University of Louisville’s Review of Its Hospital Operations.

And Who Will Take Care of the Poor?

One doesn’t ask of one who suffers: What is your country and what is your religion? One merely says, you suffer, That is enough for me. You belong to me and I shall help you.        Attributed to Louis Pasteur.

The Commonwealth of Kentucky once required hospitals and doctor’s offices to post the prices of their top 20 services. This was fair– hospitals were asking their patients how they expected to pay. The policy concept of disclosure was and is reasonable, but the results were embarrassing, unused, and perhaps not even helpful. Under pressure, the Commonwealth repealed the law after two years.

I suggest we would all feel better (and probably even be better) if we would post the above thesis instead. Why don’t we? Most or all of the doctors with whom I went to medical school would have echoed Pasteur at the time. I suspect most hospital administrators and their corporate boards also wish they could post Pasteur’s profession on their front doors. After all, the earliest hospitals were established almost entirely to serve the poor. The non-profit status of today’s hospitals stems from those charitable roots. The sad fact is that in our system, no single physician or hospital could stay in business if they actually tried to serve all who showed up on their doorstep. It takes a community effort. In Louisville, talk of indigent care usually focusses on University Hospital. Why is that, and should it?

Fitness of University Hospital to serve the poor.

Earlier this month, and under the sword of an examination by the State Auditor’s Office, the University of Louisville announced that it would review its hospital operations to address questions of the strengths and vulnerabilities that were raised during the debate over their proposed merger/acquisition by Catholic Health Initiatives. They will retain an outside consultant of their choosing and have named a 9 person review committee. We are told that the review will consider how University Hospital compares to other academic hospitals financially and in the amount of “indigent care” provided. The University obviously still has a partnership on its mind, but declined to answer a direct question of whether it had resumed discussions with the new KentuckyOne Health entity. [Of course it has!]

I credit the University folks for opening the planned meetings to the public, but it looks to me that they want to control what is discussed just as tightly as they did when they rolled out their campaign for last Fall’s failed merger. Faced with a truly independent outside audit, and still embroiled in the courts over their withholding of court-ordered documents, some damage control might be judged imperative. It is axiomatic in matters such as these, that if you can select the issues and define the vocabulary of the debate, you have won before you even start. The University wants this discussion to be about how many medically indigent patients they serve, and to convince us that all that is needed is more money from the state or elsewhere. One strategy that I see evolving, seeks to give the Governor and Attorney General’s offices the political cover needed to reverse their previous rejection of the CHI acquisition.  The University leadership has (1.) already demanded more money than they know the Commonwealth can provide, (2.) will claim that only more money will solve the problem, and then (3.) present once again a deal they still hope to make with Jewish Hospital and CHI, (now KentuckyHealth One).  This would be an incomplete victory. Continue reading “University of Louisville’s Review of Its Hospital Operations.”

Horse Liniment for Your Arthritis and Healthcare Reform.

While looking in today’s paper for inspiration for something to write about, I saw an advertisement claiming that the “Arthritis Pain Mystery” had been solved, and that the secret was “Horse Liniment.” Naturally there was something you can buy. The only corporate identification or images in the ad were the prominent trademarks of both Walgreens and RiteAid. I know something about arthritis, and I initially assumed that these two giant drugstore competitors had joined forces to bring this breakthrough to the public. At first it looked to me like the drugstores had placed the ad themselves.

Actually, the truth is that this advertisement caught my eye because is was one of a long series by many companies that make what is in my professional opinion overly sensational, misleading, and unsupported claims to be effective treatments for arthritis and other musculoskeletal ailments. I have always had to look hard and usually unsuccessfully for the grain of truth in these kinds of ads that might make them legal. No doubt the promoters of ARTH ARREST, “considered a medical miracle by some” had their ad reviewed by lawyers. It may well have passed such muster, but in my professional opinion, it fails the sniff test of ethical medical promotion. Any ad with the word “miracle” or which relys on anecdotal testimonials should wave a red flag. Even the big pharmaceutical companies do not make such claims, and they are not my ethical champions.  When I read closer, I saw that the drugs were simply available at Walgreens and RiteAid. Both companies were apparently merely lending their good names to the promotion. Continue reading “Horse Liniment for Your Arthritis and Healthcare Reform.”

Kentucky Medicaid is a Mess.

Slow-Payments or No-Payments for medical care.

