Author: P Hasselbacher

KentuckyOne Health Is More Than “Talking” with Tenet Healthcare.

In with both feet. But how far?

26 July 2014, 3:30 pm

Reports that KentuckyOne Health was talking with Community Health Systems of Nashville about the sale of Jewish Hospital drew unequivocal denials from KentuckyOne. The hospital system and its partner, the University of Lousiville, finally broke silence and admitted that the couple had gotten off to an unanticipated (but perhaps not unpredictable) rocky start to their marriage. An additional report that Catholic Health Initiatives was talking with Tenet Healthcare has not been denied publicly to my knowledge, as of course it could not be. The fact is that Tenet is now fully engaged in providing services at Jewish Hospital. How much of the Jewish Hospital operation has been transferred to Tenet, and the ultimate outcome of the involvement of yet another out-of-state-corporation in Louisville remains to be seen.

There were of course any number of reasons CHI might wish to talk to Tenet. For one thing, since 2012, the two large corporations have been partners in jointly owned Conifer Health Solutions. Conifer specializes in “revenue-cycle” services for hospitals, including many, if not most of CHI’s. To my non-business mind, such services involve getting every last nickel that’s due out of patient billings. Since KentuckyOne Health has been losing money for CHI, it is not surprising that calls for outside help may well have been suggested or demanded. Continue reading “KentuckyOne Health Is More Than “Talking” with Tenet Healthcare.”

UofL Sends Its Recent Audit and Report Card to the Public.

What would you say to your kid if they brought this home?

I received a letter from UofL President James Ramsey this week along with a copy of the “almost an audit” of the University’s financial operations from Strothman and Company that I wrote about earlier. The package was not sent to me as a journalist, but was presumably sent to everyone connected with the University such as people like me who contribute to its fund-raising initiatives. This Strothman “Report” is identical to the one released to the UofL Board of Trustees and the press, and suggests to me that it was intentionally written for a technically less sophisticated audience thus reinforcing my belief that the comprehensive report is still being kept secret– perhaps even from the Trustees.

The mailing includes a cover letter and report card from of this month’s Board of Trustees evaluation said to reaffirm that UofL is continuing on its “amazing trajectory.” However, the bulk of Dr. Ramsey’s letter deals directly with the problem of “a few employees who are dishonest.” While he expresses the University’s “regret” over the violation of the public trust, he did not go so far as to apologize. Perhaps that would have been too much to ask. Continue reading “UofL Sends Its Recent Audit and Report Card to the Public.”

The Audit That Might Have Been at the University of Louisville.

Last September, following a string of multimillion dollar embezzlements at the University of Louisville, and in the midst of ongoing concerns about the health and even the integrity of the its financial operations, the University retained Strothman and Company of Louisville for an independent outside audit. Strothman has relevant experience auditing large public institutions and has a member of the UofL Board of Trustees as a client. It is more than competent to perform an in-depth financial or management audit. The cover sheet for the Request for Proposal required that the auditors would, by March 31, 2014, perform:

• A special examination of the processes and procedures of internal audit,
• survey banking to identify UofL accounts,
• evaluate internal controls related to signature authority and vendor legitimacy,
• and examine the financial controls for faculty professional practice.

While this certainly was a reasonable business decision given the obvious system breakdowns and criticism from the community, I suspect the University felt compelled to offer at least some measure of accountability much as it did when it agreed to an audit of its handling of the QCCT fund for indigent care in early 2012. There is always some risk that an external review will turn up shortcomings, or worse. The QCCT review was not at all flattering and for whatever reason, that funding mechanism seems to be being phased out. A subsequent audit of the University’s involvement in Passport, the Medicaid managed care plan, revealed financial manipulations that were frankly illegal. High-ranking officers lost their jobs. A source of unrestricted money for the school dried up. In outside reviews of its academic affairs as evidenced by rejection of yet another application for a Phi Beta Kappa chapter, and placement of its entire Medical School and its Continuing Medical Education program on probation, UofL has not been faring very well either. Little wonder the University spends most of its promotional effort on its sports programs– Beer and Circus instead of Books and Brains. I suggest that identifying problems is not something to be afraid of. It is how the institution deals with unflattering appraisals or criticism that defines both its credibility and its strength. In my opinion, UofL’s reflexive posture of stonewalling the public is hurting it much more than revelation of its failings. This has to stop if the community is to gain the confidence needed for it to provide needed support. Continue reading “The Audit That Might Have Been at the University of Louisville.”

Medicare Payments to Oncologists in Kentucky.

Since my initial exploration of Medicare’s Physician Payment Database, I have not done much with it. The expectation that the information would be of great interest to many has been validated, and the utility and shortcomings of the data better understood. The potential is great that these data can be used to improve the quality, affordability, and availability of medical care. As might have been predicted however, a great deal of attention has been focused on identifying medical malfeasance and fraud.

I have always been of the opinion that examination of outliers in big data sets like this one is extremely valuable in health policy research. This is especially true in American medicine where there is such great variation both in the frequency in which various medical services are provided, and the amount of money charged. Looking at outliers does not automatically assume that something inappropriate is going on. A place or provider where a large number of things are being done may be a center of recognized excellence. On the other hand, and as we have seen in this series of articles, such “hotspots” of activity may represent inappropriate, abusive, or even illegal medical practice. I believe that large utilization data sets like this one beg us to ask questions about how to use our healthcare resources fairly, efficiently, and most of all effectively. A strategy I recommend is to start by looking more closely at the top 10 and the bottom 10 on any such list. Is that entry there for the best of reasons to be emulated, or for reasons of less value to be corrected? When you are done with the top ten, go on to the next, and so on. Continue reading “Medicare Payments to Oncologists in Kentucky.”