University of Louisville Hospital Designated as Best Regional Hospital for Cancer in Louisville.

Kudos to my colleagues at University Hospital.

jgbcancercenterI recently wrote about the disappointing representation of Kentucky’s hospitals in this year’s 2015 version of US News & World Reports list of Best Hospitals. Of Kentucky’s approximately 130 acute-care hospitals for adults, not a single one achieved national ranking in any of 16 different specialties. Nine Kentucky Hospitals were designated as a “Best Regional Hospital” by having one or more of 16 specialty services considered “high-performing” as defined by scoring in the top quarter of all eligible hospitals for that specialty nationally.

I went on to discuss what are in my opinion some of the difficulties and shortcomings of current attempts to rank hospitals for quality and safety. I reinforced US News’s stated intent that their program was designed to identify hospitals best suited for the most difficult cases where the services of large, high-volume teaching hospitals with abundant in-house technology might make a difference. Hospitals not on their lists may still provide high quality routine care. With a focus on cardiology and cardiac surgery, I also discussed how the mix of data elements examined can boost or diminish a given hospitals standing [and perhaps even add fuel to the current technology arms-race among hospitals]. Continue reading “University of Louisville Hospital Designated as Best Regional Hospital for Cancer in Louisville.”

Recent Court Decisions Impact University of Louisville Hospital.

Same-sex marriage advances– hospital secrecy recedes.

While I am sure it is coincidental, I find it ironic that on the same weekend the Supreme Court refused to take on the same-sex marriage issue in Washington– thus making such marriages legal in 11 additional states– the Kentucky Court of Appeals ruled that University Medical Center Inc. is indeed a public agency. I wondered what was happening to that lingering litigation. I will try to assemble and post the various briefs from the trial and appeals courts and try fill in the gaps. The opinion gives a useful overview of hospital history. Read it here. Continue reading “Recent Court Decisions Impact University of Louisville Hospital.”

Why Is There Only One NCI Cancer Center in Louisville?

In Reporter Michael McKay’s account of the UofL Board meeting earlier this month when progress towards the University’s 2020 Plan was summarized, and when the post-fraud “Audit” was formally presented; President James Ramsey commented on the University’s failure to earn a National Cancer Institute (NCI) designation for its James Graham Brown Cancer Center. Dr. Ramsey stated that it was unlikely that UofL would receive an NCI designation because the UK program is so close. (The Markey Cancer Center at the University of Kentucky was designated as an NCI Comprehensive Cancer Center in 2013.) Dr. Ramsey is said to have implied that UofL had been in talks for some sort of “partnership” with UK before that institution went on its way alone. These comments sound more to me like excuses than explanations. I found nothing in the NCI application documents that would indicate that distance from another center would be a factor. Indeed, depth of collaborations with other research and clinical centers is highly desirable if not essential.

Continue reading “Why Is There Only One NCI Cancer Center in Louisville?”

Recognition of Legal Same-Sex Marriages Now [Briefly] the Law in Kentucky.

What will KentuckyOne Health and other employers do?

For a single day following Judge G. Heyburn’s historic court order requiring Kentucky to recognize legal same-sex marriages from out-of-state, such couples were legally able to do things that many of us take for granted such as changing names on drivers licenses. Sadly, there are reports that despite having two weeks to prepare, some clerks turned people away yet again. Confusion about what to do seemed the socially acceptable and perhaps even understandable excuse. This was the justification offered by the Attorney General’s office in requesting a 90-day stay of the Judge’s order so that the Commonwealth could prepare for an orderly implementation of the new law, and to minimize confusion.

The Judge balanced the lack of any strong argument that the Commonwealth would be harmed by moving forward, against the further injustice of enforcing unconstitutional policy. He may also have been influenced by information presented at Friday’s hearing that some married couples would in fact be harmed by a further 90-day interval. In the end, Judge Heyburn stayed his order of February 27 for 20 days until March 20 to allow the state “proper time to administratively prepare for compliance with the Order.”

