Did the KMA get rolled?
I was out of the country for most of the past few weeks and missed the Fall annual meeting of the Kentucky Medical Association (KMA). I was surprised to learn that the Association’s House of Delegates passed a resolution opposing the new Brownsboro Road location for Louisville’s Robley Rex Veterans Administration Hospital and furthermore resolved that it supports “a location in close proximity to the University of Louisville Medical Center.” As I investigated what happened, I was not surprised to find a cast of familiar characters affiliated with Grow Smart Louisville, a one-issue advocacy group initially founded by neighbors to oppose building a new VA on the Midlands site at Brownsboro Rd. but which appeared to redirect its focus to advocate specifically for a downtown location.
In truth, I did not expect that the University would give up on its cherished dream of having another captive group of patients on its doorstep. I congratulate the players on the success of this latest tactical maneuver. Of course I had no right to be surprised, because the organizers told me explicitly last spring at a country club reception held for community physicians that this was how they planned to open an avenue for President James Ramsey to renew the University’s opposition to the Brownsboro location. You can read about that event and the operational strategy it launched in an earlier article.
The resolution.
In previous years, I sat on the Government Affairs Committee of the greater Louisville Medical Society that prepares resolutions to be offered to the statewide organization. This year, for some reason, I did not receive any of the preparatory materials! Here is the final resolution as submitted– read it for yourself. The resolution restates the familiar argument that as is the case with other hospitals, VA Hospital in-patients are commonly transferred for a variety of reasons to other facilities for medical services. It also states the truism that a number of other VA hospitals around the country are located in downtown urban settings close to affiliated University teaching hospitals, including Lexington. No arguments there.
Who can best serve our veterans? Who should decide?
However, the underlying assumption that the only physicians or healthcare facilities in Louisville worthy of take care of our veterans are located in close proximity to the University of Louisville Medical Center is completely unsupported, and frankly, insulting. It was initially difficult for me to understand why the medical Society would have taken sides in this way. A resolution proposed by the Louisville Medical Society some years back expressing concern about deterioration of clinical programs at the University of Louisville also seemed inappropriate to me at the time– more politically than clinically motivated.
In truth, measured quality of care and success in attracting patients who have other options have not been bright spots for University Hospital. At a medical conference last week, a prominent UofL physician who practices at Jewish Hospital stated with regret that people just don’t feel they need to come downtown for the best medical care anymore. Indeed, individuals need not do so. Several alternative medical facilities with excellent reputations, state-of-the-art facilities, and equal or better quality and safety have and are being built. Jewish, Norton, and Baptist are all well on their way to shifting their primary focus away from downtown Louisville. That is what makes control of a large captive group of patients (with a payer behind it) to make up the difference such an economic prize.
Time and distance:
Which scenario provides more flexibility for Veterans?
The differences in time and distance that are stressed in the resolution are overstated. Google Maps tells me that the present Zorn Avenue location of the VA Hospital is 5.1 miles and 14 minutes from University Hospital. The new Midlands/Brownsboro location is 8.9 miles and 17 minutes away from University– a three minute longer drive but with better parking that will more than make up for the difference. The new location puts the Robley Rex Hospital 4.7 to 5.3 miles and 11 to 13 minutes away from three of Louisville’s other major hospitals: Baptist East, Norton Brownsboro, and Norton Suburban. There is no reason why a VA patient could not also be transferred downtown if that was in their best interest. The VA, which already contracts out major services such as cardiology, will have more options to provide high quality services at competitive rates. (At present, neither University Hospital or its new sister institution, Jewish Hospital, holds the cardiology contract at this time– but they would probably like to.) Robley Rex already directly employs primary care and specialty physicians. The hospital, already a well respected and highly rated facility, is no longer totally dependent on the University for professional services and that is not a bad thing.
Community Based and Other Primary Care Clinics.
The resolution did raise a legitimate concern about which I was unaware. Apparently one or more of the VA’s Community Based Outpatient Clinics will be relocated to the new campus. It is claimed that the otherwise unspecified closings will place primary care locations further away for most veterans using them but I am unaware of the evidence supporting this assertion. The VA at Zorn Avenue currently has off-site outpatient clinics on Dixie Highway in Shively, on Newburg Road, and on Dupont Circle. There are additional clinics at Fort Knox and in Grayson County. There are nearby Indiana clinics in New Albany and Scottsburg. I have no knowledge about which of these, if any, will be affected by relocation to the new hospital campus.
The Shively clinic serves as a center for women’s services, and the Dupont Circle location for mental health. Presumably, veterans are already traveling to those locations from further away. I do not know how veterans currently seeing physicians in those locations might feel. I do know that at all of the public forums I attended that were held by the VA during its site-selection process, the almost universal opinion voiced by veterans was that they did not want to go downtown for their medical care. It appeared to me that the majority of the remainder who expressed support for a downtown location were affiliated with the University in some way, or lived adjacent to Brownsboro location. No matter where a VA hospital is located, public transportation needs to be arranged so that patients can get there– from whatever direction they begin the trip!
Who was behind this effort?
It was immediately obvious where this initiative came from. I asked my former committee colleagues how the resolution got to the table. The two principal physician advocates identified for me are active supporters of Grow Smart Louisville. I met at least one of them at the aforementioned congenial Country Club affair. (No one there seemed to buy these arguments either.) One will be a neighbor of the relocated Robley Rex Hospital. One has moved his practice out of Kentucky. One was recently prominently featured in Valeo, a “lifestyle” magazine for physicians published by Eric Gunderson who is also President of Grow Smart Louisville.
When the resolution was first put up for a committee vote, it failed to gather a majority to proceed further. I am told that continuing efforts by the sponsors “wore down” the committee which finally forwarded the resolution along with others to the annual state convention. You can bet that much lobbying was involved. In my opinion, the attempt to win the economic prize of serving VA patients is being piggybacked on the legitimate personal concerns of neighbors at the new hospital site which have been summarized extensively in these pages and elsewhere. It is appropriate to have this discussion, so long as it is being conducted in the open. (Click the “Veterans Hospital” category tag below or in the sidebar to review what has been written in these pages.)
Is veteran’s care to be earmarked?
I congratulate the sponsors for their tactical success, but in my opinion, the reputation of the medical society has been used to further special interests. I rather doubt that the KMA will be putting much muscle behind any legislative initiatives in support of the resolution, but that is not what the University needs. As was explained to me several months ago, what UofL wants is the political cover that will allow it’s very good friends in Washington to intervene on its behalf and give it effective control of a downtown VA hospital after all. Our federal legislators in both the House and Senate are currently on record supporting the decision-making process of the Veterans Administration. It remains to be seen if they will stick to their guns in the face of the hands-on lobbying that is certain to occur during the fall sports season. I urge them to do so.
If, following the hospital-destroying experiences of hurricanes Katrina and Sandy, the University of Louisville can convince anyone in Washington that it is appropriate to build a veterans hospital in a floodplain against the wishes of its patients, I will eat my hat, buy the Martini, and congratulate the institution once again for the effective use of it’s lobbying and earmarking clout to further its parochial interests.
Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
October, 2013
Downloads:
KMA Resolution.