GlassHospital

Demystifying Medicine One Month at a Time

Category: charity (page 1 of 2)

Wallet X-Ray

Have you ever heard the term ‘wallet biopsy?’

A wallet biopsy is what occurs in U.S. health care when you or a loved one show up with a medical complaint to seek treatment.

From the emergency department to the inpatient hospital, to the doctor’s office or the procedure suite—at any location where an American might receive health care, you’re subject to a wallet biopsy.

Health care is a business. An expensive one. And the beast has to be fed—not only to keep the lights on, but also to buy the latest equipment and pay the folks that provide the care.

In a recent piece for Kaiser Health News, journalist Phil Galewitz updates us on how the U.S. practice of wallet biopsy has morphed into wallet x-ray.

The idea is longstanding: grateful patients (with financial means) have always looked for ways to share their good fortune with the medical establishments (and professionals) that have treated them.

Galewitz’ piece suggests that the practice of seeking out potential donors has ramped up in intensity: large health care enterprises (often university-based or affiliated) are performing financial background checks on patients they deem to be potential donors—and then aggressively wooing them.

There’s nothing necessarily wrong with this—it just smells a bit fishy. And it implies that if you’re not a grateful patient, or in financial position to be one, that you may wind up getting a bit less…er, attention? Fewer amenities? Less TLC?

Check out the article, which also ran in the NY Times, and let us know what you think of the specialty of wallet radiology.

Hedge Fund to the Rescue?

Daughters-of-Charity-Health-System_3Tucked away amid the deluge of awful news from California last week was a story about a tentative deal in which a hedge fund (BlueMountain Capital Management) received a green light to manage a chain of non-profit hospitals (Daughters of Charity Health System) that is on the brink of bankruptcy. Said hospitals span the state — from San Jose to Los Angeles.

Notable facts about the deal include:

  • It’ll be the largest transaction involving a non-profit system in California history.
  • It’ll be the first time a state-level decision governing non-profit hospitals has included a hedge fund.
  • The hedge fund is paying $100 million up front for the ‘right to purchase’ the hospitals within three years. (Final costs of which will be many hundreds of millions more.)

California’s attorney general had to give her blessing to the deal. She instituted strict conditions to permit the option, which are listed at the bottom of this post. On the plus side, community-serving hospitals stay open, and stay non-profit for a period of years. They are infused with cash which a) keeps them open b) allows capital improvements c) keeps their employees working and d) keeps their pensions funded.

Potential downsides are that the hedge fund has no prior experience managing a hospital system — it will create a spin-off to do the managing. Some community advocates are worried the hedge fund will (years from now) turn the hospitals for-profit, consolidate them, shed employees, and thus hurt the various communities’ access to care.

It will be an interesting deal to watch. No one has ever said health care is simple. Or that it’s cheap.

From the San Jose Mercury News article:

AMONG THE CONDITIONS [California AG Kamala] HARRIS IMPOSED:

  1. For 10 years, O’Connor Hospital, Saint Louise Hospital and Seton Medical Center and St. Francis Hospital in Los Angeles must operate as acute care hospitals and offer emergency services.
  2. For 10 years, Seton Coastside must operate as a skilled nursing facility with 24-hour emergency services and a minimum of 116 licensed skilled nursing beds.
  3. For 10 years, the six facilities must provide the same types and/or levels of emergency and nonemergency services to Medi-Cal beneficiaries and maintain Medi-Cal managed care contracts at each of the facilities.
  4. A sum of $180 million must be invested in capital improvement expenditures at the facilities.
  5. Charity care for needy patients and community benefits must be provided at historical levels.
  6. All facilities must meet seismic compliance requirements until 2030.

Is this a Faustian bargain or was it the only viable option?

The 1% Solution

C M Burns, Yale 1914

C M Burns, Yale 1914

The Downturn.

Global financial meltdown.

Sequestration.

“Fiscal realities.”

Whichever your term of choice, non-profit entities like hospitals are finding their resources constrained as never before.

Costs are up (aren’t they always?); revenues are down; market competition is fierce. How to bridge the gap?

