healthy4u: Lifespan

$100 million Epic install dampens Lifespan Rhode Island Healthcare's credit

Lifespan Rhode Island Healthcare System's Siemens EHR was apparently causing thousands of electronically-generated prescriptions to become scrambled, as I posted in Nov. 2011 here: <a href="http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html">http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html</a>. Due to this "glitch" - and other factors, I surmise - they switched to Epic. Here are the current results: <blockquote class="tr_bq">$100 million Epic install dampens Lifespan's credit <a href="http://www.modernhealthcare.com/article/20140606/NEWS/306069948">http://www.modernhealthcare.com/article/20140606/NEWS/306069948</a> By <a href="mailto:bherman@modernhealthcare.com">Bob Herman</a> <div class="mh_body_12px">Posted: June 6, 2014 - 5:45 pm ET</div> A multimillion-dollar <a href="http://www.modernhealthcare.com/section/articles?tagID=975">electronic health-record</a> system installation is eroding the cash flow, and bond rating, of Rhode Island's largest health system. Moody's Investors Service downgraded the rating of <a href="http://www.modernhealthcare.com/section/articles?tagID=2479">Lifespan</a>, Providence, R.I., to Baa2—only two notches away from junk-level status. The ratings agency also <a href="https://www.moodys.com/research/Moodys-downgrades-Lifespan-Rhode-Island-Obligated-Group-RI-to-Baa2--PR_300980">gave the system</a>, which operates four acute-care hospitals and one children's hospital, a negative outlook. ... At the heart of the downgrade is Lifespan's new health IT system. In March 2013, Lifespan chose to implement an Epic platform, a system spokeswoman said. Lifespan expects to go live with Epic's EHR by the spring of 2015. Moody's analysts noted the investment will cost $35 million this year and $100 million total over the next several years. This has slammed Lifespan's operating performance, Moody's analysts wrote. Lifespan is projecting a 2.8% operating cash flow margin for fiscal 2014, which is far below the Baa2 median of 8.8%. The operating margin is predicted to hover around -1.7%. And it's not likely to get better soon—executives told Moody's they don't expect to post improved results until 2016. “The thin performance provides little cushion during a period of increased capital spending and the installation of a new IT system with short-term implementation risks that could disrupt cash flow,” the report said</blockquote> They're a year from going "live" and they've already damaged their financials.  (This does not account for the losses from abandoning an older system.) $100 million is not an unusual cost for a commercial EHR, as I noted elsewhere, e.g., <a href="http://hcrenewal.blogspot.com/2006/10/70-million-for-electronic-medical.html">http://hcrenewal.blogspot.com/2006/10/70-million-for-electronic-medical.html</a>.  An entire hospital or large hospital wing can be built with that much money...not to mention the hiring of quite a lot of human health information management professionals. Hospital executives have bought the "EHRs will save massive amounts of money, eliminate medical errors, and heal the sick" marketing hype hook, line and sinker (as opposed to the more sober "improve healthcare somewhat when implemented expertly").  They are so eager to have this unregulated technology, NOW, that they will place their organizations - and patients - into jeopardy to get it. (As to patient risk, see <a href="http://hcrenewal.blogspot.com/2014/04/fda-on-health-it-risk-reckless-or.html">http://hcrenewal.blogspot.com/2014/04/fda-on-health-it-risk-reckless-or.html</a> and its hyperlinks). I find this phenomenon stunning, and even more so the cognitive dissonance and refusal to believe the actual evidence when the starry-eyed predictions of Cybernetic Medical Nirvana just don't come true. -- SS

$100 million Epic install dampens Lifespan Rhode Island Healthcare's credit

Lifespan Rhode Island Healthcare System's Siemens EHR was apparently causing thousands of electronically-generated prescriptions to beco...

