@KHNews calls out @JohnsHopkins and @UMMC for ignoring asthma in Baltimore

Thursday, December 7, 2017

Kaiser Health News published a hard-hitting piece on asthma in low-income housing in Baltimore yesterday, essentially calling out Johns Hopkins and the University of Maryland Medical Center for profiting from the poor in the city's worst asthma hot spot. The article asserts that the two medical centers receive tax benefits and research dollars for "serving the community" while also reaping profits from Medicaid clients who are repeatedly hospitalized with severe asthma attacks, because they do next to no community-based work with the clients themselves - in effect, by not serving the community.
The supreme irony of the localized epidemic is that Keyonta’s neighborhood in southwest Baltimore is in the shadow of prestigious medical centers [Johns Hopkins and UMMC]...Both receive massive tax breaks in return for providing “community benefit,” a poorly defined federal requirement that they serve their neighborhoods.
But like hospitals across the country, the institutions have done little to address the root causes of asthma. The perverse incentives of the health care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.
The authors conducted interviews with asthma patients and their family members in zip code 21223 and visited homes to report on environmental conditions. They also analyzed three years of de-identified hospital admissions data for the state of Maryland. (The methodology is detailed in a box at the bottom of the article.) The analysis is eye-popping, but sadly familiar to those of us who have worked with Medicaid or similar data:
For each emergency room visit to treat Baltimore residents for asthma, according to the data, hospitals were paid $871, on average. For each inpatient case, the average revenue was $8,698. In one recent three-year period, hospitals collected $6.1 million for treating just 50 inpatients, the ones most frequently ill with asthma, each of whom visited the hospital at least 10 times.
They then go on to depict officials from Hopkins passing the buck:
Hopkins’ own research shows that shifting dollars from hospitals to Lemmon Street and other asthma hot spots could more than pay for itself. Half the cost of one admission — a few thousand dollars — could buy air purifiers, pest control, visits by community health workers and other measures proven to slash asthma attacks and hospital visits by frequent users.

“We love” these ideas, and “we think it’s the right thing to do,” said Patricia Brown, a senior vice president at Hopkins in charge of managed care and population health. “We know who these people are...This is doable, and somebody should do it.”
The subtext, of course, is that "somebody other than us should do it," a subtext made all the more obvious with the article's direct contrast to the Children's National Health System in DC, which sends asthma patients to a clinic that provides education to families on how to manage their medications and remove environmental asthma triggers in the home.

The piece highlights the health consequences of low-income housing in a powerful way. I imagine the average middle-class American has no idea that there are people in this country who live in houses with dirt-floor basements or neighborhoods with no trash pickup to speak of, or that there are moms who resort to "[wielding] a BB gun to keep rats from her asthmatic child." I also like the way it draws attention to the divide between the ivory tower and the real world, so to speak - well-paid researchers who receive millions in grants to run studies on asthma public health interventions and publish papers in high-profile journals, but then who have no connection to, or interest in, community programs that could actually scale up those interventions for the benefit of people living in their own backyards.

At the same time, I can see how it could be frustrating for administrators at these hospitals to be villainized in a piece like this when they are also held to account for the other 982 public health crises in a community like Baltimore, which all have their roots in a fragmented, overpriced health care system. The authors mention off-hand that "[e]xecutives...acknowledge that they should do more about asthma in the community but note that there are many competing problems: diabetes, drug overdoses, infant mortality and mental illness among the homeless." Arguably, those executives are absolutely right, and I would argue that it does make more sense for them to prioritize things like drug overdose and infant (and maternal) mortality, particularly when the asthma triggers in low-income housing should be addressed by agencies like HUD. The article interviews Ben Carson and paints him in a positive, almost sage-like light, when it could justifiably throw an equal share of the blame at his feet. It is HUD and similar agencies, not hospitals, that should be providing assistance like holding landlords accountable for shitty housing conditions and interfacing with municipal governments to clean up crack houses and ensure a trash pick-up schedule that respects human dignity.

Overall, though, this is an important piece that draws attention to an issue that does not get enough of it.

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