Dust-Up Over Disbursement of QCCT Funding to University Hospital

There was a little excitement this week in the Louisville Metro Council over whether or not to continue the next installment of the $7 million indigent care payments to University of Louisville Hospital from the QCCT funds. The City of Louisville and Kentucky provide many millions of dollars annually against which University Hospital can bill for eligible indigent patients.

There were a number of issues that caused the Budget Committee to put the brakes on the city’s payments as of January 1. One was that that in the post-Passport scandal era the Hospital had not provided the requested and expected accountability. It is puzzling to me that the Council expressed the same transparency concerns last July but had still not been satisfied. Is the council giving too much deference to the university?  The procedural move also signaled that there are deep concerns about the proposed acquisition of University of Louisville Hospital by the hospital chain Catholic Health Initiatives out of Denver. Would the same services be provided, and would it even be legal to give public funds to a private religious organization.

Two days later the Council as a whole voted to release additional installments of the remaining $4.8 million funding until March, pending the apparently delinquent reports by the Hospital. Councilman Downard said that, “the hammer is still there” concerning their demands for information, but I thought the hammer had already been cocked! So much for transparency from this self-declared private institution. Amendments were offered to make the continuation dependent on providing the same range of services after as before any take-over but they were defeated. The protest of the committee hold was overridden, but its point was made. The University of Louisville made some of its documents available publicly the very next day. The University seems to realize that it has lost its public relations war against the citizens of Louisville. I sent the Council an open letter the day of their main meeting. It gives additional details and outlines my thoughts about whether the QCCT mechanism is still an appropriate way to fund indigent care in our city, or whether it has had unexpected and undesirable consequences. What do you think?

Continue reading “Dust-Up Over Disbursement of QCCT Funding to University Hospital”

Health Care Reform: Vision or Hallucination?

Has anything in health care improved for the better for us patients… for anyone?

Over 10 years ago as we approached the new millennium I was finishing an intensive Health Policy Fellowship.  As a synthesis of all I had seen and learned from an insider’s perspective, I penned a vision of what I thought healthcare should look like in the next century.  It was more a statement of some twenty principles and directions rather than specifics. We are now more than a full decade into the 21st century so it seems a good time to take a look at my old roadmap.   Perhaps it is a measure of my current pessimistic state of mind, but I am not immediately able to declare progress towards any of the goals I envisioned.  In fact, it seems at first blush that despite all the money and best efforts of public and private interests, that most of the items on my wish list are getting worse.

What do you think?  Please prove me wrong.  Help me indentify something good that has happened to us as collective patients.  Is anyone better off?   If so, who?    Convince me that we are not irreversibly lost in a status quo of decreasing access to healthcare of uncontrollable cost, and of unknowable quality.

Add a comment below.  I will not spam you, I promise.

Peter Hasselbacher

New Suburban Veteran’s Hospital for Louisville

On Veterans Day, 11-11-11, the Courier-Journal reported on the status of plans to build a new Veterans Hospital for the region of Louisville Kentucky.   The community has been waiting with decreasing patience for the results of all the promises and hearings.  The update did not, however, announce that a final site had been decided, nor that financing was in hand, nor that a start date was known.  Instead, the big news was that the site selection process had decided against leaving the hospital where it is on Zorn Ave, and against moving to the downtown medical center of metropolitan Louisville.   Subsequent notice of new road work near the intersection of the Watterson Expressway and Route 42 suggested that the new VA would be located there.  On Dec 14, we received further official verification from United States Secretary of Veterans Affairs, Eric Shinseki, that indeed the 4906 Brownsboro Rd  address is the first choice for the new medical center.  The second choice site is the one Factory Lane near the Gene Snyder Expressway.  It was estimated that from the time financing is secured, construction will take a little more than three years.  The letter from the Secretary appears to be in response to a request from Sen. McConnell for a realistic timeline for the project.  The Veterans’ Day update quoted 5 veterans, 4 of whom expressed disappointment and a preference for staying at Zorn, one of whom was relieved that at least it would not go downtown. Continue reading “New Suburban Veteran’s Hospital for Louisville”

Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital

Last week I submitted the following letter to the Governor’s Office.

