Atlanta Medical Center Closure

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rowsdower88

rowsdower88

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khn.org

Impending Hospital Closure Rattles Atlanta Health Care Landscape and Political Races - KFF Health News

The nonprofit owners of Atlanta Medical Center, a 460-bed Level 1 trauma center in the heart of the city, plan to close the hospital in November. As many community members worry about the hole the closure will leave in the city’s safety net, the news has thrust health care into the political...
khn.org khn.org

Anyone from Atlanta care to comment on this disaster? This hospital was one of the two Level 1 trauma centers in the city and now the remaining center (Grady) will see an estimated increase of 2500 emergency room visits a month. They're setting up a "24 bed field hospital" and converting offices to patient rooms to help address the load.

The article hedges that this closure may not entirely be due to the lack of medicaid expansion in the state, but it definitely exacerbated the problem given their patient demographics.

The poor of Georgia deserve better.
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This is just the beginning. Hospital systems closed out 2021 with record profits because of all the Covid money. Now that is all gone, they are all stuck with much higher labor costs (>20% across the board) and flat reimbursement.

I’m expecting a large number of closures soon (hospitals & Ascs).
 
nycitygas said:
This is just the beginning. Hospital systems closed out 2021 with record profits because of all the Covid money. Now that is all gone, they are all stuck with much higher labor costs (>20% across the board) and flat reimbursement.

I’m expecting a large number of closures soon (hospitals & Ascs).
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True. Many hospital systems that were +$1billion last year are now forecasting to be -$1billion this year. Some of it has to do with equity market performance but the factors you mentioned are also key components. Recently, there was a high level meeting about stemming the bleeding at our hospital system. Glad we got glidescopes for every room, a bunch of new ultrasound machines and davincis last year.
 
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nycitygas said:
This is just the beginning. Hospital systems closed out 2021 with record profits because of all the Covid money. Now that is all gone, they are all stuck with much higher labor costs (>20% across the board) and flat reimbursement.

I’m expecting a large number of closures soon (hospitals & Ascs).
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Don't forget consolidation of services in region. E.g., fewer places that have L & D, neurointerventional, other surgical subspecialties, etc.
 
There is a thread about this in the EM forums with some Georgia docs’ thoughts, but one of the big points was that the other big “safety net” hospital in Atlanta (Grady) frequently gets big injections of cash from the county to remain solvent while this one doesn’t.
 
This article had a lot of funny statements in it. Like this one

“iliana Bakhtiari, the Atlanta City Council member whose district includes the hospital, was sharp in her assessment. “There will be loss of life and critical injuries that will not be taken care of, and I wish that mattered more to Wellstar,” she said”. Hahaha. Silly Iliana.

Or this one
“If you acquire a hospital, you should have an obligation to fix it up,” said Kane. “Wellstar has the funds to invest in this hospital. It’s a choice.” HAHAHAHA. you’re a funny one Ms Kane.
 
epidural man said:
This article had a lot of funny statements in it. Like this one

“iliana Bakhtiari, the Atlanta City Council member whose district includes the hospital, was sharp in her assessment. “There will be loss of life and critical injuries that will not be taken care of, and I wish that mattered more to Wellstar,” she said”. Hahaha. Silly Iliana.

Or this one
“If you acquire a hospital, you should have an obligation to fix it up,” said Kane. “Wellstar has the funds to invest in this hospital. It’s a choice.” HAHAHAHA. you’re a funny one Ms Kane.
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Politicians are so foolish. I'm not sure where they think the money comes from to run hospitals. Grady gets many millions of dollars every year from Fulton and Dekalb Counties - not sure anything comes from the City of Atlanta itself.

Wellstar lost well over $100 million on Atlanta Medical Center last year. That's simply not sustainable. Throwing good money after bad certainly isn't the answer.

Wellstar purchased AMC from Tenet along with four other Atlanta hospitals at the same time - Tenet would only sell them as a block, not individually. One of the other hospitals closed last year. Had Tenet not insisted on selling the hospitals as a block, I think AMC might have gone under several years ago. Wellstar gave it a good run and finally threw in the towel.
 
epidural man said:
The rise of for-profit hospitals has increased administrative costs and is the MAJOR cause of the slow-death of medicine.
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Consolidation of healthcare and more governmental intervention will be the death of medicine. The Affordable Care Act was a step in the wrong direction. Profit is the reason anyone does anything . YOu take away profit then nobody does anything.. Except us because we HAVE to.
 
