What does this mean?
Yesterday I received the following eMail announcement from University Surgical Associates (USA), the independent private practice corporation of part of the Department of Surgery of the University of Louisville. I think it was sent to me as a patient rather than a doctor or policy wonk. I received similar communications in the past, such as an announcement that USA had finally renewed a contract with Humana to see that insurer’s patients again. It was that break-up a few years ago that led the University to switch health insurance for its employees from Humana to United. (UofL supports the private clinical practices of its faculty in other ways too!) The present notice also appeared on a Department of Surgery website, but not yet on the Norton or the main UofL websites. Read the release here.
UofL Department of Surgery, Norton Healthcare Sign Affiliation Agreement.
Norton Healthcare and the Hiram C. Polk Jr., M.D., Department of Surgery at the University of Louisville School of Medicine have signed a three-year academic affiliation agreement that supports the research, teaching and patient care missions of both institutions. The agreement includes general surgery; surgical oncology; plastic surgery; ear, nose and throat surgery; colorectal surgery; a pancreas program; and vascular surgery at Norton Hospital.“This extends and enhances the affiliation agreement that Norton Healthcare and the U of L Department of Surgery have had for decades,” said Steven T. Hester, M.D., MBA, system senior vice president and chief medical officer, Norton Healthcare. “It strengthens clinical programs that enable Norton Healthcare to continue to provide quality surgical care to residents of Greater Louisville.”
“The combination of the unique surgical expertise of the professors at U of L Department of Surgery and the outstanding hospital facilities and support staff at Norton Healthcare make this an exemplary partnership,” said Kelly M. McMasters, M.D., Ben A. Reid Sr., M.D. Professor and Chairman of Surgery, U of L. “This academic affiliation has created an exceptional training ground for surgical residents, fellows and students that is clearly among the best in the country.”
I do not disagree that the University of Louisville should be cooperating and working with the entire medical community for which it is a resource. Concerned about the University as I have come to be, and having to grasp at crumbs, I tried to ferret out some insight about what is going on behind UofL’s information barricades. This is the kind of academic and clinical agreement that was specifically prohibited by the hospital merger contract with Catholic Health Initiatives (CHI) that UofL was so willing to sign last December. In that agreement UofL also promised to use its best efforts to prevent its faculty from practicing at Norton and other non-CHI hospitals. Does this affiliation agreement with Norton mean that ongoing efforts to finally consummate that takeover have foundered? Then again, a renewal of an existing agreement might have been permitted. After all, UofL needs some kind of arrangement with Norton if only to have access to Kosair Children’s Hospital for its Department of Pediatrics, or at least until another pediatric service is built elsewhere. But we are told that the current affiliation agreement has been “enhanced” and “strengthened” suggesting this is something more than the status quo. What is particular is different?
Does this independent announcement by a single major department mean that the University’s attempt to organize all the clinical practices of its faculty into a single group practice under its control is not proceeding according to its plans? The University helped build a gorgeous spanking-new private practice building for its faculty. Surely they have expectations of getting something in return. Previous senior UofL executives have complained to me that the clinical practices are not giving enough money back to the University. We have not heard the last about the support by UofL for the private practices of its faculty. I do agree that we need to break out of the silo mentality that has existed among the clinical departments.
Who are the signatories of this affiliation agreement? The notice refers to the Department of Surgery and not the University of Louisville. How can the two be different, given that the faculty are full-time employees of UofL and “research and teaching” are covered ? Traditionally the private practices of the faculty have been free do do business as they see fit. Is the Department “going rogue?” Was UofL or the Department worried about the encroachment of the University of Kentucky into its traditional backyard teaching hospitals? I will ask both Norton and the Department of Surgery for a copy of the agreement, but I do not have high hopes for success. If any of you can help, our readers will be grateful. Other academic University affiliation agreements have been made public by UofL, I don’t know why this one should be different. It will probably describe an exchange of money, responsibility, and commitments. Such an affiliation agreement is mandated by organizations that accredit medical schools and teaching hospitals in order for students and residents to be trained. I have little doubt that the Department of Surgery depends on Norton hospitals to support its training programs: there just isn’t enough work being done in University Hospital. Even though it sometimes seems that UofL has burned its bridges with Norton, it still needs Norton to survive. In many ways, Norton could have been a good “merger”partner with UofL. Maybe it still can be.
To close this piece, I asked myself the question, why was this notice sent to me? Full disclosure: I am a patient of University Surgical Associates. My major surgery was done at Norton Hospital some 20 years ago. My surgeon saved my smile and perhaps my life. He is my hero. Nonetheless, the fact that this notice was probably sent to me as a patient conveys the message that despite, and perhaps because of all the recent bad press about the quality of care at University Hospital (some of which came from this website), that University surgeons will still be doing business as usual in the Norton hospitals. I do not doubt that USA would want to protect its patient base, but I can only feel a sense of sadness. Throughout the saga of the several recent external reviews of University of Louisvill Hospital, a theme emerged of the lack of support by University faculty for their hospital as a major reason for its failings. The recent major review by Dixon Hughes Goodman made it clear that any progress in improving the financial status and clinical quality of University Hospital will require fuller engagement by its faculty. The notice that stimulated this article is not encouraging in that regard. When I came to UofL 28 years ago, it was my opinion, that despite an active trauma and emergency room program, lack of full clinical engagement by the Department of Surgery was a problem for the hospital. In fairness, the same could be said for other departments. Perhaps those issues have been resolved since I left clinical practice 16 years ago, but independent external reviewers still emphasize an ongoing and crippling lack of faculty engagement. The notice I am waiting to see will tell me of that support.
We are locked into a self-fulfilling prophecy. The hospital has an image, supported by many measurements, deserved or not, of having below-average quality of care. Therefore it is not generally used by patients or doctors who have a choice. However, until we do put our full confidence and support behind it as both a medical and lay community, it will never get any better. How very sad. The affiliation agreement above and the others that surely exist make it oh-so-easy to use competing facilities. The up-till-now aborted merger/acquisition by CHI would have done the same thing. We are trapped in the very status quo the the University of Louisville asserts is unsustainable. Money will not fix this, certainly not alone. If our faculty are as good as we claim; patients, money, and quality will follow commitment. How do we break out of this terrible situation that perpetuates a second-tier system into which we funnel our most vulnerable and otherwise disadvantaged neighbors?
What are your ideas? I have a few, and they center on all patients walking in the same door for their clinical services. Head counts I did last month at the new private practice building and the Ambulatory Care Clinic Building confirm that this is not happening now. It frightens me to even consider that I might be the only person unhappy with our inherited system. How about a little support out there, or at least prove me wrong!
Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
July 14, 2012
Shortly after I wrote this, I learned that UofL might be planning an announcement concerning their pediatric heart transplant program. Since this involves a Norton Kosair Hospital program, I immediately wondered if this was part of the affiliation agreement with Norton recently announced by University Surgical Associates. I suspect not. The UofL surgeons who would be involved in pediatric heart transplantation are indeed members of UofL’s Department of Surgery, but they are not listed as members of University Surgical Associates. Complicated enough for you? Welcome to the cascading and interlocking world of corporations that is the University of Louisville!