Who will take the blame for the reduction in services, staff and payroll at Connecticut’s financially stressed nonprofit hospitals?
That’s the question behind the renewed dance of the administration of Gov. Dannel Malloy and Tenet Healthcare Corp., the hospital chain that proposed to acquire Waterbury’s two hospitals and hospitals in Bristol, Manchester and Vernon but withdrew in the face of onerous conditions imposed by the state Office of Healthcare Access. Those conditions would have prevented Tenet from changing anything substantial at the hospitals for five years, making it impossible for the new owner to earn a profit.
In a letter sent this week to Tenet’s CEO, Governor Malloy sought to revive the company’s bid for the Waterbury hospitals as a step toward reviving the bid for the others too. “We can find a settlement that will be beneficial to your company as well as the state, Waterbury residents, and the Waterbury hospitals,“ the governor wrote.
So if the governor really wants the hospital acquisitions to happen, why did the Office of Healthcare Access obstruct them so? After all, that office is part of governor’s own administration.
The governor is playing charades and a double game here.
On one hand, both the federal government and state government are trying to squeeze money out of medical care, of which government is the biggest purchaser. Government long has underpaid hospitals for services they are required to provide to the poor, and lately the Malloy administration has greatly reduced subsidies to hospitals on the pretext that they would recover the money through the new national medical insurance program. That hasn’t happened.
On the other hand, organized labor and social service groups, constituencies of the governor’s party, the Democratic Party, oppose the sale of the hospitals, realizing that a profit-seeking corporation would be tougher than the current management of the hospitals.
While some hospitals in Connecticut are not managed well, what happens to hospital services and staff will be largely government’s decision, a matter of how much money government puts into them and how much it economizes with them.
Since the decision is to economize, the government generally and the governor particularly must want Tenet to do their dirty work and take the blame for it along with any profits.
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With the Tenet deal suspended, Eastern Connecticut Health Network’s board of trustees and community corporators are back in business. Manchester Memorial and Rockville General hospitals remain their responsibilities for the time being, and although the hospitals are so insolvent that the trustees and corporators have given up on them and want to sell them, a former trustee who is now a corporator insists that they all have been doing a great job.
The former trustee and current corporator, Robert D. Rodner of South Windsor, wrote the other day that the trustees and corporators “always have been and continue to be well-respected, knowledgable, and dedicated members of our multi-town community … insightful, cautious, challenging, questioning, and supportive.”
In fact ECHN’s Board of Trustees has been rife with financial conflicts of interest, with several trustees owning companies that have done millions of dollars of business with ECHN. Of course those “questioning” trustees have never seen anything wrong in the grotesquely excessive salaries paid to ECHN’s executives, who have arranged that lucrative business for the trustees’ own companies.
That is, ECHN’s board has never been independent, has never been in a position to distinguish the interest of the hospitals from the interests of board members themselves. A few weeks ago, even as ECHN was laying off employees and freezing salaries, the company was paying big raises to its already overpaid executives.
The corporators should install a new board without conflicts of interest. Managed for public benefit rather than the benefit of its executives, ECHN still might survive with local nonprofit ownership.
Chris Powell is managing editor of the Journal Inquirer, in Manchester, Conn.
The Ouroboros, a dragon that continually consumes itself, is a symbol for self-reference.
The authors say that problem requires ”regulatory or legislative relief. Support for legislative is substantial. Consensus recommendations of a broad swath of health policy experts called for the closure of ‘loopholes for in-office imaging, pathology laboratories, and radiation therapy.”’
Paul S. Teirstein, M.D., taking aim at the American Board of Internal Medicine (ABIM), argues in the New England Journal of Medicine that ”Maintenance of Certification” (MOC) requirements are bad for both physicians and patients because, he asserts, they waste time and money on ABIM mandates that primarily benefit the ABIM as a business.
- He writes: “Although the ABIM argues that there is evidence supporting the value of MOC, high-quality data supporting the efficacy of the program will be very hard, if not impossible, to obtain.”
- And he complains that the ABIM has become a big business from fees used, for among other things, to compensate highly paid board members and its chief executive.
- “We all support lifelong learning, but an excellent alternative to MOC already exists: continuing medical education (CME).”
- “My main recommendation would be to allow 25 annual hours of CME to be substituted for the current MOC requirements that need to be met every 2 years.””Doing so would eliminate, or make optional, the {ABIM} busywork modules that have little practical value, including all medical knowledge, practice-improvement, and patient-safety modules.”
Fierce Healthcare reports that the Mass Collaborative, with more than 35 health plans, healthcare providers and trade associations, has developed a new Web site to standardize and simplify healthcare administration processes and costs.
Massachusetts is a rich and high-tech state. The question is whether such sites can be created in less sophisticated places. And economic, political and social constituencies will continue to militate against simplification, as they do in Congress and state legislatures.
