{"id":2612,"date":"2014-02-05T13:10:03","date_gmt":"2014-02-05T18:10:03","guid":{"rendered":"http:\/\/www.khpi.org\/blog\/?p=2612"},"modified":"2014-02-25T10:51:56","modified_gmt":"2014-02-25T15:51:56","slug":"some-problems-with-university-hospital-partnership-emerge-how-bad-is-it-really","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/some-problems-with-university-hospital-partnership-emerge-how-bad-is-it-really\/","title":{"rendered":"Some Problems With University Hospital Partnership Emerge. How Bad Is It Really?"},"content":{"rendered":"

Much Distress Among the Home Team.<\/strong><\/p>\n

KentuckyOne Health\u2019s announcement of major cuts<\/a> in expenditures, layoffs of employees, and possible hospital closure(s) is bad news to lots of people. The organization\u2019s facilities and employees in Louisville are in the bullseye too. It is no surprise that nervous employees are reaching out to the media, hoping perhaps for some external recognition or oversight of their plight. KentuckyOne seems to be making a genuine attempt\u2013 perhaps too late and too little\u2013 to show some openness<\/a>. In my opinion, the University of Louisville and KentuckyOne have developed a reputation for secrecy but they have not yet earned a reputation for transparency or accountability. Hiding plans from the public also hides them from their employees. The pain felt by these latter is both financial and emotional.<\/p>\n

Severance packages vulnerable.<\/strong>
\nFor example, KentuckyOne\u2019s partnership agreement in 2012 with UofL requires KentuckyOne to provide University Hospital employees who are terminated the same severance package that the former University Hospital would have provided, but only for those terminated before March 1, 2014\u2013 three weeks from now.<\/p>\n

( c) \u00a0Severance. Hired Employees terminated within the first twelve months after the Integration Date will be offered a severance package whose terms are comparable to those ofUMC’s existing severance package.<\/p><\/blockquote>\n

Current University Hospital employees fear a rash of layoffs timed to deny them a severance package. Nice! \u00a0If KentuckyOne does delay terminations to avoid a financial component of the former package, they will be making a statement to our community that will be hard to live down. It would in my opinion be the decision of a bean-counter, not a caregiver. My guess is that the several noteworthy executives who left KentuckyOne in the recent past had a better deal.<\/p>\n

<\/p>\n

Less lip looseness<\/strong>.
\nNotices to employees about the potential loss of their jobs was preceded by a new or updated communication policy warning against talking to the media or journalist wanna-bees like me. This admonition was considered intimidating by some employees. The reminder may have backfired because I am now getting more contacts than ever from previously loyal employees and faculty members who have had enough.<\/p>\n

Same-sex health benefits.<\/strong>
\nIt doesn\u2019t help that Hospital employees are getting other unexpected surprises concurrently. The former University Hospital went out of its way to provide healthcare benefits to same-sex or other committed unmarried partners and their children. Proper University of Louisville employees still receive such benefits. In my opinion, the new University Hospital, under the complete control of KentuckyOne Health and its religious directives, seems to be doing all it can to eliminate that longstanding benefit or at least make it harder to obtain. This demeans the value of committed relationships in the process, including, and especially those who are legally married in other states. [Addendum: On Feb 12, Kentucky’s failure to recognize legal same-sex marriages was determined to be unconstitutional. \u00a0We will see how KentuckyOne reacts! \u00a0Will it provide benefits, or find some other excuse not to?]<\/p>\n

The Little University of the Poor.<\/strong>
\nEven the \u201dworkaround<\/a>\u201d that the new management must have reluctantly agreed to to provide contraceptive healthcare services to employees arrived stillborn<\/a>. Perhaps if the new and improved University Hospital can wait a little longer, it will no longer have to provide those sinful and lust-inducing benefits at all by emphasing that it is a religious institution like the Little Sisters of the Poor. We shall see. That is a topic for another article.<\/p>\n

How good was the deal for UofL, really?<\/strong>
\nAt a recent meeting with the Editorial Panel<\/a> of the Courier-Journal and as it nears the end of the first full year of its partnership with the University of Louisville, KentuckyOne\u2019s President and CEO, Ruth Brinkley, was asked how much of the promised funding had been transferred to UofL. Her answer, \u201ceverything that we are contractually obligated to pay,\u201d was no doubt carefully accurate, but it was not the answer to the question that was asked. Her reply prompted several KentuckyOne employees and faculty at University Hospital to tell me that from their viewpoints, they have not seen any of the money. Of course, the folks who talk to me may not have all the details, but as folks on-the-ground who might have been aware of any new largess, they were puzzled if not angry at this bare-bones disclosure. University officials have been similarly numeral-impaired when asked about payments from KentuckyOne\/CHI. \u00a0It was the promise of vast sums of such money that seemed to have changed the minds of those who had had the authority to authorize or reject the partnership arrangement last year.<\/p>\n