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Lifespan (Rhode Island): Yet another health IT "glitch" affecting thousands - that, of course, caused no patient harm that they know of - yet

There's been yet another health IT "glitch" that, of course, caused no patients to be harmed. See other "glitches" <a href="http://hcrenewal.blogspot.com/2011/05/twelve-hour-health-it-glitch-at.html" style="font-weight: bold;">here</a>, <a href="http://hcrenewal.blogspot.com/2011/01/orderless-in-seattle-software-glitch.html" style="font-weight: bold;">here</a>, <a href="http://hcrenewal.blogspot.com/2010/03/will-it-take-luminosity-of-dozen.html" style="font-weight: bold;">here</a> and at other posts which can be found by searching this blog on the banal term 'glitch'. I note that when a clinician makes a mistake, it's called "malpractice." When health IT causes errors that can injure or kill, it's commonly referred with the banal, now-standard euphemism for computing malpractice: <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjivTnAMIjZskLX87kQCR-LOWelEzDEUzupVGbOaKKCNKfoQe3kVzfxxERhVQOn9TIenOfKan-gR82Ogh9aqBulFgBlwHxLj2qCFmPiVm2j7sRFcyZRcO8vEFZfhsbqSGkn4802s3h9mfDF/s1600/glitch-mmo.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5671179020595590226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjivTnAMIjZskLX87kQCR-LOWelEzDEUzupVGbOaKKCNKfoQe3kVzfxxERhVQOn9TIenOfKan-gR82Ogh9aqBulFgBlwHxLj2qCFmPiVm2j7sRFcyZRcO8vEFZfhsbqSGkn4802s3h9mfDF/s320/glitch-mmo.jpg" style="cursor: pointer; display: block; height: 90px; margin: 0px auto 10px; text-align: center; width: 180px;" /></a></div> Presenting the latest healthcare IT "glitch", affecting thousands: <blockquote><a href="http://www.wpri.com/dpp/news/local_news/providence/providence-rhode-island-state-senator-jamie-daniels-calls-for-review-of-lifespan-after-medical-errors">Computer glitch led patients to receive wrong meds</a> Senator calls for review of Lifespan WPRI.com (Providence, RI) Updated: Thursday, 03 Nov 2011, 5:47 AM EDT Published : Wednesday, 02 Nov 2011, 11:56 PM EDT Reported by Steve Nielsen PROVIDENCE, R.I. (WPRI) - Rhode Island State Senator Jamie Doyle says he is shocked to hear a <a href="http://www.lifespan.org/">Lifespan</a> computer glitch caused thousands of patients to receive the wrong types of medication. [Appx. 2,000 across five Lifespan hospitals according to the Providence Journal, see below, and the <a href="http://www.washingtonpost.com/business/ri-senator-wants-investigation-after-up-to-2000-hospital-patients-got-wrong-form-of-medicine/2011/11/03/gIQAufcviM_story.html">WaPo</a> - ed.] Doyle is now calling for an independent review of all the hospitals Lifespan runs, and a review of the Rhode Island Department of Health. The DOH is investigating after learning patients who were supposed to receive medications taken once a day instead received medications meant to be taken more than once per day.</blockquote> Health IT, of course, is unregulated by FDA or anyone, and vetted for safety only so far as the seller wishes to spend money on such tasks - which cuts their margins.  Ultimately, debugging is on live patients. <blockquote>[11/5/2011 note: As an anonymous commenter pointed out, the 2,000 or so errors at Lifespan should probably be multiplied by the number of organizations using the same software ---> "The entire country may have suffered 25,000-50,000 errors from this one glitch alone", the commenter astutely notes - ed.]</blockquote> Of course, the customary "we did feel lucky today, and the gun was empty" disclaimer follows: <blockquote>"Lifespan has not reported any adverse events or situations where patients required additional medications, but the information gathering and investigation is still ongoing," said DOH spokeswoman Annemarie Beardsworth.