Author: P Hasselbacher

UofL Protests UK Moving In On Its Turf!

What did they expect?

There was a big fuss in the news yesterday and today. Norton Healthcare and the University of Kentucky (UK) announced an expansion of their clinical and academic interactions to include the pediatric services at Norton Kosair Hospital in downtown Louisville. The new announcement itself seems fairly benign– the only two children’s hospitals in Kentucky agree to share their expertise and quality protocols in service of the children of the Commonwealth. Norton Kosair is by far the larger of the two children’s hospitals in the state and has much to offer UK. Children could receive care closer to home instead of having to travel to Cincinnati, Nashville, or even further. The two hospitals will “remain separate, but will be operated jointly through collaboration.” It is anticipated that it will be easier to recruit pediatric sub-specialists to Kentucky, which is something of a problem now. An increase in clinical volume from retaining Kentucky patients instead of sending them elsewhere will help build experience and quality. Having a good network in place will facilitate the coming state Medicaid expansion.

Details remain to be worked out, but the project seems like more than a simple agreement to cooperate. For example, clinical operations will be coordinated and integrated including “clinical guidelines and patient care protocols, joint opportunities for teaching and research, and even integrating finances.” The new partners hope to further develop a statewide network of perinatal and neonatal care providers for high-risk mothers and babies, and developing more children’s outreach clinics in the state.” The medical staffs of the hospitals will not be consolidated and will have their own medical staff bylaws, rules and regulations. UofL is promised by Norton to continue to receive the academic support that it is due. How can this be a bad thing for the Commonwealth? Continue reading “UofL Protests UK Moving In On Its Turf!”

How Much Information Is There In Informed Consent at UofL?

A Retraction.research-man

Is informed consent being censored?

I take some pride that I have not, until now, had to retract anything of factual substance that I have written in these pages despite the fact that I have always invited others to offer corrections or to point out misinterpretations. I freely admit to offering a healthy amount of speculation about matters that turned out otherwise. However, I always identify speculation as such and do so in the interest of bringing a variety of issues into the arena of public discussion. However, I must now retract my earlier article congratulating KentuckyOne Health and the Catholic Church for joining the 21st century with respect to their apparent changing views on justified contraception and termination of pregnancy. I was wrong.

Continue reading “How Much Information Is There In Informed Consent at UofL?”

Passport Takes Further Commanding Lead in Region 3 Medicaid Managed Care.

Who is getting paid for what? Why should we care?

Some months ago I reported on the shifting enrollments of Medicaid Managed Care beneficiaries among the four Managed Care Organizations (MCOs) in Region 3, which includes Louisville and a few surrounding counties. Although the initial assignments by the state gave roughly equal numbers of beneficiaries to each of the MCOs selected to do business in the Region, Passport was able to leverage its previous home-court, sole-source advantage; and cooperation from its existing participating providers to recapture the lion’s share of patients from its new competitors. In this installment, I show the final enrollment figures as of April 2013 when the relatively unfettered ability of a member to change from one plan to another expired. The big winner continues to be Passport which expanded its Region 3 market share to 75% compared to 64% early last February.

enrollment-april2013

Medicaid Managed Care was reintroduced elsewhere in the state in January 2012. In little more than a year, the distribution of enrollees outside Region 3 shifted to favor two of the three MCOs. (It didn’t help that one of the MCOs has already expressed interest in leaving the state.) Competition, as opposed to cooperation, produces winners and losers. The hope (and it remains a hope) is that patients will come out winners. I present some enrollment figures below as well as the rates paid by the state to the MCOs to cover the care of beneficiaries. A table of the data can be downloaded here.

Continue reading “Passport Takes Further Commanding Lead in Region 3 Medicaid Managed Care.”

New Robley Rex VA Hospital Project on Track

Back-channel attempts to change the hospital location persist.

It has been six months since I’ve written anything about the Robley Rex Veterans Hospital being built on Old Brownsboro Road at the Watterson Expressway. Neither have I seen anything in our local media about the matter. When I called the local VA office last winter I was told that plans were going ahead on schedule. The VA was in working regularly with the leadership of the University of Louisville and it was felt that planning with UofL was going forward in good faith. It appears however that opposition to construction at the new site has not faded into the woodwork altogether.

A few weeks ago, I received an invitation to attend a cocktail reception at Big Spring Country Club sponsored by Grow Smart Louisville, an advocacy group formed as much to generate pressure to get the VA to change its mind and build the replacement hospital downtown as to oppose construction at the Brownsboro site. I had to assume I was invited because I am a physician and not because I have been following the issue as a journalist. Only a tiny handful of physicians showed up– fewer than a dozen. An effort was made to stimulate discussion about how wrong the decision not to build downtown has been, but the ball never got rolling. I must say, that we physicians present had pleasant discussions about a variety of things over wine and hors d’oeuvres, however, I heard no substantial opposition from anyone other than the organizers of the session. Continue reading “New Robley Rex VA Hospital Project on Track”