Much of American healthcare’s sky-high cost can be attributed to the fact that hospitals and other providers (who are the highest paid in the world) must negotiate multiple contracts with insurers. The cliche is the Western Europeans are the most bureaucratic and rep-tape-bound nations, when, in fact, from America’s healthcare ”system” to our multi-jurisdictional regulatory ”system” to our incomprehensible tax ”system,” America is much worse.
Fierce Healthcare reports that the aforementioned Web site ”features standardized industry forms and strategies to address insurance eligibility verification and claim appeals. Its goal is to take the cost and complexity out of the system and improve the overall end-to-end experience for healthcare providers, payers and patients in the state, according to Lynn Nicholas, president and CEO of the Massachusetts Hospital Association.”
It’s hard to believe that this will “take the cost and complexity” out of the system, but let’s grant Ms. Nichols poetic license.
The case raises questions on how much a hospital should be a tool for involuntary treatment.
By JAY HANCOCK (jhancock@kff.org | @JayHancock1)
Kaiser Health News
Obama administration officials have warned that ambitious experiments run by the health law’s $10 billion innovation lab wouldn’t always be successful. Now there is evidence their caution was well placed.
Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmissions produced significant results compared with those from sites that weren’t part of the $300 million program, according to partial, early results. The closely watched program is one of many tests to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act.
Dozens of community agencies on aging, from Ventura County, Calif., to southern Maine were offered money to try to ensure that seniors leaving the hospital received care that reduced their chances of being readmitted within a month.
But an early evaluation found that only four groups out of 48 that were studied in the Community-based Care Transition Program significantly cut readmissions compared with those of a control group.
At the same time, 29 groups have either withdrawn from the program or been terminated by the Department of Health and Human Services for failing to achieve targets, agency officials said. The CCTP project, which has grown since the evaluation was done, now has 72 participating sites that administration officials hope will still produce readmission reductions and lessons in post-hospital care in return for the investment.
The evaluation, produced under contract with HHS by consulting firm Econometrica, is one of the first independent analyses of an innovation-lab test to be made public. It is dated May 30, 2014, but was posted on HHS’s Web site Jan. 2.
The 111-page report notwithstanding, experts said it’s too soon to pronounce substantial judgment on CCTP.
“It’s really too early to tell,” said Ellen Lukens, who leads the practice on hospital and post-hospital care at Avalere Health, a consulting firm. “Can you really evaluate this when it’s been such a short period of time?”
A five-year experiment, the program signed its first round of deals with community agencies in late 2011 and its fifth and last round in March 2013. Econometrica’s report covered partial-2012 results from groups participating in the early rounds, including some for which only a few months of data were available. Congress required the lab to closely monitor all tests, which explains the early evaluation, experts said.
One positive note was that “a lot of the sites were able to implement the program very quickly,” Lukens said, adding that later data will give a better idea of CCTP’s effectiveness.
The readmissions result — less than one site in 10 significantly reducing them — “seems kind of wimpy,” said Eric Coleman, a professor at the University of Colorado whose previous work on care for discharged patients influenced the CCTP program. He said he remains optimistic about the tests, however, also noting that the results are early and praising HHS for cutting off nonperforming groups.
“This is really the first glance of the first two waves of the program,” said HHS spokesman Raymond Thorn. “It’s too early to determine whether this model is failing or not. We will have successes.”
CCTP is one of dozens of experiments being run by HHS’s innovation lab, which has a 10-year, $10 billion budget. Preventable readmissions are calculated to cost the Medicare program for seniors $17 billion a year.
Paying community agencies to work with hospitals was thought to be one potential way of reducing them. Rather than getting grants, agencies are paid according to the discharge cases they handle.
The program faces several challenges, experts said. In awarding funding, HHS favored groups working with hospitals with high readmission rates, perhaps making success more difficult.
Plus, numerous groups and hospitals are working to cut readmissions through other means. That increases competition for aging agencies trying to make their mark and raises the difficulty of measuring their results separately from those of other programs.
Readmissions have been dropping nationally since Medicare began penalizing hospitals in late 2012 if they have too many. Some CCTP groups reduced readmissions — but so did comparison hospitals. That means the system improved overall in those areas and money was saved, but statistically the aging agencies did not show up as the critical factor.
Coleman faulted HHS for requiring agencies to file detailed reports on care models and administration rather than letting them focus on the main job.
“If it doesn’t reduce readmissions it’s game over, so why do you want all these process measures?” he said. “If we want these sites to succeed we need to get out of their way.”
Originally more than 100 agencies agreed to participate. But 29, including New York Methodist Hospital and Pennsylvania’s Delaware County Office of Services for the Aging, have withdrawn or didn’t have contracts renewed because they missed readmission-reduction or enrollment targets, HHS said.
The health-law innovation program also includes Accountable Care Organizations to cut costs and improve care quality; tests giving more resources to primary-care doctors to coordinate care; and innovation awards for promising models to improve Medicare efficiency.
Administration officials like to compare the lab to a venture-capital fund, in which many investments are expected to fail but a few succeed spectacularly. Many Republicans think it’s a waste.