</blockquote> In other words, there could have been adverse events, we just at the Dept. of Health don't know yet with certainty, because none have been reported yet. <blockquote>In addition, some patients who were meant to get a medication with a coating did not receive a coating. The coating can help with stomach pains of other problems. "I just don't feel comfortable right now with some of the things that are coming out of there," Doyle said, "I really don't want to point fingers in any direction. but what we need to do is we need answers." Senator Doyle wants to have the review started in the next two to three weeks. </blockquote> Mr. Doyle, see my academic site on HIT failures <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">here</a> and an account of repercussions <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=diary">here</a> from an EHR-related medication error. <blockquote> Lifespan released the following statement Wednesday: "Lifespan is actively contacting 2,000 patients affected by this issue to ensure they receive the correct form of their medications. So far, we have reached out to more than 90 percent of the patients, many of whom were already taking the correct medication." Lifespan expects to finish contacting patients by Thursday.</blockquote> It will be interesting to understand the nature of this particular "glitch" and who the software vendor is. All it takes is a single "glitch" to seriously reduce a patient's lifespan. Siemens software may be involved. See this mutually self promoting, marketing-style Siemens document "<a href="http://www.medical.siemens.com/siemens/en_US/gg_hs_FBAs/files/IT_Solutions_And_Consulting/New_2009/09-06-25_NewportHospita_CaseStudy_A9133-9564-C1-4A00.pdf">Newport Hospital - a Lifespan Partner - At the Forefront of EMR Adoption</a>" (PDF), also cached <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/NewportHospital_CaseStudy.pdf">here</a>. (As an aside, one wonders if the hospital and/or its leadership received special financial or other "incentives" in allowing their name to be used in corporate promotions.) Also, Siemens was a company that apparently did not listen to an internal informatics specialist physician's concerns that their health IT for critical care was endangering patients (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=lawsuit">link</a>). They terminated the whistleblower. Also see my Aug. 2009 post "<a href="http://hcrenewal.blogspot.com/2009/08/why-siemens-healthcare-fails.html">Why Siemens Healthcare Fails"</a> which I had emailed at the time to the Siemens Healthcare CEO Hermann Requardt. -- SS Nov. 4, 2011 addendum: Felice Fryer of the Providence Journal sent me a link to the story of Nov. 3, 2011 she wrote with a few more details, <a href="http://digital.olivesoftware.com/Olive/ODE/ProJo/LandingPage/LandingPage.aspx?href=VFBKLzIwMTEvMTEvMDM.&pageno=MQ..&entity=QXIwMDEwNA..&view=ZW50aXR5">here</a>. Excerpts: <div class="InfoComponentTextHedLine_hl1"></div><blockquote><div class="InfoComponentTextHedLine_hl1">Flaw found in hospitals’ prescriptions </div><div class="InfoComponentTextHedLine_hl2">Some patients discharged from Lifespan hospitals got right drugs in wrong form due to software error </div> <div class="InfoComponentTextByline">By FELICE J. FREYER JOURNAL MEDICAL WRITER </div> Some 2,000 patients of the Lifespan hospital group were discharged with incorrect prescriptions over the past 9 to 15 months because of a software glitch. [It took a year or more to discover these mounting errors? This is beyond the "red flag" warning signs I used to write about. This is crossing the chasm into the territory of "asking for catastrophe" - ed.] The prescriptions listed the right medications, but in the wrong form: people who were supposed to get time-release pills received prescriptions for short-acting ones. The error affected dozens of generic medications for a variety of conditions. Lifespan discovered the problem on Oct. 25 and had fixed the software by Friday, according to Dr. Mary Reich Cooper, Lifespan’s senior vice president and chief quality officer. The hospitals