Paul Levy

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Globe: Whopping $7M Settlement In Gender Bias Suit Against Hospital, Surgery Chief

Part of Beth Israel Deaconess Medical Center

Part of Beth Israel Deaconess Medical Center

The Boston Globe’s Liz Kowalczyk reports here:

In a striking settlement of a high-profile case, a Harvard doctor who said she endured years of sexist treatment at Beth Israel Deaconess Medical Center will collect $7 million — and will have the hospital’s pain clinic named in her ­honor.

Employment lawyers said the hospital’s settlement with Dr. Carol Warfield, its former chief of anesthesia, appears to be one of the largest for a gender discrimination case in Massachusetts. Ilene Sunshine, a lawyer who represents defendants in bias suits, said it seems “enormous,’’ though she pointed out that it is hard to compare because settlements usually remain confidential.

The agreement — in which the hospital and other defendants did not admit doing anything wrong — closes an embar­rassing stretch in the ­Harvard teaching hospital’s ­illustrious history.

Warfield, who became chief of anesthesia in 2000, said Dr. Josef Fischer, former surgery chief, discriminated against her because she is a woman, openly ignoring her in meetings and lobbying for her ­removal from her job. When she complained to Paul Levy, then chief executive, she ­alleged, both men retaliated against her and forced her out.

Readers, is this an anomaly or does it reflect significant cultural change? Surgeons have such a reputation as the arrogant cowboys of any hospital staff; is that truly changing? Does this suit send the message that it must? Read the full Globe story here.

Levy: A Duck Boat Rally? Really?

(photofarmer/flickr)

He may no longer be running a hospital. He may be one of the most controversial figures in local medical circles. But one thing you can’t accuse Paul Levy of is mincing words.

Here’s his latest: a blog post about, among other things, the new U.S. News & World Report hospital rankings, MGH’s ascent to the top of those rankings and a celebratory duck boat parade in an era of medical cost-cutting. Levy writes:

In response to a top ranking by U.S. News–a ranking that, as I have discussed, has virtually no probative value–a local hospital actually organized a celebratory parade of an amphibious tour boat (Duck Boat). In the past, such parades (admittedly more extensive) have been used to promote the championship seasons of local sporting teams (like the 2007 Red Sox, above), thereby giving fans a chance to yell and scream and applaud their athletic heroes.

Now, I am all for celebrating accomplishments. At my hospital, we, too, used to be happy about favorable media ratings, even if we knew they were fundamentally meaningless. But to spend thousands of dollars on a self-aggrandizing circuit (as well as on the right to use the US News logo in publicity) seems to me to reflect exactly the kind of behavior suggested by my friend. How does this kind of activity promote anything good or useful about the provision of high quality and safe health care in the community? Continue reading

Paul Levy: ‘When You Really Let Down Your Team’

The question arises now and then in health care circles: What’s Paul Levy up to these days?

Answer: The former chief of Beth Israel Deaconess Medical Center maintains his popular blog, once called “Running a Hospital” and now “Not Running a Hospital.” He speaks widely on improving hospital quality and safety. And he has just announced that the book he’s been working on is out: “Goal Play! Leadership Lessons From The Soccer Field.”

He writes:

It will come as no surprise to my readers that I have self-published this book, using Createspace.  That service provides a remarkable set of tools to any budding writer.  You can order the book here.  It will be available on Amazon in about a week.

Proceeds will go in part to the non-profit Massachusetts Youth Soccer GOALS program and he asks for feedback at goalplayleadership@gmail.com.

I confess: Though Paul Levy has many vivid and worthwhile lessons to share from his eight years running Beth Israel Deaconess, I immediately jumped to Chapter 9, titled “I’m sorry” and subtitled “What happens when you really let down your team?”

Paul Levy of "Not Running A Hospital"

After all, his last months at Beth Israel Deaconess were shadowed by a major scandal about his personal relationship with an employee, and though he was otherwise renowned for setting new standards of transparency, many of his readers felt he never gave a full enough account of what happened. Would he now?

I’d give that a qualified yes. If you’re hoping for juicy details, forget it, but he does acknowledge the mistake of “deciding, shortly after I became CEO, to hire a close personal female friend into a new position where she, first directly and later indirectly, reported to me.”

He describes the delayed fallout of that decision and how he handled it, but perhaps most interesting are the lessons he draws. Should there be a formal mechanism to save leaders from their natural tendency to have poor judgment about their own behavior or how it can be perceived? Yes, indeed. He writes: Continue reading

Paul Levy ‘Does The Math,’ Says New Partners Contracts Increase Disparity

Paul Levy of "Not Running A Hospital"

WBUR’s Martha Bebinger had a couple of follow-up questions for Paul Levy, former chief of Beth Israel Deaconess Medical Center and still a widely read blogger who, among a great many other topics, regularly takes Partners HealthCare to task for its high prices.