OptionOffense said:
Consolidation of healthcare and more governmental intervention will be the death of medicine. The Affordable Care Act was a step in the wrong direction. Profit is the reason anyone does anything . YOu take away profit then nobody does anything.. Except us because we HAVE to.
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I agree. The other lesson out of all of this is that admin will literally close down a hospital before they think about cutting back on administrator numbers/pay.
 
This is what happens when CMS reimburses the way it does. No one will take care of Medicaid patients anymore. Hospitals would rather just shut down and move on. These patients will overall receive progressively worse care as a result until they can't receive care any more despite being "insured." CMS has failed.
 
The first domino to fall. I read that over half the hospitals are currently operating in the red. This is the cost of paying crazy money for staff and nurses when there was a shortage with COVID. I was against the Covid handouts (and most others) because it always seems to make things worse. But I can't fully blame hospitals. It is hard to turn down easy money and staff was a necessity. If many hospitals follow, there will be a glut of staff looking for jobs. That may help drive prices back down to a sustainable level. Or maybe the government may help by stepping in and running things more efficiently by taking control of all of healthcare...
 
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BobLoblaw78 said:
The first domino to fall. I read that over half the hospitals are currently operating in the red. This is the cost of paying crazy money for staff and nurses when there was a shortage with COVID. I was against the Covid handouts (and most others) because it always seems to make things worse. But I can't fully blame hospitals. It is hard to turn down easy money and staff was a necessity. If many hospitals follow, there will be a glut of staff looking for jobs. That may help drive prices back down to a sustainable level. Or maybe the government may help by stepping in and running things more efficiently by taking control of all of healthcare...
Click to expand...
The big $ locums will soon end as this trend goes on.
 
Guillemot said:
Healthcare is a human right. Therefore all doctors are obligated to work for free in order to provide healthcare to the indigent.
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Doctors don’t work for free in socialized systems. Some posters from those countries have shared salaries and they are appealing if you ask me, especially compared to all we deal with in our hospitals.

Maybe the reality is we don’t need a gazillion admins or JCAHO telling us to throw away everything in sight just to do it all again with the next patient.

Yes, hospitals can’t survive on uninsured and Medicaid patients. But Americans can’t survive on the premiums that BCBS charges for high deductible crap care.
 
PainInTheAnes said:
Admin costs are solely a product of governmental regulations that stem from CMS and federal programs like the ACA/COBRA/HIPAA. Jcaho, EMR requirements for meaningful use, HIPAA data protection standards, denial of reimbursement for CAUTI/CLABSI, credentialing systems, and the list goes on.

Almost none of this has made hospitals better in any real sense, but Administrators are required to keep hospitals in compliance with this web of stuff. Otherwise CMS will shut you down.
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I agree but on the other hand this hospital’s finances are freely available online. I’m not sure you need your head of HR making $700k or your “chief nursing officer” to be making $600k to run a successful hospital, for example.
 
PainInTheAnes said:
Admin costs are solely a product of governmental regulations that stem from CMS and federal programs like the ACA/COBRA/HIPAA. Jcaho, EMR requirements for meaningful use, HIPAA data protection standards, denial of reimbursement for CAUTI/CLABSI, credentialing systems, and the list goes on.

Almost none of this has made hospitals better in any real sense, but Administrators are required to keep hospitals in compliance with this web of stuff. Otherwise CMS will shut you down.
Click to expand...
This is SPOT ON. GOvt intervention is what creates wasteful,bureaucratic, inefficient systems.
 
HemeOncHopeful19 said:
I agree but on the other hand this hospital’s finances are freely available online. I’m not sure you need your head of HR making $700k or your “chief nursing officer” to be making $600k to run a successful hospital, for example.
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It is only a problem unless you HemeOncHopeful19 are the one making the 700k. I dont necessarily agree with those salaries but if it is market pay. then so be it who am I to villify someone making money.
 
OptionOffense said:
It is only a problem unless you HemeOncHopeful19 are the one making the 700k. I dont necessarily agree with those salaries but if it is market pay. then so be it who am I to villify someone making money.
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We are still talking about the hospital that closed down because it lost so much money?

I similarly would not expect an Oncologist to suddenly be making 5x the average Oncologist salary without their place of employment going under.
 
OptionOffense said:
It is only a problem unless you HemeOncHopeful19 are the one making the 700k. I dont necessarily agree with those salaries but if it is market pay. then so be it who am I to villify someone making money.
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i don’t see a problem with Actual physicians making this money since they are the ones actually taking care of patients. How much value is the head of HR bringing to the system to result in a 700k salary. All while telling the anesthesia group that they can’t afford to provide a subsidy.
 
