Author: P Hasselbacher

King’s Daughters Hospital Finalizes Angioplasty-Abuse Settlement.

The Verdict is In– Or Is It?

[See Addendum below.]

The agreement between King’s Daughters Medical Center and Hospital and various government investigatory and prosecutorial agencies to settle claims that the hospital submitted improper bills to Medicaid and Medicare has finally been signed. Not that we did not see it coming. A Kentucky record-setting amount of least $40.9 million now flows back into public coffers. Perhaps some of the money also goes into the pockets of a whistle-blower– I am waiting for the actual settlement text.

Has justice been done? If we believe the U.S. Attorney and the FBI agent on the case– surely!  Settlement language stated or implied that King’s Daughters “knew, deliberately ignored or recklessly disregarded the fact” that its cardiologists were putting things inside their patients’ hearts who did not need them; that some doctors were in effect being over-paid to submit their patients to what I have termed angioplasty abuse; that the hospital and its doctors were stealing money from patients and taxpayers; and that motivated by financial gain, public confidence in our healthcare system was threatened. Tough talk indeed.

On the other hand, the hospital admits no wrongdoing and in its statements gives me the [probably intended] impression that it is doing its community a favor by not squandering further valuable resources over allegations on “old cases.” I guess we are supposed to just let sleeping (or injured) dogs lie. The hospital points to external reviews that are said to confirm that it is meeting national standards in at least some aspects. [I have written much already of my growing lack of faith in some such hospital-rating organizations– at least the commercial ones that charge hospitals for the privilege of being evaluated or which charge the hospitals to use their ratings ratings in advertising!] Continue reading “King’s Daughters Hospital Finalizes Angioplasty-Abuse Settlement.”

It’s Official. Louisville Contribution to QCCT Indigent Care Fund Cut to $5 million.

Some Had Advance Warning

The Board that oversees the Quality Community Charitable Trust that helps support medical care to the indigent and medical needy was apparently given advance notice of this latest reduction in government contributions. From $7 million yearly (since at least FY2012-13) the amount has been reduced to $5 million, a 29% cut. Although the state used to contribute substantially more than the city, the two units of government contribute (at least for now) at essentially the same level. No explanation or justification for the reduction of the QCCT appears anywhere in the Metro budget. In fact, the single mention of the QCCT at all is in its line-item entry.

What lies ahead?
The handwriting on the wall is clear for this once-innovative program that cast University Hospital as the poor-people’s hospital of Louisville and made it easier for other hospitals to contribute less than their fair share. A combination of multiple changes in the QCCT partners, a crack-down by Medicaid on the methods used to finance the fund, and a scathing audit of oversight and management practices led the way. An increasingly difficult budget situation in both Frankfort and Louisville, and the anticipation that the Affordable Care Act (ACA) would reduce the amount of indigent and medically-needy care necessary provided either the coup de gras or the excuse for state and local governments to back further away from their commitment.

As I have argued many times in the past, this is not necessarily an undesirable result.  As long as our community demands that the healthcare system care for all comers to its doorstep, there must follow a corresponding expectation of community support to help pay for such services. Our community is no healthier than its sickest member, and whether it is paid for from private insurance, government funding, charity, or some provider’s other pocket– the risk of the few must be spread over the resources of the many. I believe however, that we need a different system locally (if not nationally) to share the assumed obligation. Continue reading “It’s Official. Louisville Contribution to QCCT Indigent Care Fund Cut to $5 million.”

Changes Coming to Downtown Louisville for KentuckyOne Health.

Not so bad so far!

I have been scanning the usual media outlets for some clue about what went on at the Tuesday institutional town meetings that Jewish Hospital announced publicly last week. I am finding nothing, nor have I any idea what was discussed.  I have a feeling that if something big had been revealed, that we would have heard of it by now. KentuckyOne and the University of Louisville continue to keep the lid on pretty tight.

What I did find was a YouTube video message from KentuckyOne’s CEO, Ruth Brinkley. It contained nothing particularly surprising or controversial. Its principal function appeared to be to calm employee anxieties that arise naturally during rapid institutional change. It begins by telling the “good news” that half of the $218 million budget deficit has been made up through the hard work and sacrifice of employees, although no details are offered. It restates the obvious, that major change takes time and is difficult. Employees were told that no further large-scale layoffs were anticipated.

Patient referrals and provider recruitment.
Other successes announced include increased referrals to system physicians and mid-level primary care providers through the “Anywhere Care” tele-health initiative or from referrals through HealthGrades. Fifty-eight new primary care providers of a variety of professions have been added to the network.

Employees are told they can help by speaking well of and conveying their pride in the organization to their family and friends. They are urged to select KentuckyOne primary care providers. Suggestions for cost-saving measures from employees are solicited with special recognition awarded for measures that are adopted. Much of the rest of the message is a restatement of the goals of the organization including improving the health of Kentuckians. It is noted that the challenges still facing KentuckyOne are not unique to it. [I agree.] Continue reading “Changes Coming to Downtown Louisville for KentuckyOne Health.”

Troubles Persist at King’s Daughters Hospital.

Settlement proceedings with federal agencies ongoing.

A measure of the difficulty facing our Louisville Hospitals.

Last March I gave an update on the struggle of King’s Daughters Hospital in Ashland, KY to recover from the abrupt decrease in patient volume and income following the disclosure of a Federal investigation of their cardiac program. Several years of financial boom and building turned into a bust of multi-million dollar losses and a downgrading of their bond rating. A paragraph in their FY2013 Audit led me (and pretty much everyone else) to believe that the hospital had reached a settlement with the Department of Justice and Inspector Generals’ offices. My efforts to obtain a copy of the settlement from Kentucky authorities was unfruitful despite apparent cooperation with my request. A report in today’s Modern Healthcare gives the reason why as well as an interim financial update.

The jury is still out!
In fact, settlement discussions were indeed in progress but are not final. The $48.9 million mentioned in the footnote of the audit referred to a reserve set aside to cover any fine and associated legal costs. The Hospital corrected the misleading language.

“Standard accounting principles require a reserve be set to reflect potential exposure for legal matters once the amount can be reasonably determined. Unfortunately this accrual was reflected in the audit footnote disclosure as though a final settlement agreement had been executed. While it is true King’s Daughters has been in ongoing negotiations with the Department of Justice, a final settlement has not occurred. King’s Daughters will update this notice if a final settlement with the Department of Justice is reached.”

Ongoing losses despite some improvements.
As of March 2014 the hospital reported a 13.5% decrease in admissions and a 15.2% decline in patient days for the year. Meaningful savings in operating expenses were won and the state’s expanded Medicaid program led to a decrease in “self-pay” uninsured patients. These gains were lost to unspecified severance benefits, and consultant and legal fees. The hospital, like others, continues to pay a heavy price for its alleged angioplasty-misadventures. Continue reading “Troubles Persist at King’s Daughters Hospital.”