have placed calls to nearly all the affected patients, although not all have called back, Cooper said. Most patients reached had already obtained the correct medication because the error was noticed by someone at the hospital, or a pharmacist or doctor outside, she said. So far, Cooper said, there is no evidence that anyone was harmed. But Dr. Michael D. Fine, state Health Department director, said that the incident is an example of how electronic medical records, which normally help reduce errors, can sometimes amplify them by quickly affecting large numbers of people. “It’s the flip side of what has otherwise been a process that has improved accuracy and reliability,” he said. [I don't notice mention of a "flip side" to health IT in the aforementioned glossy hospital/IT company marketing brochure - ed.] The Health Department is investigating the incident. Fine also plans to examine whether the department should regulate the safety of electronic systems in health care. [Readers of this blog know my opinion on that matter - ed.] Asked whether he was worried there may be other as-yet-unrecognized software glitches, Fine said, “I’m reasonably concerned about the accuracy and integrity of electronic medical records.”... The software in question is not in use at other hospitals in Rhode Island, and the software vendor, Siemens, is notifying hospitals elsewhere in the country, according to Cooper. [In the interests of public health, I believe it incumbent on Siemens to make this "glitch" widely known not just to the hospitals but to the public in areas served by those hospitals, especially with the admission that "the (RI) hospitals have placed calls to nearly all the affected patients, although not all have called back." To not do so reflects negligence in my opinion - ed.] ... The errors arose from the process known as “medication reconciliation,” in which the physician compares the medications a patient was taking before hospitalization with those prescribed during hospitalization, and ensures that the patient goes home with a correct set of prescriptions. The Lifespan hospitals recently adopted an electronic system for this process. Doctors were correctly prescribing medication, and the prescriptions looked right on the computer screen, Cooper explained. But when printing out the prescription list, the software was cutting off a two-letter abbreviation that indicated certain medications should be in long-acting form or coated to protect the stomach. [As at Case 9 from FDA's MAUDE database at the post "<a href="http://hcrenewal.blogspot.com/2009/10/out-policy-is-to-always-have-unabashed.html">Our Policy Is To Always Have Unabashed Faith In The Computer</a>". Do these vendors robustly validate their products? The current errors, in fact, were only peripherally related to medication reconciliation. They were primarily related to computer errors impairing (sabotaging?) the clinicians. It would seem med recon now needs to include comparing what the doctor enters to what is output to the nurses and other healthcare personnel who provide written instructions to patients. Is such a task performable by healthcare personnel when the computer cannot be trusted? Further, do the doctrine of the "learned intermediary" and "hold vendor harmless" clauses seem appropriate here? - ed.] ... Cooper said the risk of harm from taking a short-acting medication instead of a long-acting one was “very, very minimal.” [Cooper misses the point, and IMHO such nihilistic attitudes have no place in healthcare - ed.] But Fine, the health director, said such mistakes “can be scary.” People taking medication for angina or high blood pressure would find their medication wearing off over the course of the day, putting them at risk of heart attack or stroke, he said. </blockquote> Medical errors that might seem innocuous or minor to health IT amateurs can prove catastrophic.  I've seen it happen, leading to injury and death. -- SS

