Friday, 20 May 2005

Princess Health and The "Misconduct" of a Leader with "Gravitas,". Princessiccia

Princess Health and The "Misconduct" of a Leader with "Gravitas,". Princessiccia

A follow-up on the story of Staten Island (NY) University Hospital's settlement of charges that it had defrauded the state Medicaid program....

According to the NY Times, it turns out that Joseph Pisani, the former Executive Vice President of State Island University Hospital, who was accused of involvement in the scheme to defraud Medicaid, had taken a position as Senior Vice President for financial planning and forecasting at troubled Westchester (NY) Medical Center in 2003, at a salary of $275,000. In 2004 he was promoted to Executive Vice President and Chief Administrative Officer, with a salary of $480,000. At the time, employees and union officials said this salary was excessive given the perilous financial condition of the institution. (The Journal News reported that the hospital has lost $200 million since 2002, and is projected to lose $60 million in 2005.) However, the Chair (in 2004) of the Westchester County Health Care Corporation defended Pisani's salary thus,
  • "To get out of this thing, you need good troops, and Joe is really C.E.O material. He has that kind of gravitas and can think outside the box and can think of creative solutions."
Yesterday, when the story of the fraud settlement at Staten Island University Hospital, and Pisani's involvement in it was revealed, Westchester Medical Center fired him. Staten Island University Hospital had announced its regrets over its leaders' "misconduct."
OK, here comes my rant. How many times have we heard about the brilliance of health care leaders (often proclaimed by other health care leaders)? How many times have we heard about their intelligence, their vision, their ability to think outside the box? How many times have we heard about how their brilliant plans will improve care, lower costs, etc., etc.? And how many times do these predictions turn out to be wrong?
My favorite example of the over-hyping of health care leadership: In 1995, Sherif Abdelhak gave the prestigious Cooper Lecture at the American Association of Medical Colleges meeting, later published in the prestigious journal, Academic Medicine. In it he proclaimed how through his brilliant leadership, the Allegheny Health Education and Research Foundation was moving into the brave new world of large-scale integrated health care systems. (Remember, they were all the rage in the 1990's.) In 1997, the ACP Observer reported that Abdelhak was considered a "visionary." By 1998, AHERF was bankrupt, the second largest bankruptcy in the US at that time. Abdelhak was convicted of misappropriating charitable funds, and went to jail. (See my summary of the case here starting on page 5.)
So maybe the next time we hear that some top health care leader is "visionary," has "gravitas," or the ability to "think outside the box" of another, a high degree of skepticism is in order. Maybe we should look for leaders who display some modesty, humility, and realism, for a change.
Princess Health and  The "Misconduct" of a Leader with "Gravitas,".Princessiccia

Princess Health and The "Misconduct" of a Leader with "Gravitas,".Princessiccia

A follow-up on the story of Staten Island (NY) University Hospital's settlement of charges that it had defrauded the state Medicaid program....

According to the NY Times, it turns out that Joseph Pisani, the former Executive Vice President of State Island University Hospital, who was accused of involvement in the scheme to defraud Medicaid, had taken a position as Senior Vice President for financial planning and forecasting at troubled Westchester (NY) Medical Center in 2003, at a salary of $275,000. In 2004 he was promoted to Executive Vice President and Chief Administrative Officer, with a salary of $480,000. At the time, employees and union officials said this salary was excessive given the perilous financial condition of the institution. (The Journal News reported that the hospital has lost $200 million since 2002, and is projected to lose $60 million in 2005.) However, the Chair (in 2004) of the Westchester County Health Care Corporation defended Pisani's salary thus,
  • "To get out of this thing, you need good troops, and Joe is really C.E.O material. He has that kind of gravitas and can think outside the box and can think of creative solutions."
Yesterday, when the story of the fraud settlement at Staten Island University Hospital, and Pisani's involvement in it was revealed, Westchester Medical Center fired him. Staten Island University Hospital had announced its regrets over its leaders' "misconduct."
OK, here comes my rant. How many times have we heard about the brilliance of health care leaders (often proclaimed by other health care leaders)? How many times have we heard about their intelligence, their vision, their ability to think outside the box? How many times have we heard about how their brilliant plans will improve care, lower costs, etc., etc.? And how many times do these predictions turn out to be wrong?
My favorite example of the over-hyping of health care leadership: In 1995, Sherif Abdelhak gave the prestigious Cooper Lecture at the American Association of Medical Colleges meeting, later published in the prestigious journal, Academic Medicine. In it he proclaimed how through his brilliant leadership, the Allegheny Health Education and Research Foundation was moving into the brave new world of large-scale integrated health care systems. (Remember, they were all the rage in the 1990's.) In 1997, the ACP Observer reported that Abdelhak was considered a "visionary." By 1998, AHERF was bankrupt, the second largest bankruptcy in the US at that time. Abdelhak was convicted of misappropriating charitable funds, and went to jail. (See my summary of the case here starting on page 5.)
So maybe the next time we hear that some top health care leader is "visionary," has "gravitas," or the ability to "think outside the box" of another, a high degree of skepticism is in order. Maybe we should look for leaders who display some modesty, humility, and realism, for a change.

