An article in today’s LA Times about Anthem Blue Cross excluding Cedars-Sinai and UCLA Medical Center from the health plan provided to people employed by the City of L.A. (due to these two institutions’ prices being higher than some other community hospitals) omitted several crucial facts.  These facts were provided to the reporter, but for some reason were not included anywhere in the article.

As someone who knows the extraordinarily high quality of care that you and your colleagues provide to all of our patients, you may have taken exception to the statement that our clinical quality isn’t measurably better than other community hospitals and therefore is not worth the higher cost.

I’ve attached some key facts about Cedars-Sinai quality that were not included in the article.  I’ve also attached key points about the unique, highly specialized services provided by academic medical centers like Cedars-Sinai that are not provided at lower-cost community hospitals, but which benefit the entire region and nation.

Cedars-Sinai treats more patients with highly complex medical problems than any other medical center in California.  Much of this highly specialized care – for complex cancers, advanced heart disease and serious brain diseases, for example — is not available at community hospitals, as it requires an enormous investment in special technology and equipment, as well as superbly trained experts on staff.

We also provide care for a high volume of Medi-Cal patients and uninsured patients as part of our mission.  In most cases we are paid only a small fraction of the cost, or in some cases not paid at all.   In fact, the total amount of Cedars-Sinai’s subsidy of these programs, as well as the hundreds of programs and services we provide in the community, and our research and education programs – was more than $600 million last year.

While many people recognize the importance and value of these services we provide, others have not connected the dots about the importance of how these programs are funded, and the shared stake that everyone has in keeping these programs viable for the continued health and well-being of the community, California, and the nation.

While academic medical centers will always be more costly than community hospitals for all the reasons I’ve noted, we must also uphold our obligation to accomplish our mission in the most efficient way possible.  We must continue to look for ways to lower costs without lowering quality, and without losing sight of our unique mission. Our current work to do this, including initiatives such as Cedars-Sinai Medicine as well as the work being done in every department to ensure we are operating in the most efficient, patient-centered way possible, will  continue to be crucial to our long-term success on behalf of our patients and our community.

KEY POINTS

• Cedars-Sinai’s quality of patient care and our clinical outcomes are significantly better than most hospitals in California and the nation:

• Cedars-Sinai is the only hospital in California (and one of only 7 in the nation) to have a 30-day survival rate better than the national average for four consecutive years in all three of the following key diseases:  Heart Failure, Pneumonia and Acute Myocardial Infarction (Heart Attack).

• Cedars-Sinai is significantly better than other hospitals in California and the nation in reducing the incidence of Central Line-Associated Blood Stream Infections (CLABSI).   Cedars-Sinai’s CLABSI infection rate is 80 percent lower than the state average and 91 percent lower than the national average.

• Out of 301 hospitals in California, Cedars-Sinai is one of only 10 that is better than the national average for complications in Hip and Knee Replacement Surgery.

• The quality of the physicians in Cedars-Sinai Medical Group and Cedars-Sinai Health Associates consistently ranks in the top among the more than 200 California medical groups participating in HMO and managed care plans.  On independent surveys, Cedars-Sinai Medical Group and Cedars-Sinai Health Associates consistently rank in the top tier (90^th percentile and above) for patient satisfaction.

• In addition to our higher quality, the many region-wide services that academic medical centers like Cedars-Sinai provide (and community hospitals do not) add to overall cost, but benefit everyone in the region:

• Many of the highly specialized services that only academic medical centers like Cedars-Sinai provide for everyone in the region are costly to maintain.  These include:

• Advanced heart disease treatments
  • Specialized treatments for complex (and in some cases, rare) types of cancer
  • Surgical and medical treatments for serious brain disorders, such as complex aneurysms, brain tumors and stroke
  • Advanced Neonatal Intensive Care Unit
  • Comprehensive Transplant Center

• Having these services centralized at academic medical centers is actually much more cost-efficient for everyone than having these complex, costly services available at every hospital.

• The added cost burden that academic medical centers like Cedars-Sinai take on to benefit the entire region includes the cost of specialized technology and equipment, as well as the costs of keeping highly trained specialists on staff.

• For example, as one of just four Level One Trauma Centers in LA County (and the only one not operated by the government), Cedars-Sinai has  a neurosurgeon and a trauma surgeon in the hospital  24 hours a day, as well as other trauma specialists and equipment to treat the most severely injured people in automobile crashes and other traumas.

Thomas M. Priselac
President and CEO, Cedars-Sinai Medical Center

Mars One is a private sector endeavor to send human beings to Mars. The estimated cost of $6 billion will be raised by selling T-shirts and hosting reality shows. In theory, the mission will launch in 2023. In order to reduce costs, astronauts will not be returned to earth. In other words, this is a one-way trip

There are a lot of technical issues that the sponsors have failed to adequately evaluate. Although they acknowledge high radiation exposure, resulting in a much higher probability of developing cancer (without a realistic ability to treat), they have set the launch date for a period of high solar activity, which dramatically increases the risks to the astronauts during transit. In order to reduce radiation exposure on Mars, astronauts will be largely confined to living underground, which poses psychological risks.

Energy generation is proposed to come from solar panels. However, Mars receives 4-times less solar energy than earth. It is also susceptible to dust storms, which would reduce solar energy output to virtually zero. If the storms last longer than a few days, the astronauts will be toast. The solar energy available during winter months is also reduced considerably. The Mars rovers that relied upon solar panels had to shut down during the winter. Such an option is not available to astronauts, who must rely upon energy for heating, oxygen production and water production.

Supplying astronauts with enough food is also a problem. The Mars One website says astronauts will raise their own food. However, this idea is very unrealistic. Even on earth, it took a tremendous amount of land to produce enough food to feed people in the Biosphere 2, who complained that they were always hungry. The Biosphere experiment also suffered from reduced oxygen and high carbon dioxide, which killed many species within the Biosphere. Problems on Mars could not be solved as easily as pumping oxygen from the outside, which was done for the Biosphere.

If problems or illnesses arise on Mars, help is at least 7-12 months away. So, this mission truly is a suicide mission. Fortunately, the sponsors will probably never get enough money to get the mission off the ground.