Lifespan (Rhode Island): Yet another health IT "glitch" affecting thousands - that, of course, caused no patient harm that they know of - yet

There's been yet another health IT "glitch" that, of course, caused no patients to be harmed. See other "glitches"...

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More Repeats of Talking Points Supporting Making Non-Profit Hospital CEOs Into Millionaires

I have found even more cases of non-profit hospital leaders for whose generous compensation the only support was the usual talking points, without clear evidence on their behalf, and despite obvious concerns based on publicly available data.  In chronological order, Wellstar After the firing of its last CEO was later justified by contentions of misconduct and a "special relationship," but countered by accusations of insiders' financial "improprieties," (see <a href="http://www.ajc.com/news/health-care/execs-firings-rankle-wellstar-923660.html">this story</a> in the Atlanta Journal Constitution), Wellstar, a non-profit hospital system in Georgia, hired a new CEO, Reynold C Jennings, for hefty price, <a href="http://cherokeetribune.com/view/full_story/15144876/article-New-WellStar-CEO%E2%80%88to-earn--975K-in-base-pay?instance=home_news_bullets">per the Cherokee Tribune</a>, <blockquote>He received a five-year contract composed of an initial term of three years and two one-year renewal options. The contract pays an annual base salary of $975,000, in addition to a bonus that could range from 35 to 65 percent of his annual salary, depending on his performance, [board of trustees chair Randall] Bentley said. By comparison, Bentley said WellStar’s last CEO, Dr. Greg Simone, earned a base salary last year of $900,000. Other benefits included in Jennings’ contract are: Thirty annual paid vacation days, in addition to six holidays. Payment for time lost from a serious health condition with proper medical certification. Annual automobile allowance: $12,000. Annual cell phone allowance: $2,400. Annual physical exam allowance: $800. Annual financial planning/tax preparation services: $3,000. Because Jennings has existing medical and dental coverage and did not want to participate in the benefits plan offered by WellStar, WellStar will also pay him an annual $12,000 allowance for this reason. The contract also provides for life insurance, a retirement savings plan and long-term disability benefits.</blockquote> His total compensation thus would have to be more than $1 million, any additional bonus notwithstanding. The board gave the usual justification for making Mr Jennings a million-dollar plus baby: <blockquote>'We’re very excited to have someone of his talent and his capability, someone that’s within our community, someone that understands what it takes to take our system to a new level,' said Randall Bentley, chairman of WellStar’s board of trustees. 'We’re very, very excited.'</blockquote> The WellStar board did not elaborate on Mr Jennings' "talent and capability," or to what "new level" he was expected to take Wellstar. The Cherokee Tribune did note he had a 10 year career in management of <a href="http://hcrenewal.blogspot.com/search/label/Tenet">Tenet Healthcare</a>, ending in 2007 as Vice Chairman. Neither the news article nor the board noted Tenet's troubles during Jennings' tenure there, culminating with financial woes and a $395 million settlement of the Redding Medical Center unnecessary heart surgery scandal in 2004 (look <a href="http://articles.sfgate.com/2004-12-22/news/17458067_1_redding-medical-center-steven-campanini-unnecessary-heart">here</a>), and a $21 million settlement of US government charges of kickbacks (look <a href="http://www.nytimes.com/2006/05/18/business/18tenet.html">here</a>), a $7 million settlement with the government of Florida of charges of fraudulent billing (look <a href="http://www.bizjournals.com/stlouis/stories/2006/02/20/daily31.html">here</a>), and a $900 million settlement of federal over-billing complaints (look <a href="http://articles.latimes.com/2006/jun/30/business/fi-tenet30">here</a>, and see our post <a href="http://hcrenewal.blogspot.com/2006/07/echos-of-previous-scandals-in-for.html">here</a>), all in 2006.  At least Mr Jennings had experience dealing with allegations of financial improprieties, but if anyone raised questions about hiring someone who lead a for-profit hospital corporation at a time when it seemed steeped in a culture of dubious ethics, they were not reported. University of California - Davis The Sacramento Bee <a href="http://blogs.sacbee.com/the_swarm/2011/09/katehi-replacing-hospital-ceo.html">noted</a> that: <blockquote>Last week, UC regents approved a $259,000 raise to $960,000 a year, money paid by hospital fees, not state money or student tuition</blockquote>for UC Davis Medical Center CEO Ann Madden Rice, justified because, <blockquote>that another academic hospital was recruiting Rice and offering $1.5 million. Katehi told The Bee's editorial board today that it was 'not an easy decision' to support the salary hike. While no one is irreplaceable, she said, the cost and time of replacing Rice would be far greater than the raise. Just hiring an executive search firm would cost $500,000, Katehi said. Then the search would take a year, and UC Davis would almost certainly end up paying more for Rice's successor. That's just the way the market is, she said. Rice, the chancellor added, is a great leader.</blockquote> One wonders whether the decision was informed by Rice's leadership earlier in this year of a lawsuit against the University of California by a group of top university executives who sought a large increase in their pensions at a time that the university was under great fiscal stress (see our post <a href="http://hcrenewal.blogspot.com/2011/01/some-call-it-tyranny-top-leaders-of.html">here</a>). That lawsuit drew responses using words like "outrageous," "despicable," and "greed," (not taken out of context) from a variety of people at the university.  