Thursday, 19 May 2005

Princess Health and Jacobi's Missing Test Results. Princessiccia

Princess Health and Jacobi's Missing Test Results. Princessiccia

Another problem in New York. The Times reports how Jacobi Hospital, part of the city's Health and Hospitals Corporation, failed to notify hundreds of women of their Pap test results, including some with abnormal results.
Apparently, supposedly to reduce bureaucracy, a single clerk was given the job of scheduling all Pap tests, and notifying all patients of their results. Apparently no one was monitoring the clerks work, so it took a long time for anyone to notice that the notifications of 307 women with abnormal results never got out.
Hospital management seems at a loss to explain why all this happened.
The hospital's executive director (a quaint term in this day and age) has been suspended.
What was left unsaid is whether any physicians were notified of their patient's abnormal results.
Princess Health and  Jacobi's Missing Test Results.Princessiccia

Princess Health and Jacobi's Missing Test Results.Princessiccia

Another problem in New York. The Times reports how Jacobi Hospital, part of the city's Health and Hospitals Corporation, failed to notify hundreds of women of their Pap test results, including some with abnormal results.
Apparently, supposedly to reduce bureaucracy, a single clerk was given the job of scheduling all Pap tests, and notifying all patients of their results. Apparently no one was monitoring the clerks work, so it took a long time for anyone to notice that the notifications of 307 women with abnormal results never got out.
Hospital management seems at a loss to explain why all this happened.
The hospital's executive director (a quaint term in this day and age) has been suspended.
What was left unsaid is whether any physicians were notified of their patient's abnormal results.
Princess Health and Kling on the EMR. Princessiccia

Princess Health and Kling on the EMR. Princessiccia

A nice discussion by Arnold Kling on Tech Central Station on pitfalls to expect on the road to electronic medical records (EMRs)....
His reminds us that computer systems must be viewed in the organizational context in which they will be employed, and the health care context is a particularly complex one. He then points out two specific problems.
One is that in the current health care system, no one really owns the whole of a patient's medical record. Yet it is hard to understand how an EMR would work if no one is responsible for any given patient's record. Apparently, the Gingrich proposal includes the formation of regional health information networks. Yet if these have no power, their formation will not solve the lack of ownership problem. On the other hand, if they have the power to own the records, they risk becoming "a new and potentially intrusive entrant into the health care system."
Kling suggests instead that primary care physicians should become accountable for each patient's health care (gasp). Of course, right now primary care and generalist physicians are an embattled species, and there is little support right now for improving our lot.
The other, perhaps better known problem is the requirement for a large number of interfaces to support a large number of types of transactions done by a large number of different actors. Kling contrasted this situation with, for example, electronic banking in which the number of different kinds of actors and different kinds of transactions is small.
I don't think Kling has actually described all the important pitfalls. The elephant in this room remains the poorly understood structure of medical and health care data. Simply storing data as text and images would be clumsy, and sacrifices the ability of computers to truly process data. But we may not yet know how to store health care data other than as word processing and image files.
My fear remains that the EMR is just the latest business fad to captivate health care leaders who don't really understand the health care context. Remember mergia mania? And when physicians are forced to cope with clumsy systems that don't really work well in the clinical context, the health care leaders will be onto their next fad. We'll see.
Princess Health and  Kling on the EMR.Princessiccia

Princess Health and Kling on the EMR.Princessiccia

A nice discussion by Arnold Kling on Tech Central Station on pitfalls to expect on the road to electronic medical records (EMRs)....
His reminds us that computer systems must be viewed in the organizational context in which they will be employed, and the health care context is a particularly complex one. He then points out two specific problems.
One is that in the current health care system, no one really owns the whole of a patient's medical record. Yet it is hard to understand how an EMR would work if no one is responsible for any given patient's record. Apparently, the Gingrich proposal includes the formation of regional health information networks. Yet if these have no power, their formation will not solve the lack of ownership problem. On the other hand, if they have the power to own the records, they risk becoming "a new and potentially intrusive entrant into the health care system."
Kling suggests instead that primary care physicians should become accountable for each patient's health care (gasp). Of course, right now primary care and generalist physicians are an embattled species, and there is little support right now for improving our lot.
The other, perhaps better known problem is the requirement for a large number of interfaces to support a large number of types of transactions done by a large number of different actors. Kling contrasted this situation with, for example, electronic banking in which the number of different kinds of actors and different kinds of transactions is small.
I don't think Kling has actually described all the important pitfalls. The elephant in this room remains the poorly understood structure of medical and health care data. Simply storing data as text and images would be clumsy, and sacrifices the ability of computers to truly process data. But we may not yet know how to store health care data other than as word processing and image files.
My fear remains that the EMR is just the latest business fad to captivate health care leaders who don't really understand the health care context. Remember mergia mania? And when physicians are forced to cope with clumsy systems that don't really work well in the clinical context, the health care leaders will be onto their next fad. We'll see.

Wednesday, 18 May 2005

Princess Health and New York Hospital Settles Fraud Charges Twice in Six Years. Princessiccia

Princess Health and New York Hospital Settles Fraud Charges Twice in Six Years. Princessiccia

From the NY Times, Staten Island University Hospital has agreed to pay $76.5 million to settle claims that it fraudulantly billed the state's Medicaid program. This is the second time the hospital has been charged with over-billing Medicaid. In 1999, it paid Medicaid $45 million and agreed to provide free care worth $39 million to settle previous claims. New York Attorney General Elliot Spitzer also issued a criminal complaint against the hospital, but dismissed it in response to the settlement. Spitzer noted "the magnitude and depth of this fraud, and the willingness of the leadership there to tolerate it, was unusual."
The hospital was charged with billing Medicaid for clinic services at a higher rate allowed for clinics that are open only part-time, while it ran the clinics full-time. It was also charged with lying on state financial reports. The investigation found that the hospital had real-estate contracts with a doctor who was allegedly an associate of the Gambino crime family.
Hospital executives who were warned by their lawyer and the Department of Health, CEO Americo Varone, Executive Vice President Joseph Pisani, and Senior Vice President James Walsh, have left the hospital.
The hospital released a statement that "we deeply regret and are embarassed by the misconduct carried out by former executives of the hospital that led to this settlement."
This is just a reminder that pharmaceutical companies are hardly the only health care organizations accused of misconduct, nor are they necessarily responsible for the worst misconduct in health care.