A week ago I was pretty tough on a possibly hypothetical physician who was said at a Frankfort hearing to have abandoned two child patients because one of the three new Kentucky Medicaid Managed care vendors had not paid him for three months. What is not hypothetical is that the Medicaid system is now in shambles. There are now four independent Medicaid managed care systems in Kentucky plus original Medicaid itself to deal with. Each of these has its own bureaucracy and unique systems. Thats a lot of different hoops for physicians and other healthcare providers to jump through. I have no doubt all are pulling their hair out. By all accounts, all three new vendors are in the pay-slow, pay-low mode. Cynics will point out that this is an easy way for an insurer to make a profit. After all, even Kentucky government uses the gimmick of paying healthcare providers late as a way to balance the books and make it look like they have actually been doing their jobs.

It is easy to assume that the three new managed care companies are to blame. That does not easily explain why all three seem to have failed at the same time, or why they appear successful in other states in which they work. When I worked in Kentucky Medicaid in the 1990s during my first-ever sabbatical and later as a faculty fellow, it was clear to me that there were major inadequacies in the state’s Medicaid computer systems and their ability to transfer and analyze information. I hope things have improved since then. Remember that all information about eligible beneficiaries, hospitals, and other providers has to be transferred to the managed care companies and continually updated so they know who to pay and for what. The three vendors have been silent publicly, but I will bet a martini in your favorite Louisville bar that internally they are struggling to interface with the state’s system. When you consider that each hospital and doctor’s office may also have their own computer system, it is no surprise that Kentucky Medicaid is staggering under its own weight and complexity. I hope we can pull out of this death spiral of cost and confusion. I still expect the state and providers to hold patients harmless, but that cannot continue infinitely. What a mess! Continue reading “Kentucky Medicaid is a Mess.”

Is the University of Louisville Moving in the Right Direction or Not?

A few weeks ago, following the collapse of the attempted merger/acquisition of University of Louisville Hospital by private interests, a respected member or the community asked me how we had arrived at a point where the advocates of the takeover failed so miserably to understand the critical issues of concern to the public. I attempted an explanation, but there is no simple answer to this complex issue. Here is the reply I offered. Continue reading “Is the University of Louisville Moving in the Right Direction or Not?”

Loss of Medical Privacy? Is that OK?

Yesterday, Phil Galewitz reported for Kaiser Health News (reprinted in USA Today) on a practice that is one of my biggest disappointments in our health care system, the sale of our personal health information for the benefit of someone else.  I do not mean the use of de-identified medical information to improve public health, medical quality, enhancement our ability to treat disease, or even for law enforcement.  I am talking about the use of your individual health information to try to sell you something else that you may or not need.  Did you ever wonder why all of a sudden you started getting ads for diabetes supplies?  Or why ads for erectile dysfunction started arriving in your mailbox as well as your email?  It is because your personally identifiable medical information is being shared to improve the bottom lines of those who have access to your medical records.  The story highlighted the practices of hospitals that use information from their medical records to peddle other services to their current or former patients  Partnering with mass marketing companies, your hospital knows a lot more about you than is present in their records.  For example, if you smoke, you get a directed ad for lung cancer screening.   Believe me, when you come in for a “screening,” something can almost always be found that ”needs” to be done.    Screening can be a hospital’s or doctor’s best friend.  It all depends on how ethical or financially strapped the provider is that determines how far evidence-based scientific medical practice will be stretched.  Examples of abuse are easy to find. Continue reading “Loss of Medical Privacy? Is that OK?”

Archbishop Fights Health Plan Policy.

I have been trying to find the time to branch out to other topics on this policy blog, but material related to issues of the recently failed merger/acquisition of University of Louisville Hospital by Catholic Health Initiatives keeps rolling in. Yesterday it was reporting by Peter Smith in the Courier-Journal on local Catholic Archbishop Joseph Kurtz’s tough talk about the new federal law requiring employers offering health insurance to cover birth control pills, morning-after pills, and certain other basic necessary health services related to reproductive and womens’ health. The Catholic Church equates contraception to murder, although even the large majority of American Catholics and most of the rest of us do not agree.

The coverage requirements do not apply to churches or other purely religious communities such as convents, although presumably some (but not all) of the covered services would not be missed in such institutions. The new law only extends to entities such as hospitals and universities in the public marketplace that would hire non-Catholic employees.

Bishop Kurtz complains that, “People of faith cannot be made second-class citizens,” and that his religious ancestors did not come to these shores “only to have their posterity stripped of their God-given rights.” He complains further that the new law “has cast aside the first amendment … denying to Catholics our nation’s first and most fundamental freedom, that of religious liberty.” The Bishop apparently fails to see any irony that by forcing employees or patients in hospitals like University Hospital to follow his religious dogma, that he is guilty of violating the freedoms of others, god-given or otherwise! Reverend Simmons, a minister and teacher of medical ethics in of Louisville says it better, “that the only freedom being cast aside is the “liberty to enforce their opinions on others.” Continue reading “Archbishop Fights Health Plan Policy.”