Lifespan This last story is regrettably local, about Lifespan, the Rhode Island based hospital system, <a href="http://www.pbn.com/Union-slams-Lifespans-executives-pay,61281">published</a> by the Providence Business News, <blockquote>A release of Lifespan’s executives’ salary, bonuses and supplemental retirement contributions has been met with great consternation by the Rhode Island Hospital union. The forms - the U.S. Internal Revenue Service 990 forms for non-profit organizations - show that Lifespan’s nine highest-paid executives received $9.4 million in total compensation in the last reported year, including $1.8 million in bonuses and $2.6 million in supplemental retirement contributions. Lifespan President and CEO George A. Vecchione received a total of $2.9 million in salary and benefits – including $853,024 in base salary, $522,051 in bonuses, and $1,485,197 in retirement or deferred compensation. Dr. Timothy J. Babineau, president and CEO of Rhode Island Hospital and The Miriam Hospital, received $1.1 million in salary and benefits – including $573,675, in base salary, $379,376 in bonuses and $92,035 in retirement or deferred compensation.</blockquote> The defense of these million dollar plus compensation packages was predictable: <blockquote>Alfred Verrecchia, chairman of Lifespan’s board of directors, said that because of the hospital system’s significant size and complexity, the board places a priority on recruiting and retaining a highly skilled leadership team who can manage in both good and bad times, with the goal of providing the highest quality care to patients. 'The process for setting leadership compensation is undertaken by a board committee and is informed by national surveys provide by the The Hay Group, an independent compensation consultant,' Verrecchia said. Over the past several years, Verrecchia continued, 'base pay for executives has been relatively flat. A significant portion of the executive pay is at risk and is only paid out if quality, service and financial performance goals established by the compensation committee are achieved.' Verrecchia praised the current leadership team at Lifespan, saying: 'Lifespan hospitals are fortunate to have a stable, sound leadership team with a proven track record of addressing significant financial challenges in order to continue to fulfill our mission of providing the best and safest care to our patients.'</blockquote> The system's employees did not all agree: <blockquote>'We are angry, we feel disrespected,' said Helene Macedo, president of the United Nurses & Allied Professionals which represents 2,200 employees at Rhode Island Hospital. 'It’s not justified, when we see the sacrifice that those of us who are working at the bedside are being asked to make,' she told Providence Business News. Macedo, an operating room nurse who has been at Rhode Island Hospital for 20 years, was further irked by the fact that Lifespan had just announced a decision to cutting the matching contributions to employee’s 403(b) Fidelity plan for 2011 and eliminating the matching contribution for 2012. 'It looks like another example of corporate greed,' she said, 'when you look at their executives’ salaries, bonuses and supplemental retirement, compared to that of what employees are making – and the sacrifices we’ve been asked to make during the last several years.' The atmosphere in the hospital, Macedo said, 'is one where we’re counting every penny and cutting every corner. But there doesn’t appear to be any corner-cutting or counting in the corner office.'</blockquote> Summary Here were three more examples of million dollar (more or less) non-profit hospital system CEOs. As we have noted frequently, even non-profit hospital systems that are supposed to put their patient care and academic missions, when applicable, first somehow seem increasingly unable to function without yearly making their leaders instant millionaires. It was striking that the justifications, by boards of trustees or hospital spokespeople, for these indulgent pay packages followed the talking points we have <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">identified before</a>: -  We pay what everyone else pays -  CEOs work hard and are brilliant, so they deserve high pay -  High pay is needed to attract and retain competent, if not brilliant people Yet in these cases, as in nearly all cases we have discussed before, there were no logical, fact-based arguments why - the particular CEOs deserved at least what supposedly comparable CEOs got, if not more, and how the comparator group were judged to be comparable; - why the CEOs were so brilliant, (or in this case, had such "talent and capabilities," was a "great leader," or was "highly skilled," and "stable and sound") when there were at least reasonable but unanswered questions about their leadership based on publicly available information So despite their hospitals' financial challenges, and despite questions about their previous leadership, more non-profit hospital leaders are becoming million dollar babies, encouraged by boards of trustees who seem to be basing their "stewardship" on the same talking points, rather than reasoned arguments.  One can only wish that the boards who supposedly exercise stewardship over our formerly revered health care institutions actually had to answer some tough questions about the leaders they continue to uncritically endorse. So ad infinitum, I repeat.... health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior. If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

More Repeats of Talking Points Supporting Making Non-Profit Hospital CEOs Into Millionaires

I have found even more cases of non-profit hospital leaders for whose generous compensation the only support was the usual talking points, w...

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