Private Practice is not Dead Yet...

[Tenesma]

i sit on the board of my hospital - and familiar with the finances of the parent hospital - and our system is about to be swallowed up by an even larger parent hospital.

the acquisitionss/buildings that have occured are typically either bonded or covered by foundational/fundraising contributions. And some are seen as "strategic"investments although were in fact, and always be loss leaders... Ie: building a "cancer center" right across the street from a large and very well respected large (but private) cancer center...

In new england, the hospitals are really struggling financially across the board - the only ones that tend to do well are the ones affiliated with a large research/teaching hospital --- the rest are just lucky to survive every year.
although they probably all would be in better shape if they weren't hiring consultants all the time to do the work of the expensive administrators.

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[Baritonebass]

i sit on the board of my hospital - and familiar with the finances of the parent hospital - and our system is about to be swallowed up by an even larger parent hospital.

the acquisitionss/buildings that have occured are typically either bonded or covered by foundational/fundraising contributions. And some are seen as "strategic"investments although were in fact, and always be loss leaders... Ie: building a "cancer center" right across the street from a large and very well respected large (but private) cancer center...

In new england, the hospitals are really struggling financially across the board - the only ones that tend to do well are the ones affiliated with a large research/teaching hospital --- the rest are just lucky to survive every year.
although they probably all would be in better shape if they weren't hiring consultants all the time to do the work of the expensive administrators.

My wife is a fellow at one of those hospitals affiliated with Best Medical School and her division is plagued with inefficiencies and survives primarily on large donations and poor compensation to the clinical faculty. She regretted her division in 4 weeks but is stuck in a 3 year surgical fellowship.

 

[ampaphb]

i sit on the board of my hospital - and familiar with the finances of the parent hospital - and our system is about to be swallowed up by an even larger parent hospital.

the acquisitionss/buildings that have occured are typically either bonded or covered by foundational/fundraising contributions. And some are seen as "strategic"investments although were in fact, and always be loss leaders... Ie: building a "cancer center" right across the street from a large and very well respected large (but private) cancer center...

In new england, the hospitals are really struggling financially across the board - the only ones that tend to do well are the ones affiliated with a large research/teaching hospital --- the rest are just lucky to survive every year.
although they probably all would be in better shape if they weren't hiring consultants all the time to do the work of the expensive administrators.

This is something I don't get. In certain regions, hospitals are huge money makers. In the northeast, they are hanging on by a thread, and many are closing. Is this a reimbursement disparity? A result of poor management? Or some other structural disconnect too complicated for this simple-minded doc from Louisiana to understand?

 

[Tenesma]

there are several factors that i can see as a doc, but also as a board member...

1) many of the north-east states are in financial straits (too many big promises that they can't keep up with - they can't fund pension plans, etc)... so many of them have been using gimmicks to balance their budget, and one of them is to tax hospitals. Now when those hospital taxes/licensing fees were brought to the table, they came with the promise that hospitals would get even bigger state funding to reimburse for medicaid/non-insured care. However over the last 5-6 years, the hospital taxes have gone up and the state funding has dropped dramatically. Which basically means hospitals are being tapped to help close budget gaps...
2) reimbursements/managed care in the north-east is generally terrible - so less income
3) there is a bigger density of hospitals per region/population - so several hospitals are having to fight each other for patients - to the detriment of their own finances (only lately we have started to see some degree of hospital aquisitions and mergers).

 

[Aether2000]

We have much less managed care in the midwest. Nearly every hospital in the state has had major building projects over the past 3 years with several building entire new hospitals. Ohio is not far behind. The systems of hospitals are getting huge with at least 1/3 no longer independent.