$1 Billion Donation Eliminates Tuition at Albert Einstein Medical School

Albert Einstein College of Medicine in the Bronx joins NYU Grossman School of Medicine in becoming tuition free. Einstein’s tuition was eliminated by a $1 billion donor gift from Ruth Gottesman EdD (1). Dr. Gottesman, a retired clinical Professor Emeritus of Pediatrics (Developmental Medicine) at Einstein, has been a specialist in learning disabilities at the school since 1968 and is currently Chair of the Einstein Board of Trustees and also serves on the Montefiore Health System board. Announced to the cheers of the assembled student body, Dr. Gottesman announced that beginning in August, tuition will be free "in perpetuity". Tuition at the school is nearly $59,000 per year, leaving nearly 50% of the students owing more than $200,000 after graduating.

Dr. Gottesman’s fortune came from her husband, David "Sandy" Gottesman an early investor in Omaha, Nebraska-based Berkshire Hathaway, Warren Buffet's multinational conglomerate. Mr. Gottesman died in September 2022 at the age of 96 leaving his widow with a large stock portfolio and instructions to “do whatever you think is right with it”.

The gift evolved from Dr. Gottesman’s close friendship with Dr. Philip Ozuah, the pediatrician who oversees the medical college and its affiliated hospital, Montefiore Medical Center (Figure 1).

Figure 1. Dr. Philip Ozuah and Dr. Ruth Gottesman.

In early 2020, the two sat next to each other on a 6 a.m. flight to West Palm Beach, Fla. It was the first time they had spent hours together. They spoke about their childhoods — hers in Baltimore, his, some 30 years later, in Nigeria — and what they had in common. Both had doctorates in education and had spent their careers at the same institution in the Bronx, helping children and families in need. During the COVID-19 pandemic, Dr. Gottesman’s husband became ill with the virus. In the weeks that followed, Dr. Ozuah began making daily house calls — in full protective gear — to check in on the couple as Mr. Gottesman recovered.

Dr. Gottesman and Dr. Ozuah’s friendship and his commitment to assisting his patients even in threatening times likely led Dr. Gottesman to her amazing contribution. Dr. Gottesman said that not only would future students be able to embark on their careers without the debt burden, but she hoped that her donation would also enable a wider pool of aspiring doctors to apply to medical school. “We have terrific medical students, but this will open it up for many other students whose economic status is such that they wouldn’t even think about going to medical school,” she said.

Richard A. Robbins MD

Editor, SWJPCCS

Reference

1. Goldstein J. $1 Billion Donation Will Provide Free Tuition at a Bronx Medical School. NY Times. February 26, 2024. Available at: https://www.nytimes.com/2024/02/26/nyregion/albert-einstein-college-medicine-bronx-donation.html (accessed 2/27/24).

Cite as: Robbins RA. $1 Billion Donation Eliminates Tuition at Albert Einstein Medical School. Southwest J Pulm Crit Care Sleep. 2024;28(2):24-25. doi: https://doi.org/10.13175/swjpccs011-24 PDF

Kern County Hospital Authority Accused of Overpaying for Executive Services

Becker’s Hospital Review is reporting that the Bakersfield, CA-based Kern County Hospital Authority, is accused by the local employee union of overpaying two private firms that provide its top executives (1). The union alleges that Cantu Management Group and Meridian Healthcare Partners - both based in Bakersfield - have exceeded contractual amounts by 40 percent to 147 percent, leading to $23 million in overpayments over the past four years. Andrew Cantu of Cantu Management Group is also the CFO of Kern County Hospital Authority and its management representative for independent audits. Russell Judd served as the hospital's CEO until December 2021, and remains president and owner of Meridian Healthcare Partners.

A 9-page report alleges the hospital failed to disclose management compensation accurately, to properly correct the issue when notified,  and attempted to conceal the overpayments.  The union claims to have repeatedly brought questions about the hospital's financial management to the hospital and received "no substantive response." The union hired Scott McHone, a certified forensic accountant, to better understand the financials alongside their investigative team.

