There are weeks when I spend most of my time on the beach (my way of saying being retired) being a grandfather. The past week was one such week.

Instead of thinking deep thoughts about our purportedly wayward healthcare situation and putting the resultant thoughts into writing, I spent more time than usual with my grandchildren.  In many ways, that time spent is more satisfying than the years I spent as a healthcare system CEO.

Still, a few things caught my eye that are worthy of comment.  Kaiser Permanente, whose top management specializes in virtue seeking while spending other people’s money, received criticism this week for sponsoring “Thrive City” at the new home of the Golden State Warriors opening this September in San Francisco. I commented about this two weeks ago in “How Not To Spend Money”.  Normally, when Kaiser does these kinds of things, they escape criticism.  Not this time. About time someone in journalism woke up.

On Sunday the San Francisco Chronicle ran an article based upon some research they did on the amount of money Kaiser was committing to this virtuous project.  Kaiser had been steadfastly ignoring requests for the dollar amount.  According to the Chronicle, it may amount to as much as $295 million over a twenty-year period.  That’s a lot of virtue devoted to a fabulously rich basketball team by a nonprofit health plan. I want some.  Any.

Earlier this year, Kaiser committed to another virtuous project to the tune of $200 million to help with the homeless problem in areas where they have facilities.  The homeless problem is real but is this commitment of resources what the purchasers of Kaiser health insurance want to pay for?  I doubt it.

Keeping on the Kaiser theme, the June 17 issue of “Modern Healthcare” contained a brief item regarding Kaiser’s displeasure with a healthcare system in Honolulu which was planning to bill directly Kaiser patients who used its emergency service now that its contract with Kaiser has expired. The nerve!

The thrivers at Kaiser were upset because, well, just because. Kaiser wants to pay the healthcare system what Kaiser considers an “usual and customary rate” for its members and does not want its members directly billed.  Put another way, Kaiser wants to determine what it should pay when another healthcare system helps it thrive.  Kind of like going into a grocery store and telling them what price you will pay for a loaf of bread.

Sound familiar?  I wrote about a similar situation in California in “Chumps” in February.  I related how NorthBay Healthcare had won a legal judgement against Blue Shield in a similar situation and how NorthBay and other providers in California were proceeding in similar fashion against Kaiser.  Everyone deserves to thrive.

So, let’s sum up the situation. So far this year Kaiser has committed almost half a billion dollars for virtuous actions unrelated to the direct provision of healthcare, sticking that bill to the public and private employers who buy health insurance from them.  At the same time, they expect other providers to subsidize these wonderful endeavors by gratefully accepting what Kaiser wishes to pay for services provided to their members.

What a deal!  This is why being a grandfather makes more sense sometimes than being in healthcare.

P.S.:  The thrivers also announced last week plans to build a new $900 million headquarters in Oakland.  It’s good to be the king or at least a virtuous thriver. That makes almost $1.5 billion dollars in non-healthcare  spending so far this year.  Hope those paying health insurance premiums take note.

“Get your facts first, then you can distort them as you please.”

Mark Twain

I was listening to a travel podcast recently about President Trump’s decision to immediately stop visits to Cuba by Americans. The podcast hosts were very upset and one said that the immediate impact would be on 800,000 passengers who had booked a cruise which included Cuba as part of the itinerary. That caught my notice.

I am not interested in the politics of the decision. I am interested in the cavalier use of statistics to make a point. There is no way that 800,000 cruise ship passengers will be affected by this decision. Given the number of ships calling on Cuba this year and their size, that is a dubious number.

We see this same careless use of statistics in healthcare where the stakes for being wrong far outweighs that of a disappointed passenger. Careless use of statistics means resources may be wrongly deployed to everyone’s detriment.

For instance, take the Institute of Medicine’s 1999 report, “To Err Is Human”. The report was a shocker with its estimate that between 44,000 and 98,000 people a year died in hospitals as the result of medical errors. Even one such death is one too many.

That report resulted in a great deal of concern as it should have. Hospitals and medical professionals made changes in care including things as simple as being more diligent about hand washing between caring for patients. That effort continued as incentives both positive and negative were created by the government and others. No one I knew in healthcare was happy about the idea of patients needlessly suffering or dying.

Fast forward now fourteen years to 2013 when the Journal of Patient Safety published an article estimating that there were between 210,000 and 440,000 hospital deaths due to medical errors. All the efforts to decrease the number of preventable deaths noted by the Institute of Medicine in 1999 seemed to have had no impact at all. It was discouraging. There was a question which should have been asked: What gives?

Two years later in 2015 the Leap Frog organization, which attempts to give hospitals letter grades for quality using a problematic methodology, estimated that there were 205,000 preventable deaths in hospitals. That was followed three years later by another estimate by Leap Frog of 160,000 preventable deaths. Again, I have to ask the question, what gives?

