Letters: Universities have hospitals

There are several mis-assertions in Dr. Frank Opelka’s recent letter “Medical training changing for better.” A review of the recent U.S. Medical School Rankings (http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/primary-care-rankings) reveals that of the top 15 medical schools in the country, 13 are state universities. Each university has its own hospital system that they oversee and govern. Some like Michigan even have their own insurance system, M-Care.

These institutions achieve a diverse payor mix because they are not micromanaged by their state capitols. This autonomy is essential to excellence in medical education.

The public hospital system in Louisiana has been essentially subsidizing the private sector for decades. The assertion made by Dr. Opelka that the proposed changes to the LSU System will improve medical education is just not evidenced based. In fact, the evidence points that the proposed model will lead to potential harm and many assurances would need to be put in place that medical residents receive the highest level of training possible. This includes having an autonomous classroom, i.e. a hospital.

What is most concerning is the fact that these transitions are not using evidenced-based principles and are driven by politics. Of most concern is the input of the Governor’s Office, which lacks any expertise in this area.

The current system is not sustainable; however, changes should be made based on best practices, evidence and not politics.

The governor’s refusal of expanded Medicaid coverage and the current haphazard implementation of this wrong decision will result in the premature death of Louisiana residents and the potential irreparable harm to the state’s medical education system.

Jay K. Kolls, MD

University of Pittsburgh School of Medicine

Pittsburgh

Comments

1) Comment by InPVille - 07/11/2012

@healthbudget: I am all for getting the most benefit for those eligible from available funds. If your idea would be efficient and effective for those in need, I'd be all for it.

2) Comment by healthbudget - 07/11/2012

@ InPville: exactly; why does the LSU hospital system need to be run like a stage agency. Why cant it run like MD ANderson (a State funded entity) that has an autonomous board and budget?

3) Comment by InPVille - 07/11/2012

@swinham: Thank you for confirming that you would not put forward any effort to show any facts to justify anything you say. . . merely expect everyone to accept your claims that what others say is ridiculous -[**]- One more time. . . Produce some evidence that a number of states besides Louisiana have found it necessary to cut back state spending in the current economy. -[**]- I do have some experience with Medicaid but have never claimed to know everything. No one can seriously make such a claim. You have shown nothing. Thus far you equation is: Nothing + Nothing = Nothing

4) Comment by swinham - 07/11/2012

InPVille: I should have better sense than to respond to you in any way, but I can't resist pointing out that not only are your comments utterly ridiculous on their faces, but you accuse me of things of which you could not possibly be more guilty. There are plenty of message boards around where trolls are welcome and I assume you visit those also. You apparently already know everything there is to know about health care financing and everything else, so I have to wonder why you even bother to read the comments of others.

5) Comment by InPVille - 07/11/2012

@healthbudget: ". . . they came in well under budget but those millions reverted back to the general fund. If that is correct that is a stupid business model." -[**]- Whenever an agency of state government(federal government too based on my contacts over the years with federal employees) fail to spend every penny in their budget during a fiscal year, the money reverts to the general fund. This is one primary reason why government is inefficient. I remember a discussion I had with an employee of the federal government who told me about rooms of computers sitting in boxes which were purchased before the fiscal year ended(but had never been taken out of the box) because if money is left over at the end of the year, the money goes back and less agency funding is received in the following year. The same thing generally happens to other dedicated funding streams. The words efficient and government can rarely be used together in a sentence without planting tongue firmly in cheek. It is why placing more and more dependence on government solutions to problems is a stupid way to run a country. A bureaucrats' route to success and a higher GS Level is in how big a budget is controlled and the number of employees under him/her.

6) Comment by healthbudget - 06/11/2012

@InPVille It is my understanding that when LSU first assumed oversight of the public hospital system they came in well under budget but those millions reverted back to the general fund. If that is correct that is a stupid business model. There has to be incentives in place to be more efficient, not to mention the inherent inefficiencies of civil service.