New York’s Beth Israel Hospital had a novel idea: They turned to philanthropy. [Well, not so novel of an idea–but a novel way of implementing it.] Development, it’s called in the academic and non-profit worlds.

Situated in Manhattan, Beth Israel has the advantage of what we in health care refer to as a “silver spoon catchment area.” (Okay, I made that up.)

Seems one of their patients, Huguette Clark, was a ‘reclusive heiress’ of a bygone era (Gatsby, anyone?).

She was admitted to Beth Israel in 1991 at the age of 85–with skin cancer of the face (involving her lip) that made it hard for her to eat. She was malnourished–“emaciated,” as described in the Times article you will want to read in its entirety.

When she was well enough to be discharged, Ms. Clark decided that she liked the security and comfort that the hospital provided her.

So she decided to stay. For the next twenty years.

She died at age 104 in 2011. Know what? There’s a little, err, conflict going on over her last wishes. A $300 million estate is at stake. Hospital management, paid in full for the expansive a la carte services rendered, seems to think it’s entitled to a bit more.

The Gift that Kept Giving

Old guy, generous young guy and his even more generous sister. (Photo: AP)

In case you missed it, there was a heartwarming story in the news about two kidney transplant recipients.

One, a young man with an autoimmune disease that destroyed his kidneys, was lucky enough to receive the gift of a kidney from his sister.

When the new kidney started to fail from the same disease process, he was offered the chance to have it removed so that another, older patient (who did not suffer from the same disease process ) could try to benefit from it.

Charitably, both he and his sister (the original donor) accepted this plan.

It worked!

The older gentleman (who happens to be a retired surgeon) is now in good condition, off of dialysis, and feeling better than he has in years.

According to news reports, this is the first documented U.S. case of ‘kidney recycling.’

For you medical buffs, the disease in question is focal segmental glomerulosclerosis (“FSGS“). And it’s not unusual that it would harm the donated kidney-the disease process occurs independent of the origin of the kidney (i.e. even if the donated kidney had come from an unrelated donor, his FSGS would have started going to town on that one as well). According to the literature, this happens ~40% of the time.

Yet when removed from the FSGS environment, the kidney recovered function and now works well in a new recipient.

Weird science!

Xmas Spirit….or Bah! Humbug?

Are you a yoda or a grinch?

You’re in your 30s. You work hard. You strive to master your craft. You support your extended family. You are liked by both your co-workers and boss.

Problem: You unexpectedly become unhealthy–you find out your kidneys are failing.

Solution: Regular kidney dialysis can keep you alive, by filtering toxins out of your blood.

Problem: Dialysis is time consuming (>3 hours/session, 3 sessions/week) and leaves you feeling tired and weak.

Solution: Your brother, who is a tissue match, offers you the gift of a lifetime–one of his kidneys.

Problem: Because you don’t have health insurance (you are covered under the Medicaid program for your ’emergency’ dialysis only) you are deemed ineligible for the transplant surgery.

Fact: The estimated cost of dialysis is $75,000 per year. The cost of the transplant surgery and care is $100,000, with an additional $10,000/year in anti-rejection medication costs.

Fact: Research shows that transplant pays for itself vs. the cost of dialysis at four years. Beyond that point, transplant is a tremendous cost saver overall. Patients feel better and live longer with transplant, too.

Solution: Surgeons at a medical center agree to waive their fees to perform the transplant.

Problem: The hospital still won’t allow the transplant to go forward.

Solution: Your kind boss offers to pitch in for health insurance.

Problem: You are denied because your kidney disease is a ‘pre-existing’ condition.

Solution: Raise $200,000 to pay the hospital up front for the cost of the operation and any potential complications.

Any readers out there willing to step up?

You can read the full story of this patient’s plight here. Pay attention to the comments below the article to see the extremes of opinion.

The patient in question is an undocumented immigrant. His children were born here and are citizens. He meaningfully contributes to the community.

But because of his status, he’s out of luck in the sweepstakes world of health care.

I welcome your opinions on how this situation should be handled. Comment on the post or send an email.

Happy Holidays. Thanks for reading and sharing GlassHospital.

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