A Brief History of Kickback Schemes at Chicago Hospitals

Edgewater Medical Center in Chicago. Photo via Flickr/Zolk

News broke yesterday that six have been arrested in an alleged kickback scheme at Sacred Heart Hospital on Chicago’s West Side. According to the Tribune, the hospital was performing unnecessary procedures on patients in order to increase the money it received from Medicare. The procedures in this case appear to be tracheotomies, which is where an incision is made into the neck and trachea so a person can have an airway other than their mouth or nose. Usually a tube is also inserted to help the breathing occur.

According to the Illinois Department of Public Health, Sacred Heart is a for profit hospital and in 2011 it provided $11,742 of charity care. What’s interesting is in the breakdown of patients and revenue in the annual report it says 38.2 percent of inpatients were Medicare patients but 60.1 percent of inpatient revenue came from Medicare.

Since the raid and arrests happened on Monday, this news story is still unfolding. What’s unfortunate beyond people being heavily medicated and having unnecessary procedures performed on them is if this is all true, this isn’t the first time there has been Medicare fraud committed by a Chicago hospital as part of a kickback scheme.

Edgewater Medical Center is an eyesore that has sat empty for more than a decade due to closing after numerous staff members were found guilty of Medicare fraud. The most detailed explanation I’ve found of the hospital’s closure comes from Ken Fager of American Urbex:

Vice president Roger Ehmen and medical director Dr. Ravi Barnabas were able to turn the nearly bankrupt hospital into a lucrative profit center. The pair tapped Dr. Sheshiqiri Rao Vavilikolanu and Dr. Kumar Kaliana to recruit potential patients. For years the doctors sent hospital employees into the Chicago community to find potential patients. It did not matter if they did not have heart conditions, were drug addicts, were unable to speak English or even had no health insurance coverage. Recruiters instructed the potential patients how to feign symptoms in order to mandate services rendered by Edgewater Medical Center. In return the patients were offered money, food, cigarettes and other amenities for their cooperation.

In addition to this doctors at Edgewater Medical Center performed unnecessary angioplasties, which is a procedure where arteries are widened. People were killed as a result of these procedures. As I said earlier, news broke, people were tried and the hospital closed. A simple look on Flickr for “Edgewater Medical Center” will return numerous photos from inside the hospital, many of which make it appear as if the staff simply up and left the building, forgetting to take the patient records and chemicals with them.

There are numerous questions to be brought up with both of these cases. What would compel these hospitals to do this? It’s possible that they did this simply so they could stay afloat as other hospitals in Chicago have had to close because they couldn’t afford to keep running. (RIP Michael Reese Hospital.) There are also questions that could be brought in about what it is with Medicare’s set-up that makes the use of dangerous procedures seem like a good way to increase hospital revenue. I’ve heard some things from doctors I know about the set-up of Medicare sometimes pushing them to treat more patients, but I don’t know how much of that is true.

I also find it interesting no one criticized Sacred Heart Hospital for how little charity care it provides since it’s on the west side of Chicago. Rush University Medical Center has been criticized for not providing a large amount of charity care–although it’s right next to John H. Stroger Jr. Hospital of Cook County–as has University of Chicago Medical Center on the south side. Again, numbers on charity care aren’t everything and I imagine its status as a for profit hospital came into play with the lack of criticism, but it does strike me as odd no one criticized this hospital.

Let’s hope this story doesn’t become worse as time progresses.

Musicals That Move You (But Not in a Fosse Sort of Way)

Good theater moves you.

When I was a theater critic I always asked myself if the play moved me emotionally. (The last play to move me emotionally was “The Birthday Party” at Steppenwolf, which both me and my companion enjoyed. Prior to that, “Othello” at the Milwaukee Repertory Theater.) The greatest failure a piece of theater can make is make me feel numb for the entire thing.

Musical theater is a genre that I have mixed feelings for. When it works, it works astoundingly well. When it doesn’t work, it is really bad or very silly. The best musicals for me either make me cry or make me feel incredibly happy after watching them, as is the case with my favorite musical, “My Fair Lady.”

But let’s focus on musicals where you cry.

I can think of every musical I’ve cried during. “Into the Woods” at the Waterloo Community Playhouse, the first two times I saw “Wicked,” “Company” and three-fourths of “Next to Normal” at the Milwaukee Repertory Theater. Then there are the cast recordings I’ve cried while listening to. I can no longer listen to “Sunday in the Park with George” on my commute because I’ll start sobbing in the car at numerous points in the music.

