UofL Has Not Announced Its New Clinical Partner(s).

Has the University of Louisville’s Request for Proposal process collapsed?

Just before I left for an extended trip to Europe, I learned that Dr. David Dunn of the University of Louisville had received the blessing of that institution’s Board of Trustees to sign a deal with a new “partner.” No meaningful details were released to the community but I used the opportunity to comment on how I thought a new affiliation contract should be evaluated by representatives of the public.

Hurricane Sandy delayed my return to America where I fully expected to see headlines announcing that a new business deal had been struck. However, the mainstream media that have been following this matter were stone-cold silent. Never allowing a lack of information to stand in the way of seeking the truth, I contacted several individuals whose speculation is more informed than my own and who told the same story. Negotiations with all parties are thought to have collapsed.

I say now to the University of Louisville, it appears that your RFP may have run its course. I urge you to start over. This time you need to view your community as a partner and not as an enemy or obstacle. Because you are doing the public’s work, this is the only credible position you can adopt.

The best speculation available.
What I heard is this. The University attempted to play two RFP responders off against each other to maximize its gain. I am told that an effort to come to terms with Health Management Associates of Naples, Florida (HMA) fell apart. It has not been a state secret that HMA has been involved in such negotiations although it never made sense to me how this would further the University’s interests. I was told however that HMA was also working with the Baptist Healthcare System of Kentucky. If true, this could have changed the equation completely. (I previously characterized the statewide Baptist system as the University’s potential dream partner.) One obvious problem with such an affiliation is how to manage the fact that Baptist Hospital East in Louisville is a major competitor of the Jewish Hospital complex. In my opinion, being able to physically occupy the clinical services at Jewish Hospital is a “must have” for UofL. I was told that Baptist Hospital East would somehow be kept out of the arrangement, but anyone who could make such a disruptive carve-out work is more clever than I.

I was told that high-ranking officials from Catholic Health Initiatives (CHI) then flew into Louisville to try to wrap things up. I still believe this was the University’s preeminent goal all the time. I hope that HMA, if indeed it was part of the final negotiations, did not feel it was used as a straw man to allow the University some leverage with CHI or to give legitimacy to a flawed if not violated RFP process. In any event, I am told that even a new deal with CHI crashed and burned. As was the case with the cancellation of my flight home from Europe, the failure of an agreement with CHI is said to have been due to an act of God, in this case, opposition from officials of the Roman Catholic Church. My respected sources have told me that all that remains now is an ominous silence.

What is left?
We have two major Louisville hospitals that are, in my opinion, in big trouble. At least one of them, University of Louisville Hospital, is willing to admit that fact publicly if only for strategic purposes. I am told that CHI has been pumping money into Jewish Hospital for at least some services, particularly cardiology. The hospital is upgrading its equipment and facilities, and I am told has given money to the University to support the salaries of cardiologists who are expected to practice at Jewish. A new hospital president is in place who has the respect of at least some of the medical staff, although it is far from clear how the town-gown issues of who will run the medical services will be solved. Because of the hospital’s history of standing against prejudice, I wish them well. However I also counsel any hospital about putting all their hopes on providing services that are (at least at present) overpaid. Such a strategy can turn and bite as has been reported might have occurred at the CHI hospital, St. Joseph Hospital London. This small hospital has been taken to court over doing too many and unnecessary cardiac procedures. (A lawsuit only gives one side of the story, but the unexpectedly high frequency of cardiac catheterizations done on younger patients at St. Josephs London is a matter of public record.) In my opinion such a strategy of focusing their marketing and resources on a few lucrative services has contributed to bringing both Jewish and University Hospitals to their knees.

Prove me wrong– Please!
Disclaimer! I have few physical documents to support most of the above. My sources could be as confused as I am.  However, the course of events over the past months is consistent with everything I have been told by individuals within the institutions themselves; with reports in the traditional media; with my long experience with the University of Louisville and the hospital industry of our city; and with a logical interpretation of motives, events, and available data. I have been told first-hand that the University of Louisville reads this policy blog regularly but I have never been challenged as to the correctness of my facts. Therefore I once again invite the University of Louisville or any of the other organizations or individuals involved to offer any corrections that they are willing to support with data. My preeminent position is that we of the public have a right to know what is going on, and that failure to provide that information is causing these important institutions to lose public credibility and to compromise their proper missions. I would love to know that I am wrong.

If you have information to offer, please leave a reply below.  You can use a screen name and omit your email address without registering if that will make you feel more comfortable.  However, if I know who you are, it gives me more confidence in the integrity of the process.  Please then consider sending an email directly to me using the “Contact KHPI Confidentially” link in the sidebar or at phasselbacher@ khpi.org rather than using the “leave a Reply” function of the Blog.  I will never reveal your identity.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine
University of Louisville
November 6, 2012