Governor Steve Beshear
700 Capitol Avenue, Suite 100
Frankfort, Kentucky 40601

Re: Premature approval of hospital acquisition in Louisville.

Dear Governor Beshear,

You have been asked to consider approving a merger/acquisition involving the University of Louisville and University Hospital, Jewish Hospital & St. Mary’s, and the St. Joseph’s Hospital System under the auspices of Catholic Health Initiatives.   Individuals and Organizations (including women’s organizations) in the Louisville Community who have written or spoken about this matter are overwhelmingly against this merger, save for employees of the University, or its business partners.   The opposition continues unabated despite several public and private briefings.  This is in great measure because of the puzzling refusal of the proposal advocates to disclose relevant details supporting the real public or indigent-care need for the merger, or the implementation of its most controversial elements– especially those revolving around church and state issues. Continue reading “Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital”

Let Them Eat Cake! (In somebody else’s hospital.)

I have been reviewing all of the letters sent to the Courier-Journal by members of the community.  So far, without exception, all have been employees, faculty, or associated with one of one of the proposed partner institutions, or capital venture company that benefits from the University’s commercial research program.  One of these letters is particularly painful to me.

It was written by a medical student who has not yet even begun his clinical training.  It begins by parroting an assortment of the arguments that have been made by the University and Jewish Hospital & St. Mary’s almost as if the letter were from a University official.    Nonetheless, even a medical student deserves to have their voice heard, and perhaps especially a medical student, whose training will be very much affected by the proposed change in business structure.  The last sentence however broke my heart.  When speaking about the women’s health policy regarding tubal ligations, the writer concludes, “patients who don’t want to deal with it can always choose to go elsewhere.”  This is one of the most unfeeling  comments I have seen with respect to this proposed merger/acquisition.  I hope someone has taken the student aside and counseled them. Alas, perhaps not the two faculty leaders who also wrote regarding end-of life care, “When the stipulations of the Catholic Church make it difficult to follow the patients’s and families wishes, the patient can be transferred to another facility where the desires of the patient and family can be met.”

I hope the student above can bring more sympathy to the patients he may have the privilege of attending to in the future.  Perhaps as he learns to take a medical and social history from those patients he will learn that in fact these patients do not have a choice of going elsewhere.  That is the whole point!  Shame on the University of Louisville School of Medicine, its leadership, and its faculty for creating an environment where such a statement is thought justifiable by your student.  The privilege of caring for the indigent must be earned.  In past months, the University of Louisville has in my opinion abused that privilege.  The majority of the patients, students, trainees, and employees of the proposed merged entity are not Roman Catholic, yet their most intimate personal decisions are now subject to review by somebody else’s bishop.   How can that stand?

Peter Hasselbacher, MD
Dec 5, 2011

Why Is A Bishop Even In The Room?

I was plowing through my unread pile of newspapers and came to the report by Patrick Howington of October 17; “Hospital Merger- Altered Catholic rules pose problems.”  A subtitle asserted that “Hospital officials say fears of church interference are overblown.”  Really!   In point of fact, they are not overblown at all.  A number of  examples of church and secular hospital mergers were listed for which the winks and nods and work-a-rounds that were approved by a local bishop were overturned later by higher authorities or changes in rules.  We are not talking about a theoretical problem.

By coincidence (or perhaps as a sign) as I read this article today, the leadoff report on the CBS Sunday Morning Show focused on a Catholic hospital in Phoenix.  A woman who was 11 weeks pregnant developed severe pulmonary hypertension as a complication of her pregnancy.  The result for both her and her fetus would have been fatal.  The local hospital Ethics Committee considered her case and gave its approval for an emergency abortion to save the life of the mother.  That decision was shared by the nun who sat on the committee.  The woman’s life was saved but her pregnancy was sadly but predictably lost. Continue reading “Why Is A Bishop Even In The Room?”

Still Another Hospital “Merger” in Louisville Kentucky

Potential Questions and Issues Related to the Proposed  Acquisition or Merger of University of Louisville Hospital with Catholic Health Initiatives.