Today I was listening to the music for “Falsettos” in an attempt to relax after a very busy week. This was successful on that front, but I also burst into tears in the car while listening to certain songs.

This rarely happens. It’s not like how I know that every other week I’ll cry while listening to “Hello Helicopter” by Motion City Soundtrack. The last time I wanted to cry while listening to the music for “Falsettos”–which is split into “March of the Falsettos” and “Falsettoland” because that’s the only way it’s been released–was while riding a Metra train to Kenosha. I was reading the paper on the quiet car and found I was the only person left on the car. As I got to the song “You’ve Got To Die Sometime,” I found myself wanting to cry.

But here I was, a 21-year-old woman driving around East Lansing crying to a musical that is best known as being a musical written by the guy who wrote “The 25th Annual Putnam County Spelling Bee.” (I like to think of it as “The Other Musical from the 1990s Involving AIDS.”)

To quickly inform you of what the musical is about, it’s about a man named Marvin who has recently left his wife, Trina, and son, Jason, to be with his male lover, Whizzer. As Marvin strives for a “tight-knit family,” his psychiatrist, Mendel, falls in love with Trina. Relationships form and disintegrate. Lesbians from next door are introduced, bar mitzvahs planned. As all of this is going on, a mysterious disease in the early 1980s appears in normally healthy men and Whizzer is victim to this disease. (The audience knows this is AIDS, but the characters do not.)

That very brief plot summary has either enticed you or terrified you because this probably sounds like the weirdest musical to appear on Broadway. It ends on a down note. No one comes back to life because their friend tells them to turn around from the light at the end of the tunnel. But it’s realistic, which is probably why I like it.

There are three specific moments in this musical where I’m prone to feeling the most moved. Two are in Act One and are the songs “The Games I Play” and “I Never Wanted to Love You.” The other comes in Act Two when a character accepts that death is approaching him and he sings “You’ve Got to Die Sometime.” A couple of numbers prior to this, my favorite lyric appears:

Let’s be scared together.
Let’s pretend that nothing is awful.
There’s nothing to fear.
There’s nothing to fear.
Just stay right here.
I love you.

The lyrics aren’t as complex or subtle as Sondheim, but there’s still a great truth that strikes one as you listen to them, which is why I find it to be endlessly listenable.

For me the musicals that work the best are the ones which are incredibly realistic even when dealing with fantasy themes, such as “Into the Woods.” They move me and are the ones I’m left breathless after seeing. So whether it’s a musical about an incredibly immature Jewish man who wants a close family or a painter struggling to complete his masterpiece, I celebrate the musicals that make me cry and not even in a silent way.

What do you think makes a good musical? And what musicals move you?

(By the way, I’m not sure why I was mostly unmoved by the most recent time I saw “Wicked.” I attribute it to me being more cynical than I was in the past, but I was also cheering for Galinda throughout the entire musical, which I don’t think I’m supposed to do.)

Fear of New Flu

(I read this at The Paper Machete on March 10, 2012. With the news of a new strain of bird flu, I felt the time was right to finally post this on my blog.)

According to an article in Tuesday, March 6’s New York Times, essentially the only thing we have to fear in the fight against bird flu, or H5N1, is that amateurs could mutate the virus.

That’s right, amateurs. Not someone at USAMRIID, the army’s biomedical research facility. Not someone at the CDC, but amateurs.

The concern stems from a group of scientists doing experiments where H5N1 was manipulated to a mutant form that spreads easier than it does today. According to the Times’ article, papers on the findings will eventually be published, although no one knows when. According to a November 20, 2011 article by the New York Times, the United States government doesn’t want the exact procedures released in the articles because it could give bioterrorists a how-to guide for creating weaponized H5N1.

The idea of people mutating viruses and bacteria in their basements might seem harmless, but according to the article there is a website called DIYbio.org that has D.I.Y. biologists, about 2,000 of them. But if you think of it as a terrorist, there is the problem that too many Americans don’t think of people harmlessly manipulating pathogens in a garage, they think of something much more dangerous.

Let me put it this way: The creation of meth is also a science since the wrong balance or positioning of ingredients can trigger a toxic, dangerous explosion. In a way, meth cooks are also scientists. This, by the way, is not a conclusion I came to by binging on Breaking Bad, but that might have helped.

A Look at Data on Chicago Hospitals

(All data for this post comes from the Illinois Department of Public Health.)