One of his latest posts discusses Partners’ recent renegotiation of its contracts with Blue Cross and Tufts Health Plan, touted in press releases as saving tens of millions of dollars. He writes that the new contracts will only increase the disparity between Partners’ prices and everyone else’s, and he calculates that over the last decade, Partners has added roughly $2 billion to health care costs paid by Massachusetts businesses and individuals.

Martha asked via email:

1)Why would the disparity between Partners HealthCare System rates and other providers increase under this contract?

2)How do you get the $2 billion figure?

And Paul Levy replied:

Simple math, Martha. Everyone else is getting rate increases of, at most, the same 2-3 percent. Many are getting below that. Since the base for the others was lower than PHS, the spread between the PHS rates and theirs has to be growing. Continue reading

Levy: Why Is Partners Acquiring Neighborhood Health Plan?

A day after Partners HealthCare announced it would take over Neighborhood Health Plan, the Boston-based nonprofit with 240,000 mostly low-income patients in government-subsized insurance plans, health policy insiders are abuzz with one question: Why?

Here’s a theory from Paul Levy, former CEO of Beth Isreal Deaconess Medical Center, posted on his blog:

I am speculating, of course, but there are two ways to look at this. One is that PHS is trying to lock in a set of relationships and customers for the future; but that doesn’t make sense because these patients are poorly reimbursed. Also, the company has promised that it will not use this new relationship to limit those patients’ choice of providers. So to make that work, it would have to develop new models of care that enable this group of patients to be profitable, notwithstanding Medicaid rates that are acknowledged to be too low. A worthy, but very hard row to hoe when you operate a high fixed cost network.

The other is that a trade has taken place, related to the fact that the holding company has been facing state and federal antitrust reviews. It agrees to provide some financial assurance to a financially stressed insurance company and community health centers serving mainly the indigent, in return for being allowed to keep other human resource or geographic assets that might otherwise be subject to a divestiture that would have reduced its market power.

Or maybe they just want to make sure care is accessible to everyone.

Any other theories out there? All are welcome.

Paul Levy: Partners’ ‘Chutzpah’ On $40M Donation

Former Beth Israel Deaconess chief Paul Levy

Paul Levy’s Not Running A Hospital blog is particularly punchy today.

So here, in its entirety, is his latest post. In it, he comments on a news story published in The Boston Globe this weekend. It suggested that Partners HealthCare, which had promised $40 million to help alleviate rising health care costs in the region, might pay out the money through renegotiated insurance contracts, rather than simply writing a check. (Partners posts clarification on its blog here, saying Partners “plans to pay the $40 million regardless of whether the talks with insurers produce results.”)

Here’s Paul’s post:

Chutzpah, timidity, prediction, policy
What do you call it when a hospital and physician system gets to collect an extra, say, $200 million per year in insurance payments for a decade and a half? What do you call it when that system promises a one-time donation of $40 million towards a crisis in individual and small business insurance premiums, but then says, “We didn’t necessarily mean cash” — but preferably a negotiated offset to a previously unspecified and unknowable level of future rates?

Chutzpah.

What do you call it when the Commonwealth has the legal authority to publicize the data it has already collected and to take actions to moderate the payments made by insurance companies to this hospital and physician system, but chooses not to?

Timidity.

What do you call this?

The parties agree to experiment with bundled payments for certain diseases and procedures, staying far away, though, from a full system of capitation. The parties agree to a general rate increase of just a few percent. Together, they will say, this will “bend the cost curve” for this large group of doctors and hospitals. There won’t be much talk about the fact that the base upon which the bundled payments and other fee-for-service payments is set remains far above market.

End result: Continued use of market power as the prime determinant in setting reimbursement rates.

A pretty accurate prediction.

What do you call it when all this is happening before our eyes?

Massachusetts health care policy.

Running A Hospital: Does A Doctor Make A Better Chief Executive?

Do doctors make better hospital CEO's? (Photo: CarbonNYC/flickr)

New research suggests that when a doctor (as opposed to a business manager) runs a hospital, it may help improve patient care and boost quality overall.

 

The New York Times reports:

The findings, published in the journal Social Science & Medicine, are based on a review of 300 top-ranked American hospitals in the specialties of cancer, digestive disorders and heart surgery. Amanda Goodall, a senior researcher at the Institute for the Study of Labor in Bonn, Germany, tracked the professional background of each hospital’s chief executive and then compared the performance of physician-run hospitals with that of hospitals overseen by someone with a nonmedical background.

The study found that overall hospital quality scores were about 25 percent higher when doctors ran the hospital, compared with other hospitals. For cancer care, doctor-run hospitals posted scores 33 percent higher.

