Universal Medicaid Managed Care in Kentucky: Month Five.

Long-term recommendations from the State Auditor, and a “Modest Proposal” from me.

Two days ago, Adam Edelen, Kentucky’s new Auditor of Public Accounts, began his term in office with a bang by releasing the results of his initial investigation of the performance of Kentucky’s four Medicaid managed care vendors. There is obviously a practical limit to the amount of information that can be collected and analyzed in a short time, and the Auditor’s office appropriately acknowledged this. Nonetheless, the results were consistent with anecdotal reports and legislative hearings, and were correspondingly very discouraging. The State Auditor offered suggestions in hopes of improving future services.

In early February, Mr. Edelen asked the Commonwealth’s four Medicaid Managed Care Organizations (MCOs) to provide his office with information from the months of November and December of 2011. He asked for basic statistics such as: the number of members served, the number of claims filed and paid, the dollar value of those claims, and the number and value of rejected claims with the reasons for rejection. (Note that we are only talking about two months.)

In a press release of February 29, the Auditor noted that the managed care organizations had received $708 million while paying out only 420 million as of February 15. That is a float of $288 million! Although there was plenty of criticism of the MCOs, the Auditor also shared some of the blame on the Cabinet which was said to have failed to learn the lessons of the difficult transition to Passport 14 years ago and was ill-prepared to monitor and enforce its contracts with the new MCOs. Continue reading “Universal Medicaid Managed Care in Kentucky: Month Five.”

UofL Meets Some Potential New Partners.

Pre-submission Conference for Request for Proposal RP-57-12
University of Louisville and University Medical Center, Inc.
Feb 28, 2012

Transitional Research Building

Investing In and Delivering Health Care Services, Education, and

Research in Conjunction with University of Louisville and University Medical Center

The University of Louisville and its Hospital have been seeking a new partner to help with their various diverse missions. I attended the Pre-Proposal Conference that was held today in UofL’s new, palatial, and seemingly unpopulated Transitional Research Building. This meeting is a requirement of Kentucky’s contracting and purchasing regulations. In addition to University folks that I recognized, there were perhaps 10 or 11 other individuals. The audience included representatives from Baptist, Norton, and KentuckyOne Health. There were two or three people whose affiliation was unknown to me. The meeting began with introductions of the 5 panel members from UofL and its Hospital: Attorney Glenn Bossmeyer, Dr. Gregory Postel, CEO James Taylor, Facilities VP Steve Amsler, and Asst. Purchasing Agent Curtis Monroe. (Mr. Amsler was previously Vice President for Facilities at Jewish Hospital/St. Mary’s. I cannot recall that he said anything at the conference. Neither did I recognize any questions asked by representatives of KentuckyOne.) Continue reading “UofL Meets Some Potential New Partners.”

Information About UofL and UMC Partner Search Requested

Can you help Public of Louisville understand what is happening with regard to the ongoing efforts of the University of Louisville and University Medical Center Inc. in their undiminished quest for a new partner before it it too late do anything about it?

Over the past few months, in our community and in this Policy Blog, there has been much discussion about the University of Louisville’s efforts to find a statewide partner for its clinical, teaching, and research programs.  Its first solution fell flat over issues of secrecy, intrusion of religious directives into academic and clinical life, giving away a public asset to a private corporation, and other substantial deficiencies.  Given the initial reactions by University officers, no one should be surprised that they are at it again.  A request for a proposal (RFP) has been filed seeking a new partner.  To my viewing, it looks like the RFP has been written for a single preferred responder, but you can judge for yourself.  Worst of all, the whole process is now cloaked in even more secrecy then the first go around.  There will be a total blackout until after the papers are signed.  There is no acknowledgment that the Governor or anyone else will have anything to say about it.  I would like to think that that is incorrect.  I doubt even the University would have the audacity to act against overwhelming concerns of the public it claims to be serving. However, I have yet to overestimate University’s chutzpah!

I have heard a number of things third-hand about how the University plans to rush this deal through to completion before the issue of whether or not University Medical Center Inc., is a private or public entity is settled in the courts.  I am therefore reluctant to repeat the information in this Policy Blog without corroboration.  If you have first-hand information about how UofL or UMC is proceeding, or if there is any continuing role of KentuckyOne Health in this saga, I hope you will contact me directly using the “Contact Us Link” in the right-sided panel of this page.  I am also interested in KentuckyOne Health’s plans for St. Mary’s Hospital.  Will it remain a hospital, or will its certificate of need be transferred to a new east-end facility as Norton did with the former Humana Southwest Hospital? I promise you, I will never reveal my sources.  If you wish, you may call me at the Institute’s number, 502.802.5092.  Feel free to contribute a comment here or elsewhere on the site..  Registration is not required.

The public deserves honesty and transparency.  Please help us to that end.

Peter Hasselbacher, M.D.
Feb 27, 2012

University Medical Center Inc., Ad Hoc Operations Review Committee Meets.

Background of Internal University Review.

Last January, the University of Louisville announced that it was forming its own Internal Review Committee for University Hospital. In large measure, this must have been in reaction to the increasing calls for an audit of the Hospital’s use of the QCCT fund for indigent medical care. Indeed, the Auditor of State Accounts had already announced he would perform such an audit. Surely the University and its Hospital must already know a great deal about its own finances. After all, having a handle on internal finances is part of the job of running a hospital. Furthermore, for several years the University had been preparing for a merger/acquisition for which both internal and external reviews by the potential partners would have been mandatory as part of due diligence. University leadership admits it knows enough about the Hospital’s finances to submit an RFP to take on a new partner. Nonetheless, there is nothing wrong with taking a fresh look at the way any business is being run. Good for them!

This new committee did not emerge in a vacuum however. The University is emerging from a period of intense criticism of the way it interacts with its community– indeed that criticism continues. In my opinion the committee’s formation at this time is also part of an intensive and comprehensive public relations effort to improve or at least paper over its image. I believe this is a major reason why the offer was made that the review committee’s meetings would be open to the public. That is a major reversal of the tactics used by the University when it tried to merge with Catholic Health Initiatives and Jewish Hospital/St. Mary’s. In those proceedings, the University attempted to operate in secrecy until the last minute when it was forced to reveal at least part of its plans. The community did not like those plans. We now have an opportunity to see if the University and its leadership have changed their spots. This jury of one is still out.

Summary of the first meeting continued below. Continue reading “University Medical Center Inc., Ad Hoc Operations Review Committee Meets.”