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.”
Both state and city contributions to the QCCT charity care fund are no longer needed and have now been eliminated. Will funding be needed again if Medicaid expansion is reversed? If so we need a better way to provide medical services to this population.
Perhaps the most innovative aspect of the 1983 contract under which Humana assumed management of our state-owned University of Louisville teaching hospital was the Quality and Charity Care Trust Agreement (QCCT). In exchange for a fixed minimum of financial support from the City of Louisville and the State of Kentucky to fund indigent inpatient medical care, Humana promised to provide all necessary indigent care to eligible citizens of Jefferson County and to a limited number of out-of-county individuals. It appeared to me at the time that the arrangement worked well, but I came to realize that as a consequence, the brand-new University Hospital would be explicitly defined for the community as a trauma center and poor-people’s hospital. To the extent that University Hospital inherited the mantle of the formerly segregated Louisville General, University Hospital remained the place where people of color, those at the margins of society, or those served in the teaching clinics of the medical school were expected to be cared for. Private patients were admitted elsewhere. The Hospital has yet to shed this unfortunate constraining heritage. I have written a fair amount about this program. Continue reading “Indigent Hospital Care in Louisville at a Crossroads.”
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.”
Some Had Advance Warning
The Board that oversees the Quality Community Charitable Trust that helps support medical care to the indigent and medical needy was apparently given advance notice of this latest reduction in government contributions. From $7 million yearly (since at least FY2012-13) the amount has been reduced to $5 million, a 29% cut. Although the state used to contribute substantially more than the city, the two units of government contribute (at least for now) at essentially the same level. No explanation or justification for the reduction of the QCCT appears anywhere in the Metro budget. In fact, the single mention of the QCCT at all is in its line-item entry.
What lies ahead?
The handwriting on the wall is clear for this once-innovative program that cast University Hospital as the poor-people’s hospital of Louisville and made it easier for other hospitals to contribute less than their fair share. A combination of multiple changes in the QCCT partners, a crack-down by Medicaid on the methods used to finance the fund, and a scathing audit of oversight and management practices led the way. An increasingly difficult budget situation in both Frankfort and Louisville, and the anticipation that the Affordable Care Act (ACA) would reduce the amount of indigent and medically-needy care necessary provided either the coup de gras or the excuse for state and local governments to back further away from their commitment.
As I have argued many times in the past, this is not necessarily an undesirable result. As long as our community demands that the healthcare system care for all comers to its doorstep, there must follow a corresponding expectation of community support to help pay for such services. Our community is no healthier than its sickest member, and whether it is paid for from private insurance, government funding, charity, or some provider’s other pocket– the risk of the few must be spread over the resources of the many. I believe however, that we need a different system locally (if not nationally) to share the assumed obligation. Continue reading “It’s Official. Louisville Contribution to QCCT Indigent Care Fund Cut to $5 million.”