Author: P Hasselbacher

Behind the Acquired Hospital Condition Data Curtain.

1-percentHAC Reduction Program: How valid is the evaluation construct?
Perhaps not so much.

An increasing number of private organizations attempt to measure the quality and safety of hospital care. I have already expressed my growing concern about the validity and utility of such ratings which seem to have lives of their own. Hospitals are spending a fortune to collect and report on a variety of ever-changing indicators and to improve their ratings. When the scores are good, hospitals use them to market their services. When scores are not-so-good, hospitals either make no public comment, criticize the system, or offer putative explanations why their hospitals face greater challenges than others. This selective use of quality scores in advertising has always seemed a little hypocritical to me. Is it immaterial that a hospital can be ranked as both worst and the best of something at the same time? Things are not that compartmentalized within hospitals. Continue reading “Behind the Acquired Hospital Condition Data Curtain.”

Hospitals Penalized by Medicare for Excessive Hospital-Acquired Conditions.

I have been interested in attempts to measure the quality and safety of healthcare since my year of fellowship on the Senate Finance Committee which oversees the Medicare program. In the run-up to what would become Medicare’s Hospital Compare program, a long list of things that might be measured was proposed. Most were set aside because of concerns about utility, comparability, reliability, difficulty of collection, or ability to be gamed. The shorter list evolved into the current iteration of Medicare’s own Hospital Compare database that is incorporated into virtually every proprietary hospital rating system. The quality measurements are part of a new payment structure that hopes to pay for quality and value instead of volume alone. Continue reading “Hospitals Penalized by Medicare for Excessive Hospital-Acquired Conditions.”

Board of Trustees to Address Accountability of University of Louisville.

It has become clear that Board of Trustees of the University of Louisville is not always fully briefed about important matters. Most recently, it was reported, without denial or rebuttal by the University, that the administration withheld the non-public results of a recent external review of the University’s financial accounting system even when requested by board members. At least one Board member requested that he be permitted to resign in protest over the withholding of information and failure to allow meaningful Board discussion of important University issues. Following the controversy related to the recent departures of high-ranking University officials, I became one of many asking the UofL Board to step up to the plate. Apparently that was happening already! Continue reading “Board of Trustees to Address Accountability of University of Louisville.”

Standard & Poor Downgrades Catholic Health Initiatives Bond Rating.

Operating losses recalculated as greater than reported.

[See also Addenda of Dec 19 & 20 below]

Perhaps it was predictable, but Standard & Poor’s bond rating service downgraded its rating of Catholic Health Initiatives from A+ to A with a negative outlook based on large and unexpected losses in first quarter FY 2015, and an inability to meet the financial targets needed to deal with last year’s losses. The downgrade effects the $7 Billion of existing CHI debt for which Kentucky’s operations are also on the hook. CHI pointed to challenges in a few of its markets (particularly Kentucky) investments in capabilities, and costs in implementing computerized medical record systems.

CHI’s own “unaudited” financial report declared a $134.7 Million operating loss, but S&P recalculated this to $641 Million. Expenses were up 11% while revenues grew only by 8%. As reported by Modern Healthcare, S&P’s analyst predicted that plans by Catholic Health Initiatives to turn around its operations likely won’t be enough to avoid losses for fiscal 2015 based in part on poor performance last year— “It’s just a big hole to dig out of… They missed on their targets last year. We didn’t feel like there was a strong track record to show they will do well.” Continue reading “Standard & Poor Downgrades Catholic Health Initiatives Bond Rating.”