Employees and faculty are upset at the notion that they have to take any hit at all! It is their understanding that their hospital continues to be profitable even as resources continue to be withdrawn. They see their hospital being diminished to bail out other hospitals whose mission is not as obviously in support of the disadvantaged as theirs.<\/p>\n

How much privacy is helpful to patient care?<\/strong>
\nThat KentuckyOne is losing money has not been a secret, but its plans for the future have been. I concede that some confidentiality in business planning is understandable, even defensible. I would argue, however, that given the central role of University Hospital in the public healthcare safety net of the region, and as a recipient of considerable public largess, University Hospital under any management has more than token responsibility to enlist public buy-in before abruptly terminating important programs<\/a> such as inpatient psychiatry or emergency cardiac services. KentuckyOne may feel some need to be circumspect about their financial status. Their contract with UofL and the Commonwealth places them in default of the Partnership Agreement if they become bankrupt. Additionally, the appearance of weakness might aggravate their current situation.<\/p>\n

Show me the money.<\/strong>
\nTaking a look at the contract documents again this week reminds me that it was impossible for me to determine just how much money the University of Louisville and University Hospital were promised in the first place. So much of the millions upon millions are contingent on the profitability of KentuckyOne, or on the the achievement of a host of financial considerations, contractual agreements, or programmatic targets. Many of the promises to pay were dependent on both parties agreeing on how and where the money would be spent. (I wonder how that is going?) Indeed, it appears to me that much of the promised money would be generated by existing University Hospital revenues\u2013 i.e., not with new money! People in both organizations have said that merging the institutions after the fact was more difficult than they expected. Some of us are not surprised at all! I asked for, but have never seen a credible or understandable list of how much money was on the table and under what conditions. When all is said and done, it may not be very much at all. What was shown to our public leadership for them to become cheerleaders for the partnership? How can this be such a secret? Does anyone out there have such a tally? [See subsequent article in Insider Louisville<\/a>.]<\/p>\n

Facility closures, where?<\/strong>
\nIt is impossible to avoid speculating which KentuckyOne hospitals(s) or facilities across the state might be closed. Will it be one of the small limited-service hospitals out in rural Kentucky, or one of the four inpatient hospitals in Louisville? I speculated<\/a> that some of KentuckyOne\u2019s long term goals might be served by closing Sts. Mary and Elizabeth Hospital and transferring those beds to an existing or a new facility in Jefferson County. It is inconceivable to me, that after all that has gone on in this saga, that KentuckyOne would be permitted by the community to close University Hospital\u2013 a hospital that KentuckyOne once wanted to own and which UofL was willing to sell. More conceivable than closing University Hospital is closing Jewish Hospital or turning it over physically to the University for the use of the private practices of that institution. I do not know how that could be financed or gifted. \u00a0“Transforming the downtown medical campus in to a single academic medical center” \u00a0is still a goal KentuckyOne executives espouse.<\/p>\n

I do not know enough about the psychiatric hospital business to speculate what might happen to Our Lady of Peace. One of my contacts thought the reason the inpatient psychiatric service at University was targeted for closure was for those patients to be sent to Our Lady. I had always assumed that the emergency psych business was a money losing service. Anyone know better?<\/p>\n

Shall the weak and meek really inherit?<\/strong>
\nWe live in interesting times as the saying goes, and whether KentuckyOne recovers financial health or not, Louisville is slated to see big changes in its healthcare system for both the rich and the underserved alike. Change is not necessarily a bad thing. I visualize our healthcare system evolving to allow our human species to survive as a society in a 21st Century ecosystem. In any scenario, the medicine will go down smoother if we are presented with informed consent, know what we are taking, and take it as a truly willing partner. It will also help if the competitive civil war among our major providers is settled! \u00a0That kind of change-over-time may turn out to be an extinction event with long-lasting consequences.<\/p>\n

As always, if my facts or interpretations are incorrect, please let me know.<\/p>\n

Peter Hasselbacher, MD
\nPresident, KHPI
\nEmeritus Professor of Medicine, UofL
\nFebruary 5, 2014<\/p>\n

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