I am very troubled with the way this vaguely defined proposal has been revealed to the public.  I cannot avoid the impression that important elements of the deal have been intentionally hidden.  There is a lot to cover and these initial thoughts just scratch the surface.  If I had an opportunity to ask clarifying questions, I would start with these.  I ask them from my perspective as a life-long medical educator, physician to both the rich and poor, and a lobbyist for higher education.  What do you think?

Nature of the Proposed Arrangement:
Is a true merger of hospitals planned, or simply an acquisition by another hospital chain?  For example, will the new entity have a single Medicare Provider number?  If a true full merger is not planned, why not?  Which, if any, hospitals will be truly merged, or is University Hospital just being put in play once again by another hospital chain?  What will be new?  For what is the University of Louisville, its Hospital, and the Commonwealth of Kentucky giving up precious independence and control?

University Hospital has been managed by at least 5 outside corporate chains or partnerships of hospitals in the last 25 years.  All failed.  Other existing or contemplated partnerships, programs, or mergers with Louisville Hospitals have also failed.   What were the reasons for those failures?  What plans have been made to ensure a better outcome?  Where can we see those plans?  Why not? Continue reading “Still Another Hospital “Merger” in Louisville Kentucky”

Lots of Health Policy Still in Play!

I had the good fortune to be able to travel abroad and at home for most of the fall.  I confess I still have a foot-high pile of newspapers to look through.  It is immediately clear that a number of things have happened related to items I have been commenting upon in these pages.  Among these items:

  • The state legislature, not surprisingly, followed through with its support for a new concept of optometry by approving new regulations.
  •  The Veterans Administration listened to the overwhelming resistance by veterans and others to placing a new Veterans Hospital in downtown Louisville but also, reasonably in my opinion, felt that remaining on the existing Zorn Avenue site was impractical.   This decision has not disarmed the proponents of another downtown hospital who will no doubt continue to bring political pressure to bear against the remaining suburban locations.
  •  Drug companies continue to behave like tobacco companies.
  •  Everyone agrees our healthcare system is in big trouble but almost no one agrees with what to do about it.   My prediction: it will get worse before it gets better.)
  •  For sheer volume of public concern however, nothing comes close to the resistance against a vaguely revealed merger or acquisition of University of Louisville Hospital by the religious organization, Catholic Healthcare Initiatives.  In some as yet undisclosed way, University of Louisville Hospital will combine with Jewish Hospital & St. Mary’s Healthcare.

I will try to comment on these and other issues.  Please join me.

Peter Hasselbacher

New Public Health Director for Louisville: Follow-up (or lack thereof).

On June 24, I sent a copy of the June 18  Blog entry below to Louisville’s Mayor Greg Fischer, and to Mr. William Altman, Chairman of Louisville’s Department of Public Health. I repeated my request to reconsider the employment structure of Dr. LaQuandra S. Nesbitt, the new Director of Public Health and Wellness. (Cover letter here.)  The letter contains the mission statements of the Louisville Board of Health emphasizing its independence.

I have not had a response, nor am I aware of any new information.  What do you know, and what do you think?  Add your two bits.

[Addendum Dec 14, 2011:  When I wrote the above letter to the Board of Health and the Mayor’s office, I somehow thought that the Louisville Metro Department of Public Health and Wellness  reported to the Louisville Board of Health– imagine that!   While the details of accountability still elude me, it seems that the LMPHW Department is a branch of Louisville Government, reports to the Mayor, and is only “advised by the Board of Health. The Board of Health is “independent,” and is appointed by the Mayor.  Its Chairman was on the search committee for the new Director, Dr. Nesbitt.  If anyone can straighten me out about this, please do so.  The details of the organizational chart do not affect the substance of my letter nor my concerns.  I still think her dual employment it is a bad idea. The absence of her counsel in the current debate over the acquisition of University Hospital is appropriate given her conflict of interest, but missed.

Peter Hasselbacher, MD

Apologies!

I am in the process of upgrading the site and its software.  Please excuse the dust and any intermittent lack of access.

As of August 6 I am still working on this. I had to repair all the links to images and documents.   I also hope to have a less generic header soon!  Managing a website has been a continual learning experience for me.  The new format and theme should allow us greater flexibility and security.

Peter Hasselbacher