The union report indicates that Meridian Healthcare Partners was overpaid. Mr. McHone and the investigative team found that invoices filed with the California Department of Health Care Access and Information show the hospital paid the firm $39.9 million, although the union says the invoices it received documented only $19.3 million. The day after the union requested these payment records, the hospital's legal department took action to remove Meridian's name from financial disclosures, according to the report.

Kern County Hospital Authority denies all allegations. The hospital further stated that the services offered have been beneficial to patients, but did not directly comment on the compensation discrepancies.

Richard A. Robbins MD

Editor, Southwest Journal of Pulmonary, Critical Care & Sleep

Reference

1. Kayser A. California Hospital Accused of Overpaying for Executive Services. Becker’s Hospital Review. June 28, 2023. Available at: https://www.beckershospitalreview.com/compensation-issues/california-hospital-accused-of-overpaying-for-executive-services.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6133H6750001J5K

Cite as: Robbins RA. Kern County Hospital Authority Accused of Overpaying for Executive Services. Southwest J Pulm Crit Care Sleep. 2023;27(1):7. doi: https://doi.org/10.13175/swjpccs029-23 PDF

SWJPCCS Associate Editor has Essay on Reining in Air Pollution Published in NY Times

Dr. Dona Upson

Dona Upson MD, an associate editor of the SWJPCCS from Albuquerque, recently had a Guest Essay published in the NY Times (1). In the opinion piece titled “The Government Is This Close to Reining in Some of the Worst Air Pollution” Dr. Upson states that the science is clear that when oil and gas are extracted and transported from wells, methane and other pollutants, including volatile organic compounds, leak out. These form ozone and may exacerbate asthma and COPD, cause cancer and birth defects, and affect the nervous system. Emissions from oil and gas production also produce nitrogen oxides, which can exacerbate lung disease. Methane is also a powerful greenhouse gas, over 80 times more potent than carbon dioxide in its warming power, though its life span in the atmosphere is much shorter. One of the fastest and cheapest ways to reduce these emissions and improve health is to prevent methane leaks, venting and flares, which would also go a long way in reducing ozone pollution.

According to Dr. Upson the federal government has a huge opportunity to reduce methane emissions, improve health and slow climate change. The first and most important way is through a rule proposed by the Environmental Protection Agency (EPA) to cut pollution, including methane, from new and existing oil and gas operations nationwide. Outside of the EPA the Bureau of Land Management has proposed a rule to limit venting, flaring and leaks of natural gas on public lands. Dr. Upson argues in her essay for support of both these rules.

Reference

1. Upson DJ. The Government Is This Close to Reining in Some of the Worst Air Pollution. NY Times. March 14, 2023. Available at: https://www.nytimes.com/2023/03/14/opinion/air-pollution-oil-gas-methane.html?unlocked_article_code=LsW56AyPBUFnQsdIIrFwy1HaNHxISpGdOo0FpzCnqqqP1YfKdSWQWrYoynSV01-SQEQyrA5w2wi-sVQGEROE0EwLWjE-3BChLi8DB4Oe5oxhLRyMnMMG7MpddaOr7EGGc_U-aqOX8XbiFd65ISJze9VOeElVgCqstnghXBz6Q2-H0DE1GBXPOniX-vrTep6gnAwAykHSM8zOkCBLmW95ctQT6HSKVyDO9ucEUFkvD_3njOYXmq6eCS4ZajhnvvO02qZQ2kUnw8E8bu72-MBdexXamik2wvUkk7gtc_nJMaVWhHiBLWGV33W2EE635C8xGF9TLtA0MvjDNm4mdYsq1-iP6O4Jqkw&smid=em-share (accessed 3/28/23).//

Cite as: Robbins RA. SWJPCCS Associate Editor has Essay on Reining in Air Pollution Published in NY Times. Southwest J Pulm Crit Care Sleep. 2023;26(4):59-60. doi: https://doi.org/10.13175/swjpccs017-23 PDF

