KentuckyOne Health To Sell Its Major Assets In Louisville.

Beginning last Thursday, word began trickling out to journalists and the public that KentuckyOne Health, a major regional unit of Catholic Health Initiatives (CHI), was preparing to announce plans to sell almost all its hospitals and medical centers in Louisville and a handful elsewhere in the state. I had been told earlier in the week that the announcement would be made today, Monday, but there were so many leaks that KentuckyOne sent an email to its employees outlining its plans.  I presume KentuckyOne wanted take control of the message before the reportage dam broke. The email can be read here.

For those of us in Louisville, the only major facility not being sold is Our Lady of Peace, a psychiatric hospital.  Both of KentuckyOne’s acute care hospitals, (Jewish Hospital and Sts. Mary and Elizabeth Hospital), the Frazier Rehabilitation Institute, and all four outpatient Medical Centers (Jewish East, South, Southwest, and Northeast) are on the chopping block. Nearby Jewish Hospital Shelbyville, which recently underwent a critical review by the Inspector General for an EMTALA violation, is also for sale.  KentuckyOne employs many physicians. The fate of individual owned- or contracted medical practices in Louisville and elsewhere is not clear to me from the email. Continue reading “KentuckyOne Health To Sell Its Major Assets In Louisville.”

What Is Happening To Our Downtown Louisville Medical Center?

A number of threads that I have been following this past year or so came to a head this last month. These include a guilty verdict in federal court for a cardiologist in Ashland, Kentucky who had been accused of falsifying billing records to secure payment for performing medically unnecessary invasive procedures. The Leapfrog organization published its updated list of hospital safety grades. Additionally, and certainly not least, there are worsening signs of a dysfunctional and perhaps disintegrating relationship between the University of Louisville and KentuckyOne Health, the unit of Catholic Health Initiatives (CHI) that in Louisville owns Jewish and Sts. Mary and Elizabeth Hospitals, and manages the University of Louisville Hospital and its James Graham Brown Cancer Center. Although these themes are not necessarily unrelated to each other, in this article I will comment on the UofL/KentuckyOne situation and deal with others subsequently. First some background for what promises to be a major change in the alignments of the downtown medical center. Continue reading “What Is Happening To Our Downtown Louisville Medical Center?”

KentuckyOne Poised To Announce Layoffs of Senior Executives.

I have been advised by two sources that KentuckyOne Health will soon announce the elimination of several system-wide or senior executive positions designed to improve efficiency, reduce costs, and emphasize local leadership.  The as-yet unconfirmed names of the individuals currently in those positions include clinical and operational executives at the highest level.  I am unaware if the names of included leadership comprise a complete list or represent the tip of the iceberg of things to come.  Perhaps as an early indicator, the senior physician executive at Jewish and Sts. Mary & Elisabeth Hospitals left that position a few weeks ago.  As a company outsider, it is impossible to know all the reasons for changes in personnel.  These often include the personal career plans of the employee, but also concerns about the fit between employer and employee in meeting the goals of the particular corporation.  KentuckyOne may well once again be feeling financial pressures that cannot be denied. It has laid-off employees in the past to decrease expenses – a strategy that in the longer run was not entirely successful at University Hospital.

On the other hand.
One of the most common complaints I hear from my University of Louisville colleagues reflects what is considered to be unwanted and disruptive outsourcing or other “outsider intrusion” on the part of Catholic Health Initiatives or KentuckyOne management that does not allow for appropriate local initiative or control, or which treats all hospitals the same no matter where they are located, or fails to acknowledge the particular needs of their patient population. From this perspective, a diminution of the role of system-wide executives might be considered a worthwhile result. On the other hand, I suppose it is possible that a state-level KentuckyOne system control might be replaced by even more direct CHI control from Colorado!  The desire for local control is, however, at odds with current national and local policy, or financial pressures for hospital and health system consolidation and coordination.  The health of KentuckyOne and its partnership with the University of Louisville is a matter of critical concern for Jefferson County and the Commonwealth.  Things have not been going well so far. Continue reading “KentuckyOne Poised To Announce Layoffs of Senior Executives.”

A Herd of Humans – A Murder of Mosquitoes.

Revenge of the Aztecs- Part II

Lessons and challenges from the outbreak of Zika virus.

Although it was discovered 69 years ago in the Zika Forest of Uganda, even as a physician I had not previously known of the Zika virus. I first read about it a month ago in the daily two-page news brief on a cruise ship as it left the harbor of San Juan, Puerto Rico – one of the very places we were now warned by pubic health authorities to avoid!  Additional concern was generated by the fact that our cruise itinerary included two other islands in the Caribbean where the disease was breaking out.

