What is Happening at Louisville’s Norton-Kosair Children’s Hospital?

Louisville’s Messiest Divorce Ever.kids-balloon

Last August, the Louisville public was treated to a gloves-off confrontation between the University of Louisville and Norton Healthcare (and their respective allies) over the physical control of Norton-Kosair Children’s Hospital. Tough-talk was punctuated by threatening lawyer-letters and an all-stops-out public relations effort to capture the hearts and minds of us citizens. Some motivations were partially exposed. State government was drawn in. At least one court action was set in motion. Then, nuclear options having been wielded, cooler heads prevailed and the promise of continuing “discussions” was made. The matter moved behind closed doors and perhaps even out-of-state. Security has been tight. Not even long-standing medical staff know what is going on.

When Norton Healthcare and the University of Kentucky announced their intention to cooperate more effectively in providing children’s hospital services to Kentuckians, it was reported that they hoped to conclude negotiations by the “end of the year.” Obviously that has not happened but that milestone allows us a rationale for asking the question, “what is going on?”  Reports are filtering up from employees that negotiations have collapsed and that the sides are back to square one. Although I have good reason to believe that things are not going well, spokespersons at both Norton and UofL tell me that talks are still  continuing. That would be the diplomatic, albeit unrevealing thing to say.

This seeming hiatus, real or perceived, is a good time to inform the broader constituencies of these organizations and the public at large about what the difficult issues are. After all, “We the People” have a child in this fight, and are paying the bills to boot. Based on my long career in academic healthcare, I have some ideas about what the most problematic issues probably are, but on behalf of the public for which I consider myself an advocate, I invite the parties involved to enlighten us as they construct public policy that will effect everyone.

No one will be surprised at my claim that the issues revolve around (as they always do in such commercial enterprises) money and control, with a healthy dose of academic politics and pride thrown in. It is more about control of the local healthcare market than control over what medical trainees might be learning. The evident bad-blood between the institutions is not helping either. Continue reading “What is Happening at Louisville’s Norton-Kosair Children’s Hospital?”

Norton Healthcare and University of Louisville Meet Over Kosair Children’s Hospital Dispute

This started out to be the shortest ever post in the history of this policy blog. All I had to report was the following press release from Norton Healthcare.

Earlier today, representatives from Norton Healthcare and U of L held a meeting to discuss a number of issues relating to Kosair Children’s Hospital. Norton officials characterized the discussion by saying:

“We had a constructive meeting and plan to meet again.”

I was going to add that in diplomatic-speak, this amounts to the equivalent of, “everyone walked away from the meeting alive.” Continue reading “Norton Healthcare and University of Louisville Meet Over Kosair Children’s Hospital Dispute”

New Medicaid Managed Care Providers for Kentucky.

But only for new beneficiaries and not in Region 3?

Significance to Norton-UofL dispute over pediatric care.

We have been waiting for these next shoes to drop. The Commonwealth of Kentucky has announced its award of new contracts to three Medicaid Managed Care Organizations (MCOs) to provide services to new Medicaid beneficiaries in the 104 Kentucky counties not in Region 3. The contracts went to: Anthem of Kentucky (a division of Wellpoint that is an entirely different company from WellCare), Humana, and Passport (University Health Care, Inc.). These additions come just ahead of the major expansion of Kentucky Medicaid resulting from the federal Patient Protection and Affordable Care Act, known affectionately to some as Obamacare. Some 300,000 new beneficiaries will be added to the current 715,000 beginning January 2014. Continue reading “New Medicaid Managed Care Providers for Kentucky.”

Newborn Nursery and Neonatal Care in Kentucky’s Hospitals, 2012

Focus on Louisville.

Although in a previous life as a clinician I always cared for a few children by default, I cannot claim to have insider or expert knowledge about the operations or politics of children’s hospitals. Nonetheless, when I was a hospital lobbyist, I always made a point of bringing visiting legislators through Norton Kosair Children’s Hospital to brag about the fruitful cooperation between the University and a private hospital in which no patient was ever turned away for inability to pay no matter how long they stayed. (I would have to think twice before doing that today.) I therefore take the opportunity provided by the current University of Louisville/Norton Healthcare dispute to familiarize myself with pediatric care in the state.

Going to the numbers.
It should be no surprise to my readers that as an old scientist, I like to look at the numbers. I can’t spell or remember names, but patterns emerge when I look at tables of data causing me to want to know more. So it was when I looked at the distribution of Neonatal Intensive Care Units throughout the state. The obvious next step was to take a closer look at how those beds were being filled with patients. I have already posted relevant pages from hospital utilization data collected by the Cabinet for Health and Family Services for 2012. Lets take a closer look. For simplification, and to get an initial handle on what the data might tell us and what it cannot, I extract here the numbers for births and special care bed admissions for children in Louisville, and for comparison, the University of Kentucky. (Download Table as PDF.) Continue reading “Newborn Nursery and Neonatal Care in Kentucky’s Hospitals, 2012”