Author: P Hasselbacher

Norton vs. UofL Lawsuit on Front Burner Again.

Is accreditation of UofL Medical School hanging on the result?

This case has been slowly grinding through the court system since it was filed in September of 2013.  Although things had been brewing for some time, the trigger event was a letter of agreement between Norton and the University of Kentucky to work more collaboratively at Kosair Children’s Hospital.  An indignant UofL fired off a letter threatening to evict Norton physically from its hospital and retain the hospital’s equipment for itself.  UofL’s self-righteous demand was much discredited when it emerged that the University had earlier promised to turn over its pediatric service to KentuckyOne Health– Norton’s chief downtown rival that badly needs a children’s hospital for its planned statewide system.  Norton responded by filing a lawsuit requesting a judicial determination that UofL had no standing to take over the hospital to use with its new best friends. The festering boil is more than ripe to lance! Continue reading “Norton vs. UofL Lawsuit on Front Burner Again.”

Highest Prescribers of Opioid Analgesics in Kentucky & Indiana by Specialty.

Is there any rational justification?

Summary.
This article in a series further examines the prescription of opioid analgesics in Kentucky and Indiana, I identify the individual prescribers in each of some 70 different Medicare-designated specialties in both states who prescribed the highest number of opioid prescriptions. The differences within individual specialties, between specialties, and between the two states are staggering and beggar any obvious explanation. Single or small numbers of prescribers are outliers that shift the averages of their specialties significantly.  Even within their own peer group, some pain-management providers are far-outliers. Some cities seem to have more than their share of highest prescribers. Cancer and designated hospice providers to not appear to be big users of opioids in this data. Much “pain-management” probably occurs within specialties traditionally considered as generalist. Generalist specialties should not be considered differently than pain-management specialties in public health and law enforcement efforts to deal with prescription drug abuse and diversion. Continue reading “Highest Prescribers of Opioid Analgesics in Kentucky & Indiana by Specialty.”

Protest at UofL Board of Trustee Meeting Over Its Racial Composition.

board-sep-600I suggest two potential immediate remedies!

The University of Louisville Board of Trustees had a major annual meeting yesterday, Sept 3, 2015.  It was a busy day with an overview orientation in the morning for the three new Board members, two committee meetings, and a long Trustee meeting.  I will have more to say about some of the proceedings that included a misfire or two such as the Trustees being asked to vote on the recommendations of the report of the Ad Hoc Committee on Governance that had not been distributed, and a surprise vote on an internal review of the governance of the UofL Foundation that was passed when all the press had been excluded from the meeting room.  An update on the litigation with Norton Healthcare was given in executive session, but the resulting resolution informs us of another round of court-ordered mediation in October with a rigorous imposed format.

A “non-disruptive” protest.
To follow up on a series of earlier articles, I want to report here on a protest held during the trustee meeting by several clergy and community activists standing with of the Justice Resource Center of Louisville.  These advocates for the African-American community continued to draw attention to the fact that the Board as it was seated was the first not to contain a single African-American trustee appointed by a Governor since 1970.  The 7 or 8 individuals sat quietly in the meeting room until the first executive session when most folks were sent from the room.  At the press conference in the rotunda of Grawemeyer Hall that followed, the protest was anything but reserved. Continue reading “Protest at UofL Board of Trustee Meeting Over Its Racial Composition.”

Prescription of Narcotic Analgesics in Kentucky and Indiana– A Comparison.

Summary
There are 37% fewer providers in Kentucky than in Indiana who prescribed opioid narcotics to Medicare patients in 2013, but they wrote 43% more total opioid prescriptions  per prescriber than in Indiana (254 vs. 178). Indiana spent more on opioids overall than Kentucky ($80.1 million vs. $53.6 million) at a cost that averaged 34% higher per prescription. Of the specialties with the largest number of prescribers or the highest rates of individual narcotic prescribing, only Nurse Practitioners and Rheumatologists prescribed a higher rate in Indiana than their Kentucky counterparts.  In both states, Nurse Practitioners prescribed opioids at rates substantially below those of Internists or Family Practitioners.  The almost across-the-board higher rates in Kentucky were substantial, but were particularly striking for the three major pain-management specialties. Cancer and end-of-life providers in either state did not prescribe opioids at greater than average rates per prescriber– well below those of physicians in general practice and only at a small fraction of the rates of pain-management providers.  High-prescribing outliers skewed the averages upwards in several specialties, if not most. The data pose the question: are there structural reasons for the differences in narcotic use between the states, or do the substantial differences result from simple practice preferences or amount of endemic prescription drug abuse? Continue reading “Prescription of Narcotic Analgesics in Kentucky and Indiana– A Comparison.”