The common thread to all these statistics is this word: “estimate”. That is a word which needs clarification by the people issuing these reports. The words “estimate” and “estimated” could simply be another way of saying we don’t know.

Estimates are not facts; they are guesses. In baseball, no one says that Buster Posey’s batting average is estimated as being .294. Should we not expect a more rigorous committment to facts and statistics in healthcare when dealing with important matters?

When you have a range from 44,000 to 440,000 deaths, you have a lack of preciseness which is troubling. Furthermore, when the estimates increase significantly after a decade of process improvements directed at reducing such deaths, you have to wonder whether the report issuers have their own error problems. Or maybe they are just lousy estimators.

I certainly knew during my career as a healthcare system CEO and a board member of a risk retention company providing professional liability insurance of medical errors which led to needless suffering and/or deaths. There is no defense for any such occurrence and every and all effort should be made to eliminate the errors. There were too many such errors.

We have a problem but we do not know exactly how big a problem it is. We need more than just estimates if we are going to be able to measure how effective we are in reducing preventable deaths to zero. Of equal concern is we don’t know how many faulty “estimates” are being used in other areas of healthcare to drive decision making in important areas. Perhaps there is a need for a report on “To Estimate Is Human”.

Now that I have been on the beach for over two years I find myself beginning to question certain practices by healthcare providers.  Things that made sense to me when I was in an office rather than on the beach no longer make sense.

For instance, for some reason I have been attending University of California football games in Berkeley for over 50 years.  It is certainly not for the thrill of victory which seldom occurs.  In a sorry commentary, Cal fans were ecstatic last season when we won just enough games to be invited to the “Cheez-It Bowl”.  The Rose Bowl for Cal fans is the impossible dream.

Cal football games in recent years have been a further source of aggravation since Sutter Health, a competitor to NorthBay Healthcare, is an official sponsor of the football program and their logo is plastered around the stadium.  Losing football games is apparently not aggravation enough.

Sutter Health is also the official sponsor of the Oakland As baseball team which makes me happy that I am a lifelong San Francisco Giants fan.  Of course, Dignity Health is the “official health care provider” of the San Francisco Giants so if these two teams ever again compete against each other in the World Series, not likely this year, it will be Sutter versus Dignity.    May the best healthcare system win.

Recently announced deals have  moved beyond just plastering logos around stadiums. Whole geographic areas are being given new names.  Kaiser has struck a multi-year, multi-million dollar deal with the Golden State Warriors to name an 11 acre area around their new Chase Center Arena in San Francisco “Thrive City”.  I suspect the deprived homeless in the neighborhood will not be welcomed to pitch their tents in that swanky area.

Similarly, Dignity Health has struck a deal with the Los Angeles Galaxy soccer team to name their stadium “Dignity Health Sports Park”.  Now that Dignity has merged with Catholic Health Initiatives to form CommonSpirit Health, will they change the stadium’s name?  Hopefully, the team will play with a degree of dignity and commonspirit and there will be no flopping on the field at the first sign of contact. Many soccer players act more like gymnasts than “footballers”.

All these activities are usually deemed “community benefits” which is an obligation nonprofit organizations have to justify their tax exempt status.  The large system CEOs prattle on about how spending this money aids the community, not to mention the sport teams owned by fabulously rich individuals.  That’s hogwash.  They just want to make sure they have good seats at the games.

Nonprofit healthcare organizations should not be adding to the bottom lines of well off sports teams and they certainly should not be pretending anyone else benefits from their largess other than the sport moguls. Shame on them.

It is not just the big guys who get involved in these expensive deals.  Many smaller healthcare organizations sponsor events or other activities which are at best tangentially related to their missions.  The cost of these deals are proportionately less but still significant.

Viewing these activities from the beach I have to wonder whether the money could be better spent.  Should  sick people really have to bear the expense of these vanity activities?  Could the money be better spent on free vaccination clinics or free sport examinations for high school athletes?

I can hear the protests from the healthcare organizations which inappropriately devote their resources to non-healthcare uses. It is a branding effort they will say as if the fans really care. No, it is just a fun way to waste other people’s (patients) money.

I have no problem with advertising to the public about the services a healthcare organization has to offer.  I consider that a legitimate expense and a worthwhile endeavor. Similarly, any effort by healthcare providers to educate the public about healthcare concerns through publications, health fairs and the like should be encouraged. There is a benefit to that.

Spending millions of dollars over multiple years on what are essentially corporate vanity efforts is not defensible.   The next time you hear about layoffs by a healthcare system or the closing of a service or the increase in health plan insurance premiums, ask yourself if perhaps Thrive City should close instead.

From where I sit on the beach, healthcare providers lose credibility when they spend money this way.