Will or won’t the Commonwealth appeal?
A decision of whether or not the Commonwealth will appeal the underlying Order within the allowable 30 days will apparently be made soon. The basis for such an appeal would likely be that the Attorney General has a responsibility to enforce state laws and policy. Of course that is a justification used in the past to suppress the civil rights of minorities. I believe that our Governor and Attorney General will not appeal, even without the cover provided by the United States Attorney General advising that states’ Attorneys General need not defend unconstitutional laws, or last June’s US Supreme Court’s United States v. Windsor decision that turned gay-rights marriage law on its head. This high-drama matter will play out in Kentucky and several other states as it will. In the meanwhile, it is not only the Commonwealth of Kentucky that must prepare for compliance with the new law, but other public and private institutions that have used Defense of Marriage- type laws to support their choice not to recognize legal same-sex marriages. I predict much squawking and maneuvering to avoid doing the right thing as occurred following other civil rights actions in the past.

Here in Kentucky, one of the most prominent actors who will have to change their spots is KentuckyOne Health, the hospital corporation that manages several facilities around the state including in Louisville: Jewish, Sts’ Mary and Elisabeth, Our Lady of Peace, and the University of Louisville Hospitals. Currently in these hospitals, the legal marriages of same-sex families are not recognized for the purposes of employee healthcare and other benefits. In the case of University Hospital, and following the directives of its Catholic parent company, benefits that same-sex partners earned from the previous manager of the hospital were taken away by KentuckyOne Health.

What will KentuckyOne Health do? What should it do? Continue reading “Recognition of Legal Same-Sex Marriages Now [Briefly] the Law in Kentucky.”

Order to Recognize Same-sex Marriages in Kentucky is Stayed for 20 Days.

Breaking News!
4:26 p.m

Kentucky must recognize all legal out-of-state marriages regardless of the mix of the sexes involved by March 20, 2014.

On February 27, 2014, Federal Judge John G. Heyburn, II issued a historic final order declaring null and void, Kentucky’s statutes and Constitution forbiding the state to recognize legal out-of-state marriages of same-sex couples. In an earlier Memorandum & Opinion on February 12, the Judge found that no state purpose was served by such discrimination. The carefully reasoned and sensitively written memorandum is destined for the history books.

Immediately following the final order, the Office of Kentucky’s Attorney General filed a request for a 90-day stay in order to give the Commonwealth time to consider whether or not to appeal the judgment and to allow time to prepare for implementation of that order. In a hearing today at the Federal Courthouse in Louisville, Judge Heyburn granted a short stay. For all the happily married same-sex couples, the doors are opening wide to all of the rewards, civic, financial, and emotional, of their commitment. The order granting stay can be viewed here. Continue reading “Order to Recognize Same-sex Marriages in Kentucky is Stayed for 20 Days.”

KentuckyOne Health Financial Woes Leading to Staff Layoffs.

University of Louisville Hospital to share in the employee cuts.

Breaking Information. 6:00 p.m.

It is no secret that KentuckyOne has been losing money continuously across the state. Contacts have told me that the amounts are as much as $70 million per quarter and growing. Little wonder then  that KentuckyOne and Catholic Health Initiatives (CHI) may not have transferred the funds they promised to the University of Louisville and to the Governor to seal their deal to take over University Hospital. The remaining shoe has finally dropped. Continue reading “KentuckyOne Health Financial Woes Leading to Staff Layoffs.”

KentuckyOne Health Buys Largest Block of Land at Dupont Medical Center

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The plot thickens, but what is the plot?

It seems like the juiciest news stories break when I am out of town. Last week, John Karman and David Mann of Business First, and Sheldon Schafer of the Courier-Journal informed us that KentuckyOne Health was purchasing additional land at the Dutchmans Lane/DuPont Circle medical center in eastern Louisville. The purchase price has not yet been disclosed.