The graph above looks at the amount of charity care given by teaching hospitals in Chicago during the 2011 Fiscal Year. The charity care expenses are for both inpatient and outpatient care. The hospitals were chosen from looking at a list of teaching hospitals from the Illinois Hospital Association and picking hospitals listed as “major teaching.” Both St. Joseph Hospital and Lurie Children’s Hospital of Chicago barely show on this graph due to having only gave 0.7 and 0.3 percent of the respective hospitals’ expenses compared to net revenue going to charity care.

One hospital on this graph has raised a bit of controversy due to its lack of higher charity care amounts. University of Chicago Medical Center, located on Chicago’s South Side, had only 1.2 percent of its expenses compared to net revenue going towards charity care. The following graph shows the charity care amounts over a five year period. (Additional data: 2010, 2009, 2008, 2007)

Over this period the amount of charity care given by University of Chicago Medical Center has stayed fairly consistent, only slightly climbing in recent years.

In this figure we see John H. Stroger Jr. Hospital of Chicago, which had the highest amount of charity care given, receives a majority of its revenue from Medicaid. Stroger Hospital is the main public hospital in Chicago and is operated by the Cook County Health and Hospitals System.

Lurie Children’s Hospital of Chicago, which was still Children’s Memorial Hospital during the 2011 Fiscal Year, received a majority of its revenue from private insurance but also received a third of its revenue from Medicaid. This sizable amount could be the result of Illinois’ program to ensure low-income families have insurance for their children.

The Disney Princess Project: “Tangled”

Previously:
Snow White and the Seven Dwarfs
Cinderella
Sleeping Beauty
Beauty and the Beast
Pocahontas
Hercules
Atlantis: The Lost Empire
The Little Mermaid
The Princess and the Frog
Brave

For the moment we end The Disney Princess Project with “Tangled,” the 50th animated feature released by Disney. “Tangled” is a retelling of the fairy tale of Rapunzel, but this time with a thief instead of a prince and some lovable rogues thrown in the story.

The film starts off with a prologue where we find out a magical flower was formed by a drop from the sun falling to the earth. An old woman named Mother Gothel (Donna Murphy) finds the flower and uses the properties to help her stay youthful forever. Hundreds of years later a king and queen are expecting a child when the queen falls ill. The citizens of the kingdom go searching for help and find the flower, taking it back to the kingdom. The powers of the flower help save the queen and she gives birth to a beautiful daughter with blonde hair. The princess, Rapunzel (Mandy Moore), holds the flower’s power inside of her which means Mother Gothel breaks into the castle one night to steal the baby. Mother Gothel then takes the baby to a tall secluded tower in the middle of the forest and raises the princess as her own, never letting Rapunzel go outside.

At the time of Rapunzel’s 18th birthday, Rapunzel asks Mother Gothel if she can see the festival of lanterns that happens every year on her birthday. Unbeknownst to her the lanterns she sees every year are to bring her home, but she sees them every year and wishes to see them up close. Mother Gothel forbids her from doing so as the world is a dangerous place. Shortly after this happens, Flynn Rider (Zachary Levi) climbs up Rapunzel’s tower to escape his fellow thieves, the Stabbington Brothers (Ron Perlman and John DiMaggio), and the palace guards. He is knocked unconscious by Rapunzel who questions Flynn before deciding to have him take her to the lanterns. The two leave the tower and head off on a journey through the forest where they grow closer while Mother Gothel schemes to keep the princess to herself.

After the release of “The Princess and the Frog” Disney changed the title of this film as it initially was going to be “Rapunzel.” According to the Los Angeles Times this was because a lot boys shockingly did not want to see a movie with the word “princess” in the title. Disney then decided to amp up the presence of Flynn Rider in the marketing campaign as part of the intention to get more young boys to see the film. Because of how Disney marketed the film, you might be tempted to initially approach the movie as having Flynn as the main character. I advise you to not do this because the film isn’t great if you approach it as him being the main character. If you approach the film as having Rapunzel as the main character, it is a fantastic film.

The main problem with viewing Flynn as the main character is in some parts he feels a bit underdeveloped. As the movie develops we learn more about him which does help give him depth, but for most of the movie he really doesn’t feel like a compelling character. This is also the chief problem with the film as there are numerous characters who steal the light when they’re in a scene with Flynn, including Rapunzel’s pet chameleon Pascal and a horse named Maximilian who is with the royal guard. But Flynn does manage to become an interesting character by the end of the film, which is more than some Disney movies have managed to do.