7) Comment by InPVille - 06/11/2012

@swinham: Are you including yourself in the three commenters referenced in your comment? If so, you can hardly exclude yourself as a smokescreen thrower, there is no substance to your comments. If you didn't include yourself, then count again. I checked out Dr. Kolls here. He obviously knows much about his specialty. - - - http://www.medschool.lsuhsc.edu/genetics/faculty_detail.aspx?name=kolls_jay - - - However, I don't see anything in the information presented at the above link which leads me to believe he is an expert on the funding of the several services available to the states under the umbrella of the "Medicaid Program" or the funding issues accepted by a state that may elect to participate. My comment was directed solely to that last point as you would have been able to discern were you not myopically focused on the typical fog and parroting liberals throw out to criticize the points made by others when they can't produce anything of substance to refute them. Show me where I was incorrect that a large number of states have found it necessary to cut Medicaid Funding given the current economy as I stated, and I will stand corrected on that point. I'll not hold my breath on that one. I know you can't show me incorrect about the other points in my initial points because I worked for the state in several of the Medicaid programs for a significant period during my years in civil service. That there are many in the state who need Medicaid services is well known to me. It is also well known to me that it is easy to say more money is needed for services. Actually finding the money to pay for those services isn't nearly as easy. The state is relatively poor which leads to greater service needs. But the very fact of the poverty statistics makes funding problematical. Don't think I didn't notice that in your comment about the additional Medicaid funding offered in the last four years you conveniently failed to mention the strings attached to that funding which requires additional spending by states already strapped for cash which is why more than one state has failed to avail themselves of the money. -[**]- @healthbudget: People who receive Medicaid assistance must meet both income and resource eligibility requirements no matter the age no matter the health problem.

8) Comment by healthbudget - 06/11/2012

@InPVille One could argue that Medicare should be cut before Medicaid. Medicaid is just not for the poor. It is for working parents with kids with life threatening diseases such as leukemia, cystic fibrosis and muscular dystrophy. These patients are just if not more deserving than the 70 year old who had too many meals at Ruth's Chris.

9) Comment by swinham - 06/11/2012

Unfortunately, the conservative idealogues among us seem to not only engage in selective hearing, but also selective reading, based on some of the comments here. Dr. Kolls is clearly an expert on the subject about which he is writing. He also clearly acknowledges the current system has to be fixed and nowhere does he say Medicaid or anything else should not be cut. He addresses one particular issue (completely unaddressed by the detractors) and happens to have real experience with it upon which he bases his assertions. He also expresses his belief, in the context of his position on this one issue, that Governor Jindal should not have refused the additional Medicatid funding offered by the Obama administration. The smokescreens thrown up by 2 out of 3 of the commenters so far are unresponsive to what he is saying and simply parrot the conservative line on public welfare, and public health and social programs. We know how you feel about it and it is your right, but please reserve your attacks for people advocating what you are attacking.

10) Comment by InPVille - 06/11/2012

@healthbudget: It is even more immoral to burden future generations of our citizens with an unsustainable debt. Do a search of the words "States Cutting Medicaid Spending" in any internet search engine and you will find numerous examples such as the following two examples: "15 States Try To Cut Back On Medicaid Programs" (at link) http://www.npr.org/2011/06/07/137020449/15-states-try-to-cut-back-on-medicaid-programs -[**]- "States Cutting Medicaid Benefits As They Stagger Under Economic Downturn" (at link) http://www.seniorjournal.com/NEWS/Medicaid/2010/20101004-StatesCuttingMedicaid.htm -[**]- I seriously doubt that should we suddenly release all those current in the state's penal institutions that it will do anything to increase state revenues to pay for Medicaid benefits. The social problems which would result from such action would probably exhaust much if not all of the savings. Poverty has more to do with it. The state's historic poverty rate has a lot to do with incarceration statistics and the lack of state funds to provide health and other services..

11) Comment by healthbudget - 06/11/2012

InPVille: Maybe we can start by not incarcerating the highest percentage of our population in the Country. The decision By Jindal to not sign on Obamacare for 3 years while one develops a credible business plan for the State's health budget is 1) stupid and 2) immoral

12) Comment by InPVille - 06/11/2012

@ Jay K. Kolls, MD: "The governor’s refusal of expanded Medicaid coverage and the current haphazard implementation of this wrong decision. . ." -[**]- I know for a fact that not too many years ago Louisiana subscribed to more Medicaid programs than any other state in the southern region. I doubt our ranking has significantly change. Louisiana had trouble finding the funds to pay our portion of the monies needed to receive federal matching funds then. There were several prominent stories in the news at the time about the state being caught by the feds using federal matching funds already received to pay the state's portion to receive even more federal funds. This was clearly prohibited by law. While unfortunate, during the current economic downturn and the available revenue decline which inevitably comes with such downturns, most states have found it necessary to cut funding for some programs. Medicaid and education are almost always two of them. As Medicaid and education are two of the largest revenues outlays a state has, it follows almost of necessity that these will be included when cuts must be made. This is even more true when the state constitution(stupidly I might add. . . but the people voted for it) forbids cutting spending in many other areas. Perhaps the good doctor can explain to the governor, legislature, and the rest of us the areas where funding should be cut instead.