The Zika virus belongs to the flavivirus family which includes Yellow Fever, West Nile Virus, and Dengue – serious players. It did not help matters that I had lost a friend to hemorrhagic Dengue fever on the Caribbean island of St. Croix a few years earlier. Like its sister viruses, Zika appeared to be transmitted primarily by mosquitoes carrying blood from one bitten person to another – the usual mechanism of arthropod vector transmission.

Where did it come from?
Although the primary infection itself may be asymptomatic, Zika’s usual symptoms are relatively mild and include fever, headache, joint pains, and conjunctivitis (red-eye). The first well documented epidemic of Zika in humans occurred on the Pacific island of Yap in 2007, and then in French Polynesia in 2013.  Impressive was the high proportion of individuals infected. On the French islands, a possible connection was made to an increased incidence of the reactive and probably auto-immune Guillain-Barré syndrome which can cause life-threatening paralysis by attacking the nervous system . In 2015, some traveler, perhaps attending a world cup soccer match, probably brought the virus to South America where it exploded to infect over a million individuals so far. Additional millions are expected to become ill as the epidemic runs its course. Public anxiety and my own was amplified by the fact that so little is known about the disease and its natural history. Continue reading “A Herd of Humans – A Murder of Mosquitoes.”

Big-Change or No-Change in Post-Election Kentucky Healthcare?

I have been out of the country these last two weeks and am trying to catch up. Perhaps the biggest news item while I was away happened just as I left town – the election of Matt Bevin as our next Governor.  I had only just learned of this fact when I was contacted by an out-of-state reporter who asked whether people in Kentucky who gained coverage through Medicaid expansion or through our KYNECT state insurance exchange should be concerned.  If so, why would people who only so recently obtained healthcare coverage vote for Mr. Bevin – as they obviously must have in winning fashion?

Of course they should be concerned!
I responded that based on Mr. Bevin’s campaign promises and comments alone, as reported by our local press, current KYNECT and Medicaid expansion recipients have every reason to worry about their future coverage and access to healthcare.  I would certainly worry if I were in their shoes and not the satisfied Medicare beneficiary that I am.  In the heat of the campaign, and to appeal to virulent anti-Obama haters, Tea-Partiers, and other conservative voters; Mr. Bevin unequivocally promised to undo as much as possible of the Affordable Care Act (ACA) implemented in Kentucky by Governor Steve Beshear.  At least that is what I heard.

Real promises or campaign maybes?
Campaign promises included unwinding Kentucky’s successful KYNECT insurance plan, or switching it from a state-run plan to a federal plan.  It also seemed clear to me that Mr. Bevin promised to end or roll back the Medicaid expansions that have numerically provided the most coverage to previously uninsured Kentuckians. (Mr. Bevin later apparently hedged his promise to something short of a full roll-back.)  Much was made during the campaign of Mr. Bevin’s possible confusion of Medicare and Medicaid, and statements about whether beneficiaries of publicly-financed healthcare should be required to submit urine tests for illegal drugs.  I took some of this to be red-meat stuff thrown Trump-style by both parties to their admiring crowds.  I would rather see Governor-elect Bevin improve what we have rather than walk away from it solely to satisfy his political base. Continue reading “Big-Change or No-Change in Post-Election Kentucky Healthcare?”

Potpourri of Health Policy Issues in June.

My cup runneth over with potential issues to explore.

June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so!  In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time.  The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style.  I haven’t even been able to update the Institute’s Facebook and Twitter pages!  What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later.  These are not necessarily in chronological order or of importance.

The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges.  The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA.  The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care.  Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”

Narcotized Elderly America: Diseased, Stoned, or Dealing?

pills-15The Federal Government has been releasing an avalanche of health care utilization data over the past very few years while the rest of use are still trying to figure out how to use the information.  While there exists the potential to use the data to evaluate healthcare quality and safety, to ferret out best medical practices, to more efficiently use increasingly limited healthcare dollars, or to otherwise guide good public policy; the most apparent utility so far is to identify medical fraud. It is easier to justify looking for fraud than to confront entrenched interests dug in deep in this profitable segment of the economy.

Medicare prescription drug cost and utilization data.
One month ago, the Centers for Medicare and Medicaid Services (CMS) published another data-dump. It was the first compilation of all drugs and selected supplies prescribed by physicians and other healthcare professionals to the majority of Medicare patients in 2013.  Included beneficiaries number 35.7 million and include those enrolled in freestanding Medicare Part-D drug plans, or those covered by drug plans that are part of Medicare Part-C (managed care) Advantage plans. These make up about 68% of all Medicare beneficiaries. Medicare fee-for-service patients are not included.  Recall also that a proportion of all Medicare beneficiaries are enrolled because they are disabled, not because they are over 65 years old.   Each provider has a line item for every discrete drug prescribed more than ten times by them (to protect patient privacy) including the number of unique beneficiaries receiving the drug, the number of times times prescribed or renewed, the number of days worth of of drug prescribed, and the total amount paid for the drug by the patient, Medicare, and any third party payers.  In the full data file there are 23,650,520 line items for more than 1 million individual providers prescribing 3449 different drugs or supplies. Continue reading “Narcotized Elderly America: Diseased, Stoned, or Dealing?”

