Author: P Hasselbacher

Bad Hearts, Bad Healthcare, or Both in Eastern Kentucky?

ptca-2010

Counting Angioplasties:
Too many, too few, or just right?
Although it is St. Joseph London Hospital that is taking the heat in Kentucky over accusations of performing medically unnecessary cardiac catheterizations and other invasive cardiac procedures, it is certainly not alone nationally in this regard. I examined publicly available health data from the Kentucky Hospital Association (KHA) website which confirmed that St. Joseph London was performing a lot of cardiac catheterizations and other invasive cardiac procedures for such a small hospital in a rural part of our state. The hospital today claims to perform over 3000 heart catheterizations a year, although not all are angioplasties.  Of course, absolute numbers alone do not indicate that anything improper occurred, However, given the nature of the accusations, the precedents elsewhere, and in the best interests of both the hospital and the patients it serves; it is my belief that a careful and transparent review is in order. [Addendum:  We can now be sure that very much that was improper occurred!] Continue reading “Bad Hearts, Bad Healthcare, or Both in Eastern Kentucky?”

Hospitals love their cardiologists– and are willing to buy their affection!

bemine2Back in the days when I was a hospital lobbyist, my colleagues voiced the generally accepted fact that Medicare and other insurers overpaid for cardiology services. As a medical student, I was taught the Willie Sutton Law of Medicine– “When looking for a diagnosis, think of common things first.” [When Willie Sutton was asked why he robbed banks, his answer was, “Because that’s where the money is.”] While I by no means wish to imply that all hospitals are stealing our tax and premium dollars, an increasing parade of nationwide criminal investigations, indictments, and convictions make it clear that some hospitals and their doctors are shaking the cardiology piggy bank too hard. Continue reading “Hospitals love their cardiologists– and are willing to buy their affection!”

New Leapfrog Hospital Safety Scores: Better, Worse, and the Same.

leapfrog-map-nov2012-croppedIn June 2012, the Leapfrog group released the first iteration of its Hospital Safety Scores. Drawing heavily on information collected by the federal government for the Medicare program, and supplemented by additional information submitted by hospitals voluntarily to the Leapfrog Hospital Survey, the Safety Scores attempt to highlight aspects of hospital operations that are indicative of safety as contrasted to elements relating to quality. Obviously a distinction between safety and quality is very fuzzy indeed, but it is my impression that the Safety Scores attempt to focus on preventable occurrences in hospital that cause harm. The information underlying the Safety Scores represent a combination of procedures in place for prevention as well as a count of selected actual adverse events. In November 2012, an updated set of Hospital Safety Scores was released. Continue reading “New Leapfrog Hospital Safety Scores: Better, Worse, and the Same.”

Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.

[Correction: Because of a systematic error in the on-line database of the Kentucky Hospital Association, the number of angioplasties reported for all hospitals in 2011 was exactly double. This caused me to under-estimate  the sharp drop in procedures at St. Joseph London, and erroneously indicated a statewide increase for that year. Corrected charts, tables, and discussion are substituted in the text below.]

The University of Louisville’s new academic and clinical partner, KentuckyOne Health, and its erstwhile suitor, Health Management Associates (HMA), have both been in the news lately but not in a favorable light. A story about HMA was the leadoff feature of the December 2 edition of a 60 Minutes program in which HMA was alleged to have exercised inappropriate and computer-assisted influence over its physicians to admit patients from the emergency rooms of its hospitals who would not otherwise have required inpatient-hospitalization. One of KentuckyOne’s hospitals, St. Joseph London, has been sued and is under federal scrutiny for claims it was performing unnecessary invasive cardiac procedures and worse, operating on patients with normal hearts. For many reasons, these are serious allegations, not least because they impute the ethics and professionalism of the hospital’s management, medical staff, and employees. It would also put human lives at risk without chance of benefit and be be a waste of our collective tax and insurance premium dollars.

Continue reading “Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.”