Dr. Goodall said the finding was consistent with her research in other fields, which has shown, among other things, that research universities perform better when led by outstanding scholars and that basketball teams perform better when led by former top players.

All of this begs the local question: Should the new chief of Beth Israel Deaconess Medical Center be a doctor? Continue reading

Should Paul Levy Get Up To $1.6M As He Leaves Beth Israel?

Paul Levy

The Boston Globe reports here that outgoing Beth Israel Deaconess Medical Center chief and prominent blogger Paul Levy will receive up to $1.6 million — about two years’ salary — in severance in a “negotiated departure.” Sounds a little different from Paul Levy’s blog description of realizing as he biked through some North African mountains that running a hospital just wasn’t floating his boat anymore.

The Globe’s Liz Kowalczyk reports:

“The Board concluded that this agreement was in the best interest of the medical center and the people it serves …” board chairman Stephen Kay wrote in an e-mail to the hospital community this afternoon. “Just under two years before Paul’s contract would have expired, the Board of Directors has agreed with Paul on a negotiated departure.”

The e-mail suggests a more complicated scenario behind Levy’s departure than he and Kay described Jan. 7, the day Levy announced his resignation. At the time, Kay had said, “Paul wanted a change, there’s nothing more to it.”

In an e-mail to the Globe today, Kay elaborated on how the decision unfolded, after the board had completed Levy’s first comprehensive job evaluation. Kay said that when Levy returned from a vacation to Morocco, “I updated him on questions that had been raised about his level of engagement and I told him that recent performance reviews had been mixed.”

He “raised the question of whether it would be better for BIDMC if he stepped down,” Kay continued. “Initially, his suggestion took me off guard but soon I calculated that the medical center might be better served with a leader who did not take as a burden the day to day challenges of a ‘post turn-around’ institution.”

Did the scandal around Paul Levy’s relationship with a young mentee play a role in the decision by the hospital or its chief? Whether it did or not, that relationship is playing a role in the opprobrium heaped on the outgoing chief by some commenters on boston.com. But there are also defenders like this one:

Paul Levy has done more for BIDMC than most of you ignorant mutton heads have ever done in your careers. First, he reversed the hospital’s financial spiral. This was followed by him successfully navigating through our most recent recession by collaborating with all of the hospital employees to minimize job loss by temporarily reducing raises, vacation time, etc. Once the hospital’s finances stabilized, he returned all of the previous benefits lost as promised. By accounts of those that have worked in proximity to this man, he is an empathetic leader that strives for the good of the whole. Yes he made a mistake/err in judgment, but the ridiculous demonization of this man that positively affected so many people is disheartening.

Veronica Turner, the executive vice president of the state’s largest health care union, 1199SEIU, issued a statement saying in part: “The board should immediately rescind this agreement and return the money to the public charity of the hospital. Every year, BIDMC receives massive amounts of scarce public dollars.”

The payout “demonstrates Levy’s past statements about his departure as completely non-transparent, even duplicitous, and shows his willingness to take scarce public dollars for his own personal gain.”

Thoughts, anyone?

The Little Secrets Of Global Payments

How will specialists adapt to a system of global payments?

Nice piece on Paul Levy’s Not Running A Hospital blog today about the potential complexities of a global payment system and the current “religious dogma” that fee-for-service is evil while global budgets will solve the current crisis of escalating health care costs.

…let me let you in on a little secret with regard to capitated care. Underneath the global budget, there is still a fee-for-service arrangement establishing the transfer prices among the providers in a network. That GI specialist will still get paid for each colonoscopy. The big thing to work out in this system is the allocation of any surplus or deficit in the annual budget among the various specialists.

Unless that allocation is skewed heavily towards primary care doctors, decisions about the level of care given will not change. But, if the allocation is skewed too heavily towards the PCPs, there is no real income signal for the specialists, leading to a danger that they will not feel invested in the end result. Unless the system is accompanied by intensive, real-time reporting, along with clear penalties for excessive care, it will not work.

Did I say penalties? You bet. Without those, there is no enforcement of the global budget. But with those, global budgets are likely to raise hackles and resentment among specialists. I predict that the biggest issue facing physician groups in the coming years is the perceived interference by the global payment risk unit in the clinical decisions made by specialists.

Kevin MD Posts Paul Levy On Hospitals’ Unfair Market Power

CommonHealth note: Dear readers — We linked to this post by Paul Levy on Kevin MD today, but it has been called to our attention that it is actually an old piece, and was originally posted this summer. (Dr. Kevin Pho, aka, Kevin MD, explains why the post was up today: “I regularly post articles on my Twitter stream to reach back into my archives. They are with the is.gd link. New articles have links shortened with the goo.gl link,” he wrote in an email.

Still, we should have clarified the original date of the piece. So please accept our apologies. (For Levy’s current posts, see his new blog, Not Running A Hospital.)