Can Jewish Hospital in Louisville be Saved? Perhaps Not.

If not, what then?

Surely the end-game of the years-long efforts of Catholic Health Initiatives and KentuckyOne Health to sell some or all of their hospitals in Louisville must be coming to a climax. Transferring management of University of Louisville Hospital to KentuckyOne– a move that turned out badly for both institutions– was always as much or more about saving Jewish than ULH.  Many outside entities came to kick the tires of what KentuckyOne wanted to sell but walked off the lot.  The last acknowledged potential buyer whose keys KentuckyOne was holding was the tag-team of the private equity firm Blue Mountain and its spinoff for-profit hospital management company, Integrity Healthcare– now majority-owned by for-profit Nantworks Companies and Nantworks owner Dr. Patrick Soon-Shiong.  Sound complicated?  It is!  Casting a very dark curtain over this potential transaction in Louisville is last week’s announcement that Blue Mountain & Co.’s first and only attempt to take over a failing non-profit Catholic hospital chain in California has failed– the hospital system has filed for bankruptcy. These six Verity Hospitals (formerly the Daughters of Charity) might be bought by their communities, taken over by others, liquidated for their assets, or otherwise close.  I cannot avoid concluding that the same result would occur in Louisville and for much the same reasons.

CHI has played this one very close to its corporate chest. Fanned by anxiety about the future, rumors have been flying in increasingly disparate and desperate directions ranging from “Blue Mountain” has taken a second look and will sign on soon; or Blue Mountain has walked away for good; or that Nantworks and Dr. Soon-Shiong will move forward with the deal without Blue Mountain; or that CHI will give Jewish to the University for a song; and even that one or both of the sister Jewish & Sts. Mary Hospitals will soon shut its doors.  None of the potential players is in a strong place right now as I will outline below.  The one thing I am sure of is that the ground under the downtown hospital complex is going to quake hard, and that secondary seismic activity will be felt out in the county and beyond.  The Louisville Community is going to have to make some public health decisions that are both difficult and expensive. Continue reading “Can Jewish Hospital in Louisville be Saved? Perhaps Not.”

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.”

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.”

Catholic Health Initiatives Reports Increasing Financial Losses in Kentucky.

Last Thursday, Chris Otts of WDRB News may have been the first to report on Catholic Health Initiatives’ (CHI) most recent quarterly report to its creditors covering the 90 days ending March 31, 2014. Meant to be read in conjunction with last November’s audited annual report, the current unaudited update covers the first full year that CHI has controlled “substantially all of UMCs operations” at University of Louisville Hospital (ULH). The news report focused on the fact that KentuckyOne Health, the manager of CHI’s multiple hospital-related operations in Kentucky, had lost an additional $134 million on its “faith-based” hospital operations over that 90-day period. This stunning loss comes on the heels of an earlier report that KentuckyOne had lost $100 million in the six months ending December 31, 2013.

More than just financial data is provided.
The full report is in the public domain. My reading confirmed what was reported by others. However, I was struck more by other tidbits of information that confirm or add to our knowledge of what is happening behind the surgical drapes hung to to keep the rest of us from assessing the health of this hospital system of which a public asset is part. Continue reading “Catholic Health Initiatives Reports Increasing Financial Losses in Kentucky.”

Changes Coming to Downtown Louisville for KentuckyOne Health.

Not so bad so far!

I have been scanning the usual media outlets for some clue about what went on at the Tuesday institutional town meetings that Jewish Hospital announced publicly last week. I am finding nothing, nor have I any idea what was discussed.  I have a feeling that if something big had been revealed, that we would have heard of it by now. KentuckyOne and the University of Louisville continue to keep the lid on pretty tight.

What I did find was a YouTube video message from KentuckyOne’s CEO, Ruth Brinkley. It contained nothing particularly surprising or controversial. Its principal function appeared to be to calm employee anxieties that arise naturally during rapid institutional change. It begins by telling the “good news” that half of the $218 million budget deficit has been made up through the hard work and sacrifice of employees, although no details are offered. It restates the obvious, that major change takes time and is difficult. Employees were told that no further large-scale layoffs were anticipated.

Patient referrals and provider recruitment.
Other successes announced include increased referrals to system physicians and mid-level primary care providers through the “Anywhere Care” tele-health initiative or from referrals through HealthGrades. Fifty-eight new primary care providers of a variety of professions have been added to the network.

Employees are told they can help by speaking well of and conveying their pride in the organization to their family and friends. They are urged to select KentuckyOne primary care providers. Suggestions for cost-saving measures from employees are solicited with special recognition awarded for measures that are adopted. Much of the rest of the message is a restatement of the goals of the organization including improving the health of Kentuckians. It is noted that the challenges still facing KentuckyOne are not unique to it. [I agree.] Continue reading “Changes Coming to Downtown Louisville for KentuckyOne Health.”

1964 Civil Rights March on Frankfort Redux.

separare-never-equal 50 years later, still marching for voters’ rights.

Yesterday, along with thousands of others and 50 years too late, I went to Frankfort to participate in a celebration of the 1964 March on Frankfort. Ironically, and belying the opinion of some on the US Supreme Court who must willfully be wearing blinders, the principal issue of protest yesterday was of voting rights– the restoration of suffrage to felons who have paid their dues to society. Many in the huge crowd also carried signs protesting the Commonwealth’s intention to appeal last week’s Federal Court decision requiring Kentucky to recognize legal out-of-state same-sex marriages.

