Author: P Hasselbacher

Medicare Payments to Physicians Now Available On-Line.

Take a look at the results for Louisville and Kentucky.

Our colleague Terry Boyd at Insider Louisville was probably the first out of the block this morning to report on the local results of the much-debated, long-opposed, and likely system-changing publication by the Centers for Medicare and Medicaid Services of the amounts of money charged by and payed to individual physicians and other providers for some Medicare patients. This previously top-secret financial and utilization information had not even been available to other physicians let alone the public.

Long opposed by organized medicine as a violation of individual physician privacy, the public has gotten used to, indeed gained an appetite for such information about hospitals, nursing homes and the like. This is part of the movement to increase medical safety, quality, and efficiency. It also has been very helpful for identifying medical fraud and abuse. I predict that the release of physician payment data will have as much earth-shaking effect as last year’s release of hospital payment data illustrated by the now-famous article in Time Magazine, “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill.

There will be much to learn from this extensive database. It is huge! My tricked-out Mac chokes on the size of it. You can look up individual physicians for a more detailed breakdown on the Washington Post Portal referred to by Terry Boyd, or the Wall Street Journal..  To give the community something to look at while I do the same, a more manageable aggregate list of all the physician and other non-hospital Medicare providers doing business in Louisville or the state of Kentucky is available below.  I have ranked the lists by the amount of money actually paid to individual providers– highest paid providers are at the top. Definitions of the individual items and some other comments about the data are present in the designated tabs. Continue reading “Medicare Payments to Physicians Now Available On-Line.”

Kentucky’s Universities Fare Poorly in 2014 Legislative Session.

Funding of Higher-Education in Kentucky– Death By a Thousand Cuts.

chestnut-st-2014The 2014 Kentucky legislative session is not over yet, but some would say it never really got started. The Governor has time to veto bills that have already passed, including line-item vetoes in the Budget. The House and Senate still have a final day or two to try to pass additional legislation or override any vetoes. Unless there is a miracle on the Ides of April, the budgets of the state Universities are now graven in stone.

What Makes a Good Legislative Session?
Complaints have been voiced that this session was not a fruitful one because so few bills of any significance were passed. That would be a valid observation if the most important function of the General Assembly was to pass good laws. Another school of thought, to which I have some affinity, is that the highest function of legislative bodies is to prevent bad laws from being born– legislative contraception as it were. From that perspective, our Kentucky House and Senate committees with their competitively-adversarial political party structures serve to prevent attachment of many nascent bills to the walls of their respective full chambers. Many bills deserve to be thus aborted.

I spent a good bit of my free time these past few weeks trying to understand what was happening to funding for the Quality Community Care Trust fund (QCCT) that has for some 30 years provided supplemental funding to the University of Louisville Hospital to care for uninsured inpatients. The amounts of funding provided by the city of Louisville and the Commonwealth have been decreasing, the contractual parties have changed several times, and the permitted uses of the money had slowly changed over time in an evolving medical ecosystem. In my opinion, that program is nearing the end of its useful lifetime. I have written about these matters often over the past two years and will continue to do so as I go through the Louisville archive of contracts and correspondence now available to me.

Not a Great Legislative Session for the State Universities.
Our public institutions of higher education are probably more unhappy than most with the outcomes of the session. At a time when they are being urged to enroll and graduate more students, their budget allotments from the general fund continue to shrink. Just as our state retirement systems were systematically underfunded to the point of impending insolvency, so too has funding to renovate or replace our university inventories of aging or inadequate buildings been ignored. What might have been accomplished in small pieces has now become an unmanageable disaster. Money for new educational facilities is largely a gleam in the eyes of university Boards of Trustee members. As I combed through legislative documents this spring, I had occasion to examine the blunt-knife approach to carving up academic budgets, but also to gain insight into the priorities of these institutions and the hoops they must jump through to advance their interests. The initial budgets from the General Assembly called for an across the board cut to the university budgets of 2.5%, and according to some, the 14th year in a row of such cuts. Continue reading “Kentucky’s Universities Fare Poorly in 2014 Legislative Session.”

Kentucky Legislature Restores Partial Funding for QCCT Indigent Care Fund – Sort of.

Amounts in House budget reduced.
Strings attached.
Meddling in Metro-Louisvile’s business.

The Kentucky House and Senate completed an increasingly contentious budget process last night after a weekend of behind-the-scenes horse trading. (The multitude of coal severance earmarks were also restored– a not-unrelated observation.) I suspect that few people actually believe the accompanying bilateral declarations of how well the two political parties worked so wonderfully together in the public interest. The lyrics of Kumbaya are known by heart in Frankfort: “Someone’s laughing, someone’s crying, someone’s singing, and lots of people are praying that things turn out all right!”

The 253 page document (House Bill 235) is only an outline of the various administrative units and projects receiving public funds, or of expenditures for which legislative approval is required. A summary of changes made in-conference is available here. No one can read it without recognizing the large number of earmarks that are the price for securing votes. The budget document also provides an indicator of the priorities of Kentucky’s State Universities and Community College system. Their itemized requests for public funds (or for permission to spend other money) make up 20% of the total budget document! I will write more about this latter use of the document later. In this article I summarize the partial restoration of funding by the legislature of the increasingly complicated and controversial QCCT indigent care program used to support inpatient services at University of Louisville Hospital. Continue reading “Kentucky Legislature Restores Partial Funding for QCCT Indigent Care Fund – Sort of.”

Major Settlement Between King’s Daughters Hospital and U.S. Department of Justice.

A $40.9 million settlement over issues of unnecessary cardiac catheterizations and coronary stents was apparently reached last February. Is it final yet?

Modern Healthcare reported yesterday on additional bad news for King’s Daughters Medical Center, including a $40.9 Million-plus settlement with the U.S. Department of Justice related to unnecessary cardiac procedures. The following language comes from the Medical Center’s annual independent audit for the fiscal year ending September 2013, as released this March 14.

“In February 2014, the Medical Center and the United States of America, acting through the DOJ and on behalf of the Office of Inspector General (OIG-HHS) of the Department of Health and Human Services (HHS) (collectively the “United States”) and the Commonwealth of Kentucky, reached an agreement to settle the DOJ’s review related to unnecessary diagnostic cardiac catheterizations and coronary stents. Under the terms of the agreement, the Medical Center will pay $40.9 million (“Settlement Amount”) to the United States. Interest will accrue on the Settlement Amount at the simple rate of 2.5%. Accordingly, $40.9 million is included in the current accrued governmental settlement at September 30, 2013 for the Settlement Amount. An additional $8 million has been included in the current accrued government settlement at September 30, 2013 for legal fees associated with the investigation and settlement. In addition to the settlement, the Medical Center will enter into a Corporate Integrity Agreement with the OIGHHS.”

Little or no news about the settlement.
I find no announcement of any settlement as of this morning on the websites of the Eastern District US Attorney, King’s Daughters Medical Center, or Kentucky’s Inspector General. I will try to ask for such. Apparently there was an additional settlement in September, 2013 of which I have no other details. Can anyone help? Continue reading “Major Settlement Between King’s Daughters Hospital and U.S. Department of Justice.”