Big News Day Yesterday!

Is the University of Louisville losing its grip on the messages?

Yesterday was a big news day for most of the threads that this policy blog has pursued over the last few months. You can follow the discussion by using the Topic Links below or at the right. The thing that ties them together is the involvement of the University of Louisville which has vested interests in the outcomes.

Veteran’s Hospital:
The location of a new Veterans Hospital at Brownsboro Road took a step forward when the additional report of the organization analyzing the impact on traffic in the area was released. Further studies led to the opinion that “there will be no significant impact” on traffic or other quality-of-life issues in the area. Additionally new construction on the intersection of major roads in the area has begun. A final decision is expected soon, but wasn’t it always? It will be interesting to see all the elements of any final agreements, including what is to be done with the old hospital site. Will it be used for other support for veterans [seems like a good idea to me], or traded for high-end residential development?

Medicaid Managed Care in the State:
The lawsuit between Appalachian Regional Hospitals (ARH) and Coventry Cares came to an interim head when a judge granted ARH a restraining order preventing Coventry from dropping its hospitals from its network. One immediate result of this mandate is that Coventry must continue to pay ARH, but how much and whether it is a just amount is far from clear to me. Patients will be given an opportunity to switch to another managed care company, WellCare. No mention is made of Kentucky Spirit, the third MCO, which ARH was also suing, but which was receiving the least money from the state for its Medicaid enrollees. Is Kentucky Spirit no longer a player in that region? If they were allowed to exit, why not Coventry? Does anyone know? What a mess. The good message from all of this is that an attempt is being made to protect the innocent until things get sorted out.  Recall that Louisville’s version of medicaid managed care did not start out well either.

Medicaid Managed Care in Jefferson & Surrounding Counties:
The Commonwealth placed official notices seeking at least two bidders to provide managed care services to the former Region III, now currently served by Passport, which was and still is controlled by the University of Louisville. This move was mandated by the federal agency that administers Medicaid. No doubt at the very least, the Feds had read the recent critical outside examinations by the State Auditor and by Myers and Stauffer. This was no casual decision. There are rational arguments to be made about keeping things as they are, but equally rational and more numerous arguments for busting UofL’s monopoly. If choice is supposed to be good for all the rest of us, why do we deny it to Medicaid recipients? UofL and Passport were and are like the market-controling ARH of today.  There are also the additional complications inherent when a health plan acting as the insurer is controlled by the providers it pays.

I just found two recent reports about the history of Medicaid managed care in Kentucky that were prepared shortly after it had begun. One in 1999 was from the State Auditor at that time, and a second was prepared in 2004 for the Centers for Medicare & Medicaid Services in Washington. It is like déjà vu all over again! Having a monopoly on clinical care or administration was a source of big problems then as now. Lets face it, Passport may have provided good care, but it also spawned scandals and wasted taxpayer money. I had forgotten that there was a second MCO in Lexington that failed after two short years (as some of our current ones may yet do)! I will write more about those reports later. Read them for yourself.

QCCT Fund for Indigent Care in Louisville:
Mayor Greg Fischer wrote a letter to the Courier-Journal emphasizing that the City had, contrary to University of Louisville rhetoric, not decreased its funding to University Hospital for indigent care. He also asked questions raised earlier in this Policy Blog and by others. Allowing UofL to control the vocabulary and agenda of the public debate seems finally to have reached its limit. The Mayor is asking for public discussion about how best to provide important medical services to the most disadvantaged among us.

  • How will the University respond to the concerns of inadequate oversight of the Trust raised by the state auditor?
  • How will the pending Supreme Court decision on health care reform legislation affect University Hospital? [No matter what the result it will be a new ball game.]
  • What will be the effect if the University finds another merger partner? [Does the Mayor know something we do not?]
  • What will be the effect of a new Medicaid Managed Care Program in Jefferson County?
  • What happens with the money diverted from the Hospital to the medical school with respect to indigent care?
  • Why is Louisville the only city government that pays into an indigent care trust fund?

The Mayor is quite clear about the city’s ongoing commitment to its poor and uninsured. I am reassured that he recognizes that there are “outstanding questions regarding the most effective way to manage and provide indigent care.” I and others have been asking such questions for some time. In a future contribution, I will specifically offer a forum in which our community may contribute to answering these outstanding questions that impact the health and wealth of all of us.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL

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