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Thursday, June 3, 2021

Nothing personal, just bidness. Pillaging Hahnemann

Fine piece of writing by Chris Pomorski in The New Yorker.
Hospitals in the U.S. are estimated to be closing at a rate of about thirty a year. Most closures happen for financial reasons, in places where there are relatively few privately insured patients. Increasingly, hospitals are regarded as businesses like any other: at least a fifth of hospitals are now run for profit, and, globally, private-equity investment in health care has tripled since 2015; last year, some sixty-six billion dollars was spent on acquisitions. The industry’s movement into health care has been linked to price hikes, an increase in unnecessary procedures, and the destabilization of health-care networks.
The bad actors of private equity are sometimes accused of destroying American health care. But they are more symptoms than disease…

Philadelphia is one of the poorest big cities in the United States, with about a quarter of its 1.6 million residents living below the poverty line. Since 1977, when Philadelphia General closed, it has also been the largest American city without a public hospital. Hahnemann, with nearly five hundred beds, occupied a city block on the edge of North Philadelphia, an area that includes several impoverished neighborhoods. A majority of the more than fifty thousand patients that the hospital treated each year had publicly funded medical insurance or none at all; two-thirds were Black or Hispanic.

Because Hahnemann treated so many poor patients, it had significant financial difficulties. But patient outcomes rivalled those of practically any hospital in the country, and the people who worked there were driven by a sense of mission. “The doctors at Hahnemann were there because they wanted to be there,” Logio said. “Hahnemann took care of the people that no one else wanted to take care of...”
This is a great read, about 40 minutes worth. It should piss you off. It did me.
I first came to the healthcare space 28 years ago in 1993, initially as a Nevada hospitalizations outcomes analyst for the then- CMMS nonprofit Peer Review (pdf) contractor for the state. While the focus of my eventual 3 tenures with them was on the technical side (acute care outcomes, cultural disparities mitigation, workflow, and electronic medical records systems), I have also given much ongoing attention to the ECON / Business side of things. I did my first grad school paper on an argument analysis of the 1994 JAMA-published "Single Payer" proposal (pdf).

I recall briefly encountering news of Hahnemann last year during the cacophony of pandemic news coverage last year (Philly running short of Covid19 bed space).

Chris has completed the larger picture for me in BP-raising detail. This place was looted for profit.
In Philadelphia, as elsewhere across the country, people of color have borne the brunt of the coronavirus pandemic. In March, 2020, city officials entered negotiations with Freedman to reopen Hahnemann to house covid patients during an anticipated surge. But Freedman asked for more than four hundred thousand dollars a month to lease the facility—a rate that he said was “very reasonable.” The talks quickly broke down. Responsibility for the care of coronavirus patients fell heavily on the remaining hospitals in the area, including Temple, which converted a seven-story pavilion to a coronavirus clinic, and erected a tent outside the E.R. There have been some hundred and fifty thousand confirmed infections in the city, and more than thirty-six hundred deaths...
Read it. Listen to the companion Audm audio transcript. Excellent. Read Chris's other stuff as well. Very nice.

(Dang, my Parkinson's is giving me hell today...)


From an Intercept story last year:
Joel Freedman, who shuttered Philadelphia’s Hahnemann University Hospital in September, could benefit from a provision that favors real estate investors.

...HAHNEMANN, WHICH HAD served the city’s poorest and most critically ill residents since 1848, was acquired in 2018 by a subsidiary of American Academic Health System LLC, of which Freedman is the founder and chief executive officer. That subsidiary, Philadelphia Academic Health Systems, filed for bankruptcy in June. Freedman said Hahnemann had been losing millions of dollars a month, but the hospital’s real estate was not included in the bankruptcy filing. Rather, it was redistributed to another of Freedman’s companies, Broad Street Health Care Properties.

Under the federal stimulus, which passed unanimously in the Senate and by a voice vote in the House, corporations and businesses will still see the bulk of dollars allocated, while workers get modest increases in unemployment benefits and a one-time check of up to $1,200 per individual. At least one provision benefitting real estate investors, which increases the amount of nonbusiness income and capital gains they can protect from taxation, could result in tax breaks up to $170 billion over 10 years.

“That group comprises the top 1 percent of taxpayers, according to Internal Revenue Service data,” the New York Times reported. “The result is that people can enjoy big tax breaks stemming from only-on-paper losses, even if they enjoy big cash profits in the real world…”
Is this a great country, or what?
Neurobiology meets AI.
“We are all well-trained neural networks, but our brains come with a history track, as do ANNs. New information is not stored independent of other safely stored information content. Instead, any new bit of information is processed in the context of the entire history of the network. The same experience means something different for every individual. And the better the information is aligned with previous experiences, the easier it is for the network to “believe” the new arrival. This simple thought has some interesting consequences for the concept of cognitive bias: in a network built on algorithmic growth, bias is a feature, not a bug of the system, whether we like it or not.”

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