Author: P Hasselbacher

Meeting Confirms Plans to Increase Dependency of UofL on Clinical Income.

Will the Goose Survive?

I attended a faculty and staff town-hall meeting with the senior officers of the University of Louisville that was held on the Belknap campus last September 20. I knew that I would be unable to attend a similar meeting at the Health Sciences Campus (HSC) October 12, but was hoping for an opportunity to take the pulse of the faculty on the matter of the question: “Is the University was going in the right direction.” I can’t say my question was answered, but I gained a few insights relevant to current controversies at the Medical School.

To summarize: Belknap employees expressed neither concern nor interest for what is happening on the HSC and Hospital. Financial concerns about salaries and ability to recruit faculty dominated. No magic bullets were offered. Specific remedies to current financial distress were thin on the ground. Is seems clear that the University is planning on increasing clinical revenue to support non-clinical academic activities. I invite faculty or staff who did attend the companion meeting at the HSC to tell the rest of us what happened, or to contact me confidentially. Continue reading “Meeting Confirms Plans to Increase Dependency of UofL on Clinical Income.”

End of UofL’s Search for New Partner In Sight?

What should an agreement look like?

Last week, administrators of the University of Louisville received permission from its Board of Trustees to sign a final agreement with one or more undisclosed healthcare companies to form a new management partnership for at least some portion of the healthcare operations of the School of Medicine. Doctors at Jewish Hospital have been told to expect an emergency meeting to hear of the results. The whole process has been carried out under military-grade secrecy. One hopes that at least UofL’s Board of Trustees got the whole story.

The University used as an excuse that secrecy is required by state contracting rules. Of course, playing by the rules did not stop UoL from continuing its behind-the-scenes planning with Jewish Hospital. In fact, I wonder if this column’s exposé of that activity was not responsible for forcing UofL to broaden its search options. We will soon see whether this was for the better or not. I will not belabor the list of possible participants for a new deal. The most recent one is the publicly held company Health Management Associates (HMA) out of Naples, Florida, or some combination of HMA with Baptist Hospital. It has been fun to speculate, but the game has run its course and it is time to turn over the hole-cards.

Last December, I wrote to the Governor and Attorney General suggesting that it was inappropriate for the University to ask for approval of the planned acquisition of University Hospital by Catholic Health Initiatives (CHI) when none of the details had been made available to the public.  I now find myself writing again for exactly the same reasons.  I wrote later outlining what I thought an agreement between the University of Louisville and CHI or any other new partner should look like before their offices approved a new deal. I think those suggestions are still relevant and I now update those comments briefly below. Additionally, I emphasize that any proposed arrangement must be presented to the public for its comment before any final approval is given. The University can now no longer hide behind RFP rules to avoid their obligation to its public. Continue reading “End of UofL’s Search for New Partner In Sight?”

The Joint Commission Publishes List of Top Performing Hospitals.

Who better should know how hospitals are doing?
Kentucky gets a few nods. 

At the end of September, the Joint Commission released its list of “Top Performers on Key Quality Measures for 2012.” The Joint Commission accredits all hospitals in the US, and does the bulk of data collection for Medicare’s Hospital Compare. A total of 45 accountability measures in 8 clinical areas were evaluated for some 3500 hospitals. To make the Top Performers list, a hospital had to have performed a required action 95% of the time for each indicator individually and in aggregate. Since these same quality measures are central to the rating systems of several different organizations one might expect that the lists of top hospitals would more-or-less agree with each other. To my initial observation, any agreement seems to be less rather than more. When different sets of quality measures are applied to different subsets of hospitals, the subsequent results may not be easy for us in the trenches to interpret or use.

Kentucky is home to 18 of the 620 top hospitals. Our fair share would have been 31. As previously reported, the only hospital in Louisville making the list is the Robley Rex VA Hospital. As seemed to be the case with the Leapfrog Safety Scores and Consumer Reports safety evaluations, smaller and rural hospitals seemed to have a better chance of looking good. Of the hospitals on the Joint Commission list, 43 were psychiatric hospitals, including 2 in Kentucky. A list of the Kentucky Hospitals is available from KHPI on request.

Summary of observations:

  • Most high-profile, and virtually all teaching hospitals failed to make the list.
  • It appears that few if any safety net hospitals made the list either, but I cannot yet tell how few.
  • Some hospital systems successfully contributed several of their individual hospitals to the list.
  • Correlation of standing in the Joint Commission list with ratings of hospital quality and safety from the lists of other organizations does not appear to be very good.

and comments:

  • We need to be confident of the reliability of self-reported hospital data.
  • Merger of hospitals can diminish the usefulness of hospital ratings.
  • Transparency is important in the financial relationships between the rating organizations and the institutions being rated.
  • Does what is being measured really matter?
  • Does quality in the limited number of measured processes and outcomes “trickle down” to the rest of a hospital’s patients?
  • How might the rating process itself distort the provision of healthcare in undesirable ways?
  • Are there too many different rating organizations slicing and slicing the same information?

Continue reading “The Joint Commission Publishes List of Top Performing Hospitals.”

New Epidemic of Meningitis: Predictable and Unnecessary.

National news media of all sorts have been reporting about an “epidemic of meningitis” associated with contaminated steroid shots given for back pain. I might as well chime in too. There have been 47 cases identified so far with five deaths, including one Kentuckian. Because hundreds or even thousands of people have received such injections, these numbers will surely increase over the next few weeks. Meningitis is inflammation or infection of the tissues surrounding the spinal cord and brain. The epidural or peri-spinal steroid shots in these cases are injected deeply around the spine and close (if not adjacent) to the meninges. Once the infection breaks through into the spinal fluid or bloodstream, it spreads widely in short order including to the brain. Continue reading “New Epidemic of Meningitis: Predictable and Unnecessary.”