I have been waiting for this other shoe to fall. This acquisition gives KentuckyOne Health control of a huge block of land making up fully one half of Dupont Circle adjacent to its existing Jewish Hospital East facility. The total land now held rivals the amount occupied by Norton Suburban Hospital. I haven’t seen any contracts yet (and do not expect to), but I understand that some sort or purchase agreement has been prepared and that the sale “won’t be completed for three years in order to honor the leases of the 15 tenants in the center.”  (I did not think that closings could be delayed that long.)  As it happens, all but two of the lots on that half of Dupont Circle are owned or controlled by realtor and former University of Louisville Trustee, Sandra Metts. In my opinion, the sale of land to UofL’s best new partner has never been in serious doubt. Continue reading “KentuckyOne Health Buys Largest Block of Land at Dupont Medical Center”

Major New Medical Center at Old Henry Road

header-600Additional photographs and maps supporting this article can be seen here.

Another place to collect medical dollars. Is the sky the limit?
In a previous posting, I categorized my effort at investigative journalism as a Hardy Boys adventure. I had in mind the young detectives of my boyhood reading, but a friend advised me that modern-day Hardy Boys are members of US military special forces who conduct “dark” operations. Given the nature of the secrecy surrounding healthcare planning in Louisville, perhaps I am on target in either scenario. In any case, to maintain an appropriate image of impartiality, I conducted my next excursion to the east as Nancy Drew.

As the growth of medical facilities in Louisville has evolved, all three major hospital systems have leapfrogged beyond the confines of the Watterson Expressway to the Gene Snyder Freeway (I-265) and beyond. Of course, this is neither unexpected nor unjustifiable. This is where Louisville’s population is settling — especially those with good medical insurance. I might offer my services there too. Indeed, as a patient, unless there was some special reason I needed to go downtown, I too would rather stay closer to home. Inspection of maps, real estate transactions, and observations on the ground make it clear to me that our hospitals are ready, willing, and able to expand their east-county facilities even further. New construction has already begun. What will stay downtown remains to be seen. This article will focus on the developing medical center springing up around the intersection of the Gene Snyder and Old Henry Road. I invite you to share my field trip with me and to add what you can.

Continue reading “Major New Medical Center at Old Henry Road”

Hospitals love their cardiologists– and are willing to buy their affection!

bemine2Back in the days when I was a hospital lobbyist, my colleagues voiced the generally accepted fact that Medicare and other insurers overpaid for cardiology services. As a medical student, I was taught the Willie Sutton Law of Medicine– “When looking for a diagnosis, think of common things first.” [When Willie Sutton was asked why he robbed banks, his answer was, “Because that’s where the money is.”] While I by no means wish to imply that all hospitals are stealing our tax and premium dollars, an increasing parade of nationwide criminal investigations, indictments, and convictions make it clear that some hospitals and their doctors are shaking the cardiology piggy bank too hard. Continue reading “Hospitals love their cardiologists– and are willing to buy their affection!”

Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.

[Correction: Because of a systematic error in the on-line database of the Kentucky Hospital Association, the number of angioplasties reported for all hospitals in 2011 was exactly double. This caused me to under-estimate  the sharp drop in procedures at St. Joseph London, and erroneously indicated a statewide increase for that year. Corrected charts, tables, and discussion are substituted in the text below.]

The University of Louisville’s new academic and clinical partner, KentuckyOne Health, and its erstwhile suitor, Health Management Associates (HMA), have both been in the news lately but not in a favorable light. A story about HMA was the leadoff feature of the December 2 edition of a 60 Minutes program in which HMA was alleged to have exercised inappropriate and computer-assisted influence over its physicians to admit patients from the emergency rooms of its hospitals who would not otherwise have required inpatient-hospitalization. One of KentuckyOne’s hospitals, St. Joseph London, has been sued and is under federal scrutiny for claims it was performing unnecessary invasive cardiac procedures and worse, operating on patients with normal hearts. For many reasons, these are serious allegations, not least because they impute the ethics and professionalism of the hospital’s management, medical staff, and employees. It would also put human lives at risk without chance of benefit and be be a waste of our collective tax and insurance premium dollars.

Continue reading “Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.”