“Tangled” is the first and so far only non-Pixar film released by Disney that has managed to have realistic computer animation. Not only is it realistic, but it manages to look completely stunning. The film does retain a cartoonish quality to the look, mostly with how large the eyes are for many of the characters, but there’s a distinct feeling some things wouldn’t have looked as good in previous Disney films as they do in “Tangled.” In a traditionally animated film, Pascal blending in or changing color would have never elicited a response of a chuckle while it does in this movie. It manages to go beyond a character trait and become a cute thing to look for in the movie. I also think every minute of seeing Rapunzel’s hair has some of the best hair animation I’ve seen in any animated film.

“Tangled” also manages to use anachronistic humor to a charming degree, particularly in the number “I’ve Got a Dream.” In most animated movies, including “Brave,” these jokes come off as a joke to appeal to the kids. In “I’ve Got a Dream” we have a thug with a hook who sings about wanting to be known for his showtune medley, which comes off as a sweet thing in a toe-tapping number rather than a joke to keep kids awake during the film.

As for the score, by Glenn Slater and Alan Menken, it’s not among the best scores for a Disney film. Menken’s music is very memorable, but some of Slater’s lyrics are a bit lacking. I even find the big love duet in the film, “I See the Light,” to be a bit boring. There are great songs in the film, including “Mother Knows Best” and “I’ve Got a Dream.”

The puzzling aspect of the film is Mother Gothel, who manages to simultaneously be a great villain and a bit of a weaker villain. She is a great villain because of how she manipulates Rapunzel and others for maintaining her vanity and she’s clearly driven to obtain what she wants. At the same time, Mother Gothel feels like a less-menacing version of Frollo in “The Hunchback of Notre Dame.” Both take a baby and raise it as their own, hiding it away from the world and telling the person the world outside is cruel and won’t understand them. But Mother Gothel doesn’t take Rapunzel to extract revenge on the king and queen, she only does everything she does because she is an incredibly vain person. Perhaps Mother Gothel shows us what happens when vanity is taken to an extreme as it ultimately results in her downfall.

But is Rapunzel a Good Role Model for Children? Yes.

Rapunzel is the most bad-ass princess in a Disney movie. Although Mother Gothel would like for Rapunzel to think she’s a helpless maiden in a tower, Rapunzel shows on multiple occasions she can fend for herself. Thanks to Rapunzel’s repeated use of a frying pan as a weapon it ends up being the weapon of choice for the entire kingdom as many characters realize it’s actually a great weapon. Rapunzel is the clear hero of the film as she has the smarts to take on numerous dangers facing her in the film. She is evidence the argument that Disney princesses will lead to girls becoming damsels in distress is very weak. If there’s anything parents should be afraid of children doing after seeing this movie it might be children whacking each other in the face with frying pans.

Although “Tangled” as a film isn’t among Disney’s finest it manages to be a great film to watch while having the best actual princess who is part of the Disney Princess line-up. Although “Brave” the biggest award, “Tangled” is a film that is the most enjoyable and worth multiple viewings.

The CTA’s Ventra-Sized Problem

Over the past two weeks the Chicago Transit Authority has been dealing with a backlash and revelations regarding their new fare system, Ventra. At first glance, Ventra seems like a great idea since it would cover both CTA and Pace, potentially making the use of the suburban buses more appealing to Chicago residents who want to visit the suburbs. Ventra also allows for use of debit and credit cards to pay for fares.

Tracy Swartz of RedEye revealed single rail rides using Ventra would cost $3. On the CTA’s page for misconceptions about Ventra, they address this with the following sentence:

CTA vending machines currently do not provide change, so those without exact change are already paying $3 for a single ride.

The CTA later says that only the card costs $3, but apparently people already pay $3 for a single ride so it’s no big deal.

Swartz also reported fees which would be tacked on for people who would use a reloadable Ventra card. To get the Ventra card, one must first pay $5, which will be refunded as transit funds after the card is registered. If a user of the Ventra card does not use their card for 18 months, $5 is deducted for every month it is not in use.

The more troubling news about Ventra came from Jon Hilkevitch at the Chicago Tribune. Hilkevitch reported on numerous fees added on if users of the Ventra card also use it as a prepaid debit card, a feature the CTA has been touting on their website.

The clear option CTA users have is to try to reject the debit card option, use a 30-day pass or use their own debit card or credit card to pay for fares. Although a 30-day pass recently went up to $100, it’s still a cheaper option for people who regularly use the CTA for more than commuting to work.

The CTA meanwhile has to roll out a campaign for damage control after the recent articles. For the people who still read the Tribune and RedEye, they’re aware of this and it might make them wary of using Ventra. The potentially bigger problem with this situation is the Ventra system is no longer looking like a great situation. The fare system already had numerous options that were confusing to some users. I was recently talking to a friend and we discussed how confusing Chicago Card and Chicago Card Plus can be. This was a system rolled out in the mid-2000s and it’s confusing for people from the Chicago area. Imagine how confusing Ventra will be if the CTA doesn’t properly educate the public about the program.