Amazon Launches New Messaged-Based Virtual Healthcare Service

A story in Medscape came at an opportune time yesterday (1). The article announced that Amazon had launched its latest version of virtual medical care on Tuesday, November 15, in 32 states. Called Amazon Clinic, the service omits phone and video calls but instead works through secure messaging between patients and providers. Just after finishing the story, my daughter called and wanted to know if she could buy antibiotic containing eye drops over the counter. She says that she has had “pink eye” (conjunctivitis) for about 2 weeks. Her symptoms of itchy, red eyes without discharge were mostly relieved by an over-the-counter tetrahydrozoline HCl 0.05% drops (Visine). She did not want to go to an emergency room for such a minor issue and had a demanding schedule the following day making a doctor’s appointment difficult.  I told her she probably had a viral conjunctivitis but suggested that she could try the virtual clinic since she lives in a state where the Amazon virtual clinic is available. She did contact them and below she reports her experience.

After signing into her Amazon account, she did not have a “Clinic” selection on the banner at the top of her Amazon home page. She searched Amazon using “Amazon clinic” and a page popped up directing her to the appropriate website. After selecting a diagnosis (“pink eye”), she spent about 15 minutes filling out forms which asked demographic information as well a brief history of her present illness, past medical history, and previous therapies. She also took a “selfie” as well as a photo of her driver’s license. Within about 10 minutes she heard back from a nurse practitioner and a prescription was called into a pharmacy of her choice. She was extremely pleased with the service which saved her time and only cost $35.

The service is intended for straightforward health needs in patients under 65. The virtual clinic services a list of 18 common conditions including asthma and smoking cessation. Patients with 5 established conditions (asthma, hypertension, hyperlipidemia, hypothyroidism, and migraine) can also seek medication refills. The service does not accept insurance and works on a fee basis that includes follow-up messages with providers for up to 2 weeks. After paying Amazon directly, patients can submit receipts for reimbursement by their insurer if they have one. Visit costs vary by state, condition type, and provider. Wait times for receiving a first response from a provider are also published.

The service is not available in Arizona but is in each Arizona-bordering state as well as Hawaii. Amazon's venture into health care is evolving. It offers a pharmacy service but this would have taken 4 days to have the prescription delivered in my daughter’s case. Amazon plans to shut down its telehealth service known as Amazon Care by the end of the year but recently signed a deal to acquire One Medical's telehealth service and brick-and-mortar primary care clinics according to Becker's Hospital Review (2).

Richard A. Robbins MD

Editor, SWJPCCS

References

1. O’Mary L. Amazon Launches Messaged-Based Virtual Healthcare Service. Medscape Business of Medicine. November 15, 2022. Available at: https://www.medscape.com/viewarticle/984089?src=WNL_bom_221120_MSCPEDIT&uac=9273DT&impID=4885555 (accessed 11/20/22).
2. Naomi Diaz N. - "Healthcare seen as safe bet in Amazon's cost-cutting review. Becker's Hospital Review. Thursday, November 10th, 2022. Available at: https://www.beckershospitalreview.com/disruptors/healthcare-seen-as-safe-bet-in-amazon-s-cost-cutting-review.html (accessed 11/20/22).

Cite as: Robbins RA. Amazon Launches New Messaged-Based Virtual Healthcare Service. Southwest J Pulm Crit Care Sleep. 2022;25(5):90-91. doi: https://doi.org/10.13175/swjpccs053-22 PDF

Hospitals Say They Lose Money on Medicare Patients but Make Millions

The VA patient waiting scandal in Phoenix is well documented. What is also well documented is that at least 70% of VA medical centers were engaged in similar schemes. Now a report prepared for the North Carolina State Treasurer’s Office revealed that many state hospitals and lobbyists are also guilty of misrepresentation.  The hospitals did not lose billions of dollars on Medicare patients as they previously claimed, but in fact made large profits from 2015 to 2020 (1).

