Not the promising start I had hoped for. Secrecy and control still in abundant evidence.
The Ad Hoc Operations Review Committee of University Medical Center, Inc. (UMC) met yesterday, March 12, 2012, for the second time. [Read about the history of this committee here, here, and here.] I counted six of the 10 members present, three of whom were outside Committee members. There had been some “briefing” beforehand that I suspect will not show up in the minutes of the meeting. (TC #1) [Minutes of last meeting here.]
A new potential partner!
Perhaps the most interesting piece of news was that the healthcare strategy firm that had been updating the 2008 report of UMC’s financial future just notified the hospital that they had been hired to represent another hospital system that intended to respond to UMC’s request for proposal (RFP) for a new system-wide partner! (I had suspected as much from the content of some of the questions proposed in writing following the Pre-Proposal Conference.) The potential responder (not KentuckyOne Health) appears to be serious, although the opportunity to gather business intelligence as a motive cannot be dismissed by me at this point.
Troublesome concern #2
The name of the potential applicant was released as part of a discussion over a potential perception that the new responder might somehow learn privileged information that might give them an edge over other responders [other than KentuckyOne Health of course)]. Two of the external Committee members postulated that because all the information would be made public anyway, it wouldn’t make any difference. This rational statement was countered by a hospital comment that only the final report of the Committee was promised to be made public, not necessarily the information supporting it. This was a disappointing revelation to me because it means that UMC can pick and choose the information it reveals to make its desired points. Given the long-standing and instinctive posture of secrecy within the University of Louisville, I do not believe this is healthy.
In the end, the Committee voted to terminate its relationship with its former accounting company and to give the responsibility for updating the financial status report to its new consultant, Dixon Hughes Goodman.
Troublesome concern #3
I was also troubled by the Committee’s request and the consultant’s promises to be able to select and edit the choices of benchmark institutions against which to compare ourselves. As I have stated before, a clever selection can give whatever result is desired. Pharmaceutical companies are frequently criticized for not publishing negative results of their drug studies. It would be unfortunate, indeed absolutely discrediting, if comparisons with other teaching hospitals that did not lead to a set of desired results were suppressed.
I urge the Committee to restate and make clear their promise that meetings will be open to the public. If the work of the Committee continues to be done behind the scenes and only a highly polished final report with selected underlying data is made available, then the public will not have a fair basis on which to judge the validity of any final product. For a start, why not make the earlier financial report of 2008 public? There are many people that want to help. Why not give us the tools?
Troublesome concern #4
One additional aspect of this planning session discomforted me. The consultants asked the Committee for names of individuals who might be interviewed for the process. In my opinion, the names suggested came too often from the inner circle. For example, when the consultants asked what faculty members they should interview, the hospital recommendations were Dr. Dunn, and Dr. Ramsey. I almost laughed out loud. These are the number one and number two senior administrators in the health science campus hierarchy. They can hardly be considered representative faculty! We already know what they want: more outside money, and increased transfers to the University. Even the CEO of Passport and Louisville’s Director of Public Health whose names were suggested are not independent of the University– one is an employee.
Who to interview?
It was the external committee members who suggested names from the greater community. I suggest that the consultants take their advice and include interviews from more broadly based community sources. Otherwise you will only get information you already know or what the University wants you to know. Interview some competitors. Interview some community members who represent the disadvantaged the hospital wishes to serve. Go into the clinics and wards of the hospital and interview some random patients. Aren’t they what it’s all about? Talk to some doctors and patients who actually use the hospital for their health care. Talk to some residents and medical students. Interview me! You already know that you should be doing this. Don’t let the University talk you out of it. There are many individuals in Louisville who are familiar with the University and who want a teaching hospital that is the pride of its community instead of the hospital of last resort. Excellent medical education can only occur where medical care is itself excellent. Our days of segregated healthcare in Louisville, a holdover from uglier times, must be put behind us. You can help us.
My advice to UMC: Listen to your outside committee members. They are asking the right questions. They are giving you credibility. Don’t squander it.
Initial Scope of Work.
Mr. Craig Anderson, Sr. of Dixon Hughes Goodman, and two of his colleagues walked the Committee members through a recommended work plan. These kinds of presentations always contain enough “business-speak” that I do not profit from them as much as I might. I gather however that six, and then an added seventh “hypothesis” or question would be evaluated to determine their potential impact on the current and future performance of the hospital.
- 1. What is the effect of the lack of “physician alignment?” University doctors align (practice) with the hospital’s competitors. A long-standing issue.
- 2. Does the size of our facility inhibit future growth? Even if we could attract more cardiologists, would there be enough room for them to work in an inpatient or outpatient setting?
- 3. Does the payor environment and patient insurance mix challenge our organizational mission? What is the real challenge of indigent care?
- 4. How much inefficiency and overutilization results from the continuous flow of novice students and physicians through the hospital? What is the cost of being a teaching hospital?
- 5. Is the quality of our clinical care what it should be? Even an initial review shows there is much room for improvement.
- 6. What will happen if expected reimbursement cuts come to be? Everyone is going to be paid less.
- 7. (Added by President Taylor) Is the hospital supporting the academic enterprise in a typical way? Are we giving the University too much or too little financial support? [For example, Mt. Sinai Hospital gives no research support to its medical school.]
The above areas of analysis are more than reasonable. Clearly the Committee is committed to reviewing more than just how its QCCT funds are spent. I commend it. The Committee had originally hoped to complete its work by the first week in May. Around here of course, that is known as Derby Week. I suspect the time may slip. Even so, the scope of work is wide, even massive, and as the consultants continually remind us, the time available is short. I believe it is even too short. The Committee needs to decide if it wants to make a point, or solve a problem. I say do it right, and do it in public. When will you ever get another chance like this again?
Peter Hasselbacher, MD
March 13, 2012