Another Major Data Breach for a Health Insurer.

Hackers breached whatever firewalls and security measures were present at Premera Blue Cross based in Washington state.   The personal, financial, and now even medical information of some 11 million past- and present customers were accessed. The breach may have occurred last May, was detected on January 29, but not disclosed to either the public or regulators until a few days ago.  Nice job on the accountability front.

I recently wrote about an even larger breach of security at Anthem where the personal information of almost 80 million people was penetrated.  It was not thought that medical information was compromised then, but how can one know for sure?    I predicted we would be seeing more attacks on medical record and insurance databases but it is disappointing to see them coming on so rapidly.  There are at least two driving forces or enablers.  The first follows from Willie Sutton’s law explaining his reason for robbing banks—because that is where the money is.  Some 18% of our gross national product fuels the healthcare industry— that is where the real money is.  Medical fraud is part of that big business. Continue reading “Another Major Data Breach for a Health Insurer.”

Was Kentucky Spared from CHI Layoffs?

Is there still a nursing shortage in Kentucky?

Earlier this year, and following a disappointing report for the first quarter of FY 2015, Catholic Health Initiatives announced that it would cut 1500 jobs nationally by the end of January.  The positions targeted were administrative and support staff representing some 1.7% of CHI’s total 90,500-person workforce.  KentuckyOne Health (CHI’s operation in the Commonwealth) had already absorbed an previous layoff of 500 employees one year ago but remains the weakest sister financially among CHI’s regions.  Locally, concerns were shared that we might take another hit this round. Has that happened?

To be fair, CHI is not the only big system to be laying off people.  A nationwide shift from inpatient to outpatient services has even the prestigious Cleveland and Mayo clinics trimming their staffs.  Frankly, I have not heard much of anything about layoffs in Kentucky– at least in the Louisville market. Even a usually productive Google search did not reveal much for me.  The most notable activity is in Omaha where CHI’s hospital and clinical system have no current network contract with Blue Cross/Blue Shield.  The drop in patient volume there is said to have sparked layoffs of at least 156 people including physicians! Additional job cuts were anticipated through attrition and by not filling open positions.  There have been layoffs reported in Oregon too. Otherwise things seem to be quiet. Is that what happens when administrative jobs get cut?

In fact, in the usual on-line places, KentuckyOne is advertising to fill quite a few clinical positions in Louisville. I am informed that some modest hiring of clinical-support people is also occurring. I do not know what is happening in the rest of the state.  Good! Lets face it– you can’t run a hospital or medical office without doctors, nurses, and technicians.  If you terminate too many of these, people tend to notice, including accreditors and regulators.  I asked KentuckyOne how much and in what way Kentucky might have shared in CHI’s nationwide job-reduction program but did not receive a reply. Continue reading “Was Kentucky Spared from CHI Layoffs?”

You Can’t Always Get [What You Pay For]

But if you try real hard— you might do better than Venezuela!

Providing healthcare to [some] Americans is the best economic development bonanza going. Alas, here in the exceptional USA, many people do not have access to mainstream healthcare.  Worse however, as pointed out in today’s Wall Street Journal [yes, I do subscribe], nearly all Venezuelans needing even standard medical or surgical care are plum out of luck— unless they can find and then afford to buy their own medical supplies from insulin to heart valves.  It sounds awful. Hyperinflation makes already overpriced medical devices and drugs impossible to afford. An exodus of physicians, including those whom were loaned by Cuba, makes matters worse. The situation is beyond frustrating for both patients and physicians alike.  At least our feared but imaginary American death panels would have actual choices to make!   Venezuelans are in very real death-spirals of the flesh, not the death-spirals health insurance companies face when they are left holding the bag for sick people when healthy and less ill people fail to enroll in their plans.

The disheartening article included the following graphic showing Venezuela at the bottom of the list of Latin American countries, spending in 2012 only 1.6% of its gross national product on healthcare (and that was 2 years ago). The numbers from the World Bank are only slightly different.  If fact, according to that source, its healthcare spending in 2012 puts Venezuela at the bottom of the list of every other ranked country in the world, occupying a healthcare category all of its own.  That country is suffering the melt-down that apocalyptic American alarmists either warn of, or alternatively fantasize about as a starting point from which to rebuild from the ashes. Continue reading “You Can’t Always Get [What You Pay For]”