hospital and Medical School which had recently gone through a high-profile marriage with New York University, and an even higher profile divorce.

There were some 20 people in attendance at the conference– a pretty high-powered team. President Ramsey, Provost Willihnganz, Vice President Inman (development, governmental relations, and marketing), and the Deans of the Schools of Medicine and Education made up the starting five. On the bench were the director of the University’s Residency Programs, and various division chiefs and program directors including neurosurgery, neurology, and anesthesia. I was actually shocked to find in attendance two very senior officials from Jewish Hospital who were leaders in last year’s failed merger attempt. This was not a party to which I would have been invited had I not crashed it myself. A few of the group were obviously not happy I was there and I suspect their conversations following the scholarly presentations of the conference were guarded in my presence.   Continue reading “Ongoing Planning Between UofL and KentuckyOne Health.”

Follow-up on UofL’s Search For a New Partner:

Responses by University of Louisville to questions from potential applicants to its RFP.

On March 9, the University of Louisville released its responses to questions submitted following its pre-submission conference on February 28. Some of these answers clarified questions asked at the conference. An e-mail containing the information was sent to 36 individuals and was posted on the UofL website. Most of the recipients were University of Louisville people, but there were individuals from Norton, Catholic Health Initiatives, Baptist Hospital, Jewish Hospital, Stites & Harbison, Kauffman-Hall, Price-Waterson, Health Management Associates, and yours truly.

A total of 71 questions were responded to, or requested information provided in attachments, but amazingly little was revealed. Eighteen of the questions were dismissed with the equivalent of “read my mind,” “you tell us,” “depends on your proposal,” or “will tell you after we have decided.” Bare-bones information seems to be the rule of thumb. These were not the responses I would have expected from an organization that was seriously soliciting responses from a major-league player. “Brush-offs” is a term that comes involuntarily to my mind as I read the responses. You can judge for yourself. Please tell me in the comments section if I am being unnecessarily harsh. Continue reading “Follow-up on UofL’s Search For a New Partner:”

KentuckyOne Health Lays Off Its Lawyers.

Shouldn’t we have seen it coming?

A number of sources, including Patrick Howington of the Courier-Journal, have reported that KentuckyOne Health recently dismissed its entire internal legal department. Other layoffs in the name of “streamlining” are foreseen. This, of course, is no surprise. After all, laying people off to reduce overhead is one of the reasons companies merge, isn’t it? I mean who didn’t see this coming? In fact, during the only two-sided public debate before the last merger attempt collapsed, one audience member asked the merger proponents what they probably thought was a supportive question related to the wonderful number of new jobs that would be created– right? The merger proponents embarrassingly had to hem and haw about how that might not be the case. In fact, the hospital partners of the current KentuckyOne Health entity have been laying people off for many months. Despite lots of flashy advertising, business has not been good. Artificial hearts and occasional hand transplants do not alone a well-rounded and efficiently-run hospital make. The results of several decades of unsuccessful management will take some time to alter. I am hopeful that more attention to their core business will pay off. The downtown medical center needs all its hospitals to be willing to cooperate in the public interest. We do not have that at the present time. Continue reading “KentuckyOne Health Lays Off Its Lawyers.”

Notice of Next Meeting of UMC Ad Hoc Operations Review Committee.

Media Advisory

The next meeting of the UMC Ad Hoc Operations Review Committee will be held on Monday, March 12, 3:30 – 5:00 p.m. in the Glass Room in the basement of the Ambulatory Care Building at University of Louisville Hospital.

The published agenda is:

  • 1) Approval of minutes of 2/21/12 meeting
  • 2) Conversation with Dixon Hughes Goodman re scope and timing of their work
  • 3) Next steps

Comment:

As was promised, I received this  notice on March 2.  The public is invited.  Why not attend to show that there is community concern other than mine!  Of course, I am only too happy to report for you.

The committee’s formation was announced by UofL President Ramsey last Feb 2 and its work was expected to be completed by April.  The first committee meeting was held almost 3 weeks later on Feb 21.  It was clear at that time that there was no common vision of the scope of the Committee’s work.  A consultant was hired to help define those goals and to do the work of the committee.  Next week’s meeting will be almost 6 weeks after inception with  only 3 weeks left till April.  The agenda reprinted above makes it clear that the scope of the project remains undefined.  At this rate is It is hard to imagine that much can be done over the next 6 weeks to keep on schedule for an April finish.  Indeed, the University hopes to complete its parallel RFP process and have its new/old partner on board in early April!  So why are they doing this?  There are several respected and  high-powered people on this committee, but it appears that the University is poised to do what it wants anyway before their Committee process can inform any decision.  Talk about wasted time and squandered opportunity.  If there is anybody in Louisville who feels they can trust this University and its leadership, please tell us why you think so in the comments to this posting.

Peter Hasselbacher
March 6, 2012

Universal Medicaid Managed Care in Kentucky: Month Five.

Long-term recommendations from the State Auditor, and a “Modest Proposal” from me.

Two days ago, Adam Edelen, Kentucky’s new Auditor of Public Accounts, began his term in office with a bang by releasing the results of his initial investigation of the performance of Kentucky’s four Medicaid managed care vendors. There is obviously a practical limit to the amount of information that can be collected and analyzed in a short time, and the Auditor’s office appropriately acknowledged this. Nonetheless, the results were consistent with anecdotal reports and legislative hearings, and were correspondingly very discouraging. The State Auditor offered suggestions in hopes of improving future services.

In early February, Mr. Edelen asked the Commonwealth’s four Medicaid Managed Care Organizations (MCOs) to provide his office with information from the months of November and December of 2011. He asked for basic statistics such as: the number of members served, the number of claims filed and paid, the dollar value of those claims, and the number and value of rejected claims with the reasons for rejection. (Note that we are only talking about two months.)

In a press release of February 29, the Auditor noted that the managed care organizations had received $708 million while paying out only 420 million as of February 15. That is a float of $288 million! Although there was plenty of criticism of the MCOs, the Auditor also shared some of the blame on the Cabinet which was said to have failed to learn the lessons of the difficult transition to Passport 14 years ago and was ill-prepared to monitor and enforce its contracts with the new MCOs. Continue reading “Universal Medicaid Managed Care in Kentucky: Month Five.”