Time will tell if the CTA and RTA regret using this program–both systems are using the fare system, but I imagine this will affect the CTA more. There’s no turning back, but the CTA has to think fast to not have this turn into an even bigger disaster for them.

I’m mostly annoyed because I just replaced my Chicago Card.

Alternatives: “The Thief and the Cobbler” (Miramax Release)

This post, which you are currently reading, is on the Miramax Release of “The Thief and the Cobbler,” which is the one that I imagine most people will leap for since it’s at video stores and streaming on Netflix. Please don’t post comments about how much better the recobbled cut is because I haven’t seen it and I chose to write about the Miramax release for a very specific reason.

“The Thief and the Cobbler” has a very lengthy and sad history. Animator Richard Williams decided to start working on “The Thief and the Cobbler” in 1964, intending to make it his masterpiece. Williams then went on to direct the animation for “Who Framed Roger Rabbit?” and started to work with a studio to release “The Thief and the Cobbler.” He couldn’t complete the film on time and control was taken away from him. In 1995 the film was released by Miramax as “Arabian Knight,” although it was changed back to its original title for the home video release, and the film was derided as a rip-off of “Aladdin.”

In ancient Baghdad, Tack (Matthew Broderick) is apprenticing as a cobbler when he gets messed up with a thief (Jonathan Winters) who has broken into Tack’s home. The two fall onto Zigzag the Grand Vizier (Vincent Price), who accuses Tack of attacking him. To save Tack, Princess Yum-Yum (Jennifer Beals) breaks her shoe and has Tack repair her shoe. Once again, the thief tumbles into Tack, who then tumbles into Zigzag and is thrown in jail. Yum-Yum has Tack released just in time for the three golden orbs to be taken by the thief. According to legend, the golden orbs protect Baghdad and without them, the city is vulnerable to the evil One-Eye (Kevin Dorsey). To take advantage of this, Zigzag travels to One-Eye with his loyal but abused vulture Phido (Eric Bogosian) to work together to take down Baghdad. Meanwhile, Yum-Yum and Tack travel to find One-Eye’s sister to save the city.

Knowing that the version I watched isn’t the one that Williams had planned, it is easy to see where Fred Calvert, who took over the project, added things in to make it a more marketable and mainstream movie. In the initial version, the thief is mute and in this version, he has a lot of thoughts the audience gets to hear. Many of these thoughts are anachronistic jokes and they don’t really fit in the film. But ultimately it isn’t the jokes in the monologues of the thief that grow tiresome, but the fact that he has so many monologues. Hear from the thief gets to be annoying after a certain point.

It’s also clear to the viewers that songs were added to make it more like other children’s movies. Not every children’s movie made by studios other than Disney can have great songs, but “The Thief and the Cobbler” has the least memorable songs in any animated film I’ve watched. Whenever I watch this film, I expect to have a song sung by the brigands in the film stuck in my head the next day. But I finish the film and I can barely remember the tune. I the songs posses a quality which causes the viewer to assume Calvert found Robert Folk, who wrote the songs, and had him half-ass some songs for the film.

These are the two biggest problems with the film. The film is a must watch because of the fantastic design Williams had for this project. It has some of the most fascinating animation I’ve seen in any animated film.

I’d also argue that for being an overtly menacing villain, Zigzag is an excellent villain. He’s voiced by Vincent Price and speaks entirely in rhymes. In a way, Zigzag feels like a very traditional villain, but he has a position that allows him to influence people as well as a great skill at magic. We also see bits of his cruelty throughout the film. He dislikes Tack, abuses Phido and takes advantage of thief to get the gold orbs.

I’d also throw in Princess Yum-Yum as a good role model. She’s is clever and uses that to save Tack from Zigzag early in the film. She’s also very intelligent and a good diplomat as she negotiates in the film with brigands and helps save the city. She cares very much for the future of Baghdad and its safety, but also has a strong relationship with her father. In a way she reminds me a bit of Kida in “Atlantis: The Last Empire,” which came after this movie. This isn’t to accuse “Atlantis: The Lost Empire” of borrowing from this film, but it’s an interesting similarity.

Even with its flaws, “The Thief and the Cobbler” is worth a viewing because of the story and animation. It’s an odd film during this time period as it has an original story, but the story is a fascinating tale that feels like it could have come from an old legend.