Category: Health Care Reform

Is Private Medical Insurance Really Less Intrusive than Government?

Is Jennie Stewart Hospital being treated fairly or not?

We have written about the conflicts between medical providers and insurance companies in these pages before. The recent spate of lawsuits and public recriminations related to Medicaid Managed Care in Kentucky give particular insight into the posturing and dueling over who gets to keep how much of our tax and insurance premium money. What is usually left out over these increasingly pubic spats in the magical world of medical pricing is just how many dollars are involved. Continue reading “Is Private Medical Insurance Really Less Intrusive than Government?”

The Medicaid Dominoes are Falling.

Second lawsuit by Appalachian Regional Healthcare against Medicaid Managed Care:  This time we also hear from the other side!

The prolonged period of confusion following the state-wide implementation of Medicaid Managed care throughout Kentucky was bad enough, but not unexpected given its broad sweep and its short implementation period. (Some background is available by clicking on the Medicaid Tag at the bottom of this article.)  After an initial flurry of hearings in Frankfort, not much was appearing in the media, and those of us not in medical billing offices, seeing patients, or for that matter beneficiaries of Medicaid might have hoped that things were sorting themselves out. Alas, the worst seems yet to come. For me, the most recent and indeed frightening public notice that things were not self-correcting was the lawsuit filed by Appalachian Regional Healthcare (ARH) against one of the three new managed care organizations (MCOs) and Kentucky’s Medicaid Cabinet.

In that suit against Kentucky Spirit, we learned that not all the MCOs were able to pull together the necessary state-wide networks, that at least one large healthcare provider organization with a corner on a regional market was able to thumb its nose at an MCO, that payments to hospitals were painfully slow and lower than desired, and that Kentucky Hospitals have been engaged in disputes (legal and otherwise) with the Cabinet for quite some time over the adequacy of payments. It is always true that a lawsuit only represents one side’s positions, but these conclusions seem rather self-evident. You can read the lawsuit for yourself as well as my initial analysis elsewhere in these pages. It was clear to me that something bad was going to happen.

Now other shoes are falling. Insider Louisville extended its breaking reporting to a second and not unexpected lawsuit by ARH against Coventry Health Care and included a copy of a letter from the Executive Vice President of Coventry to the President of ARH. That suit itself is not yet available to me, but it sounds like it was very similar to the one against Kentucky Spirit. We are told that “Coventry will mount a fierce defense that will be an enormous drain for ARH.” I guess this is how the big boys play, but in fairness, Coventry tells a very different and equally believable story than that told by ARH in its suit against Kentucky Spirit, and seems earnestly to want to make things right for the citizens of Kentucky. Continue reading “The Medicaid Dominoes are Falling.”

What should an agreement between the University of Louisville and a new hospital partner look like?

The University of Louisville seems desperate to find a new “partner” for its fundamental academic responsibilities. It claims its principal teaching hospital is failing and in some well-defined ways it is. Here is my best shot at what such a contract should look like and to be in the best interests of the University and the public is wishes to serve. Continue reading “What should an agreement between the University of Louisville and a new hospital partner look like?”

Third Meeting of UofL Hospital Operations Review Committee.

Finally some real data.

On April 5, the Ad Hoc Operations review committee of University Medical Center, Inc. (UMC) met for the third time. This was the first meeting in which substantive analysis was presented by the consultants of Dixon Hughes Goodman. Unfortunately, Committee attendance continues to dwindle. Only five of the 10 committee members attended, one of those by telephone. In the peanut public gallery were myself, reporter Patrick Howington, and someone from Brown-Forman. One additional meeting before a final meeting on May 9 is planned.

The entirety of the meeting was a PowerPoint presentation by the consultants with only a few questions and comments from committee members. No handouts were presented as the material was said to be a work in progress. I could not help but suspect there was also some desire that the information not be disseminated. Indeed, most of the data presented must have been disappointing to the University. In any event, I photographed the projected slides and they are available here.

Senior consultant Craig Anderson, Sr. gave an update on the status of the project and lead his team of two additional people through a brief review of the challenges facing all academic medical centers (AMCs), some themes and observations from initial interviews with Hospital and University personnel, and some initial data addressing four of the hypotheses to be tested: lack of physician alignment, quality of clinical care and operations, payer environment, and facility constraints. Continue reading “Third Meeting of UofL Hospital Operations Review Committee.”