“What we’re seeing is the biggest transfer of wealth in my lifetime in North Carolina,” North Carolina state Treasurer Dale Folwell said at a press conference on Oct. 25. “It’s a transfer of wealth especially from lower fixed-income people to these big multibillion-dollar corporations who disguise themselves as nonprofits”(2). “North Carolina hospital lobbyists claimed they lost $3.1 billion on Medicare in 2020—the same year hospitals reaped $87 million in Medicare profits,” North Carolina State Health Plan (NCSHP) stated (2). NCHSP said North Carolina hospitals charge privately insured patients 280 percent of Medicare, which forces patients and employers to pay thousands of dollars more for medical care. A range of 55 to 66 percent of more than 100 hospitals profited off Medicare from 2015 through 2020 in North Carolina, the report stated. “While many hospitals’ margins fluctuated, only 15 hospitals consistently lost money on Medicare, and 35 hospitals posted profits over all six years,” the report said (1). North Carolina ranked sixth overall in the states with the most profitable Medicare margins for five of those years, averaging between -0.3 percent and 2.5 percent Medicare margins, the report stated. Arizona ranked 13^th.

“This raises serious concerns over hospitals’ commitment to their patients and their charitable mission, and the steep costs passed on to nearly 740,000 members of the State Health Plan,” the state treasurer’s office said in a press release (2). “The hospital cartel is overcharging you because they can, not because they need to,” Folwell said, adding that hospitals have been hiding behind Medicare, claiming huge losses to justify “kneecapping” their patients (2). “This is the Wild West,” Folwell said. “Nobody’s watching it. Nobody’s holding them accountable. We need a commitment from the cartel to get back to their original mission and to stop putting profits over patients.”

Despite this statement, many researchers have found that billions have poured into hospitals through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES act created the Centers for Medicare and Medicaid reimbursement plan that allowed for hospitals that adhered to protocols for treating COVID-19 to reap up to $500,000 per patient, beginning with a positive COVID-19 test, the use of a National Institutes of Health-approved antiviral drug called remdesivir, putting the patient on a ventilator, and ending with the hospital listing COVID-19 as the cause of death on a death certificate. According to a report from TN Liberty Network, an independent think tank comprising 28 researchers, hospitals have taken lucrative payoffs from the federal government throughout the last several years (3).

In addition to the CARES Act, the Coronavirus Response and Relief Supplemental Appropriations Act provided another $178 billion in relief funds to health care providers and hospitals, with more relief funds siphoned to states from the American Rescue Plan Act beginning in March of 2021, $8.5 billion of which went to health care providers.

The North Carolina Healthcare Association (NCHA) responded to the report, stating that “Instead of bringing transparency and clarity to the public, Treasurer Folwell has created an incomplete and complicated report that fails to address how he will provide more affordable healthcare to state employees and retirees,” NCHA said. “North Carolinians deserve truthful and transparent information. This report fails to deliver it.” (2).

References

1. North Carolina State Health Plan For Teachers And State Employees, Rice University’s Baker Institute For Public Policy, and the University Of Southern California’s Sol Price School Of Public Policy. Overcharged North Carolina Hospitals Profit on Medicare. 2022. Available at: https://www.shpnc.org/media/3011/download?attachment (accessed 10/29/22).
2. McGregor M. North Carolina Treasurer’s Office Says Hospitals Reaping Billions from Medicare Despite Claiming Otherwise. Epoch Times. October 28, 2022. Available at: https://www.theepochtimes.com/north-carolina-treasurers-office-says-hospitals-reaping-billions-from-medicare-despite-claiming-otherwise_4824332.html (accessed 10/29/22).
3. DePriest AJ. Blood Money in U.S. Healthcare. Financial Incentives: The Use of “Covered Countermeasures”. TN Liberty Network. August 8, 2022. Available at: https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:a22410b7-3189-4a4a-b59a-50bdfb023de9 (accessed 10/29/22).

Cite as: Robbins RA. Hospitals Say They Lose Money on Medicare Patients but Make Millions. Southwest J Pulm Crit Care Sleep. 2022;25(4):59-60. doi: https://doi.org/10.13175/swjpccs050-22 PDF