Innumerable signs carried by the crowd recognized heroes of Kentucky’s”s civil rights movement and identified current obstacles to full implementation of basic civil rights for all citizens. These tangible aspects of the march are symbols of the slow but inexorable progress towards the ideals that underlie American culture, but which were imperfectly implemented by the first version of our Constitution. I was even more moved however, by unexpected portents that arose along the route of the march. Continue reading “1964 Civil Rights March on Frankfort Redux.”

QCCT Funding for Indigent Care: Back in Play Again.

Massive Cut Proposed in State’s Biennial Budget for Indigent Care in Jefferson County. Time for a new game-plan?

I knew I was going to have to write something more about the Quality and Charity Care Trust (QCCT) when I saw that the Governor’s budget was slated to decrease the annual appropriation substantially from $21 million to $9.5 and $6.15 million in fiscal years 2015 and 2016 respectively. That represents a 70% reduction and would surely be a body blow to University of Louisville Hospital.

I am unaware of the rationale behind the proposed reduction, but together with the decreasing contributions from the city of Louisville, it is clear that our state and local legislators are rethinking the appropriateness of the QCCT funding mechanism as the principal means to support the care of medically indigent of our community. I have argued that they are correct to do so.

The QCCT fund to support inpatient care at a public University of Louisville Hospital may have made sense in the early 1980’s, but I do not think it does any more.  Much has changed, including the amount of funding and the rules regarding its use.  Our healthcare providers and our community itself have also changed. This was never a funding system that should have been considered to operate in perpetuity. Perhaps the Governor’s Office knows something that we do not. Continue reading “QCCT Funding for Indigent Care: Back in Play Again.”

UofL Hospital Cuts Some Clinical Services.

A significant loss to the community or not?

On Aug 1, the Courier-Journal’s hard-working Laura Ungar reported that the University of Louisville was cutting some services available to its hospital patients. The digital version of the report was quickly picked up by national media. Ashok Selvam, a reporter for the industry news magazine, Modern Healthcare, could not elicit comment from the Hospital itself. His story gave the impression that the cuts were a consequence of last December’s failed merger with Catholic Health Initiatives. It seems to me that such an interpretation is exactly the story line that UofL has been using as it maneuvers to finally consummate such a marriage. Additionally, UofL has been forecasting reduced services to the indigent for many months as it argues before the Louisville Metro Council for additional public funding. Without some actual cuts in evidence, such promises might appear hollow. Given its claims of poverty and need for more tax dollars, I am not surprised that UofL might want to provide some kind of evidence that the sky really might be falling in.

Fortunately for Louisville, Ms. Ungar was very successful in eliciting more information. Despite the fact that UofL President Ramsey recently went out of his way to say that he makes it a point not to read the Courier-Journal, the Hospital would have lost much local credibility if it had stonewalled. So, what were the actual services that are said to be cut, and how might they be related to a failure of the merger or to the provision of indigent care? I must say that I agree with the comment from the Louisville Mayor’s office that “it appears these services are not critical.” Lets take a look ourselves. Continue reading “UofL Hospital Cuts Some Clinical Services.”

The RFP of the University of Louisville Remains Undead

UofL postpones partner selection for second time.

Just when you thought you were safe from any more non-data-driven updates from me about the status of the University’s search for a new business partner conducted under the invisibility cloak of its Request for Proposal (RFP), I got a reprieve. The Courier-Journal’s Laura Ungar reported over the weekend, that UofL had delayed its decision until “on or before September 28.” This three-month extension is longer than the the entire original RFP lifecycle filed earlier this year on February 23, with a deadline for responses of March 23, and an anticipated final selection the week of April 16! When April turned out to be the cruelest month, the decision deadline was extended to the end of June, and again now to the end of September.

On learning about the news, I offered the following statement:

This second postponement of an announcement about the RFP gives no clue how things are going from the University’s perspective. From my viewpoint, the news that the University wants to continue its top secret dealings about something so important to our community is very disappointing. UofL has justified many of its actions over the last few years in the name of providing indigent medical care, but those decisions are not the University’s alone to make. The longer the University administration delays engaging the public for its consent and support, the more we all have to lose. As Mayor Fischer recently pointed out, “there are outstanding questions regarding the most effective way to manage and provide indigent care.” That is a conversation that cannot be had behind closed doors.

Continue reading “The RFP of the University of Louisville Remains Undead”

Louisville Metro Council Passes Budget for 2012- 2013

Level Funding for Quality Community Care Trust (QCCT)

Last night the Louisville Metro Council passed a budget for 2012-2013 with very few and relatively minor changes from the proposed budget they and the Mayor had put together over the past few weeks. For the purposes of this Policy Blog, the controversial QCCT fund for inpatient care of the underserved  at University of Louisville Hospital received funding of $7.00 million. This is the same net amount the University has received in recent years but which the University claims is a decrease. The Courier-Journal’s report today states that a clause was added that if city income projections are better than projected next year, that additional funding would be considered. [The official published budget is not yet available to me. When it is, I will quote the language of the clause, the final numbers, and comment further.] Below are the figures from the proposed budget. A neater tabulated copy is available. Continue reading “Louisville Metro Council Passes Budget for 2012- 2013”