Providence: You can do better than this

The recent Seattle Times investigation into billing practices and care delivery in the neurosurgery department at Providence Swedish undermined the perception of Providence Health and Services within the community.

It’s the kind of reporting that is likely to stick with Providence’s brand for years.

It took Group Health decades to overcome the “Group Death” moniker.  UW Medicine is only in recent years moving past convictions from one of the largest Medicare fraud cases in US history.  Likewise, Fred Hutch needed a generation to get past the damage from conducting experiments on cancer patients without their consent and under myriad financial conflicts of interest.

In a time of escalating costs, to see the focus of the Swedish Neurosurgery Institute (SNI) on revenue generation compared to their peers – particularly in light of the quality outcomes discussed in the investigation – raises questions about what the moral compass of Providence Health and Services is.

Providence Health and Services invests a great deal of energy into educating its employees about the mission of Providence.  Executives spend a lot of time learning about the Sisters of Providence, getting grounded in why the sisters were so committed to caring for communities, and how the Providence mission today carries that forward.

That’s a mission of service that has resonance with me – and I believe many others in the communities served by Providence.

It’s not a story Providence tells often outside of its four walls, however.  The community doesn’t generally know the effort to which the system tries to build upon this foundation.

So, when stories like the Times investigation come forward, they come forward in a vacuum.  The mission-centered understanding Providence executives have isn’t well understood by the community at large.

What exists in place of careful reputation cultivation are stories like the contract dispute with Premera.

Premera countered that others they have contracted with “have committed to more aggressively control costs, improve the quality of care with performance-based payments, and enhance the patient experience.”

Premera Blue Cross spokesperson Steve Kipp said: “We will continue to work with providers, on our customers’ behalf, to ensure that customers have access to high-quality, high-value healthcare in their community after December 31, 2016. In the meantime, we remain open to working with Providence on a new contract, if they are willing to meet the needs of our customers.”

That media experience didn’t leave Providence looking too hot.  The way Providence managed that in the media, along with Premera’s spin of the episode, made it look like the hospital system was simply out for more money.  I’m sure it was more complicated than that but that was the clear and lingering sense from the story.

Likewise, in Alaska, coverage there didn’t come off too well either.  In what seemed like a “let them eat cake” view about its successful financial performance there, Providence seemed indifferent to the consequences of the most expensive medical service prices of any state in the United States.

Alaska tops the nation in medical costs. Our per-person spending on hospital care is 50 percent above the national average, even though our use of hospitals is only average.

Part of the problem is that our biggest hospital made a 17 percent profit on providing care last year — or net margin, in the language of nonprofit accounting. That doesn’t count the money it made on vast investment holdings.

“It’s generally understood that some 35 to 50 percent of health-care spend is not necessary, that it’s waste of some sort,” said Providence chief executive Bruce Lamoureux. “The system is so broken and confused that you have all these strange and wacky and perverse incentives.”

This story reads like the system is happy to “get rich” off of the fact that up to 50% of the services Providence provides are services it may recognize as “waste of some sort.”  When did that become in alignment with the Providence mission?



Providence, and I say this with all due respect as someone you fund through sponsorships, through word of mouth and through general support of our work:

Providence, you can do better than this.

Speaking to the community with a seeming indifference about costs, or with silence about preventable deaths from poor quality, is not reflective of the mission the Sisters of Providence have endowed you with.

I recognize there are legal implications from speaking publicly about such matters.  However, that doesn’t mean Providence can’t speak more openly about the mission that orients its work and how it operationalizes that mission beyond statements on charity care or community benefit.

I believe the communities which support you and which you serve want and need Providence to be successful.  Better communication will support that, I believe.

I will close with what Ralph Pascualy conveyed to you in his email to Providence CEO Rod Hochman when he sounded the alarm for the last, most vocal time, before his departure.

When truth speaks to power, it’s out of respect and not insolence.