HemeOncHopeful19 said:
I agree but on the other hand this hospital’s finances are freely available online. I’m not sure you need your head of HR making $700k or your “chief nursing officer” to be making $600k to run a successful hospital, for example.
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The CNO at a hospital I work drives a 100k car. The hospital itself loses millions of dollars a year.

Can’t wait to see the admin fat get cut soon. There’s really not much other room for cost savings across the board other than shutting down entire service lines.
 
Guillemot said:
Healthcare is a human right. Therefore all doctors are obligated to work for free in order to provide healthcare to the indigent.
Click to expand...
Doctors are, but admin-types aren’t. Why do you think admin salaries are going up while doctors are going down.
 
OptionOffense said:
Consolidation of healthcare and more governmental intervention will be the death of medicine. The Affordable Care Act was a step in the wrong direction. Profit is the reason anyone does anything . YOu take away profit then nobody does anything.. Except us because we HAVE to.
Click to expand...
It isn’t an either-or.

Hospitals were better run when they were non-profit organizations.

Once insurance companies and large corporations started taking over, hospitals needed admin types to figure out how to squeeze the system for every dime to answer to share holders.

There is a graph (I’ll try and find it) that shows that as non-profit hospitals went away and corporations started taking over, the amount of admin workers skyrocketed, and so did costs.
 
epidural man said:
It isn’t an either-or.

Hospitals were better run when they were non-profit organizations.

Once insurance companies and large corporations started taking over, hospitals needed admin types to figure out how to squeeze the system for every dime to answer to share holders.

There is a graph (I’ll try and find it) that shows that as non-profit hospitals went away and corporations started taking over, the amount of admin workers skyrocketed, and so did costs.
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What dictates cost/ prices and what you can or cannot do at the end of the day are CMS rules and the like. Every year they are dialing down reimbursements and increasing the reporting requirements.
Can you imagine telling a car manufacturer that the car that they sold for 25K last year must be sold for 10 percent less this year and the upcoming 4 years while having more standard features and an extended warranty. Can you see what that would look like?
 
Guillemot said:
Healthcare is a human right. Therefore all doctors are obligated to work for free in order to provide healthcare to the indigent.
Click to expand...

Just to be clear, my post was sarcastic. It is paradoxical to believe that something is a human right while also believing this right relies upon forced labor of other humans.

However, in a relatively affluent nation, at least basic healthcare is something that can be afforded to all if the society should so chose to allocate resources towards that service. Right now Medicaid does so in name only as the resources and therefore reimbursement are insufficient to sustain the healthcare system. (As demonstrated by closure of this hospital)
 
A lot of the conversation is being derailed by the broader topic of privatized vs public healthcare.

I don't think that was a realistic choice for anyone involved in the closure of this hospital. The hospital was always privately owned, it was not about to be nationalized nor was that option entertained.

The option before the governor/Georgia congress was to either accept medicaid expansion from the federal government or reject it and they chose the latter. Whether or not that choice resulted in this outcome is debatable, but it certainly didn't help. There are good studies that show medicaid expansion has not only improved access and utilization, but has also benefited state economies and improved the payor mix of hospitals.

www.kff.org

The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020 | KFF

This literature review summarizes findings from 404 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and January 2020. It includes studies, analyses, and reports published by government...
www.kff.org www.kff.org

It seems truly bizarre to me that a state would reject medicaid expansion to maintain some ideological purity over the expense of their poorest citizens.
 
rowsdower88 said:
A lot of the conversation is being derailed by the broader topic of privatized vs public healthcare.

I don't think that was a realistic choice for anyone involved in the closure of this hospital. The hospital was always privately owned, it was not about to be nationalized nor was that option entertained.

The option before the governor/Georgia congress was to either accept medicaid expansion from the federal government or reject it and they chose the latter. Whether or not that choice resulted in this outcome is debatable, but it certainly didn't help. There are good studies that show medicaid expansion has not only improved access and utilization, but has also benefited state economies and improved the payor mix of hospitals.

www.kff.org

The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020 | KFF

This literature review summarizes findings from 404 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and January 2020. It includes studies, analyses, and reports published by government...
www.kff.org www.kff.org

It seems truly bizarre to me that a state would reject medicaid expansion to maintain some ideological purity over the expense of their poorest citizens.
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It’s not just politics.

The feds start reducing the shared costs to 90%. It’s bait and switch.

So it’s barely been a year since it went from free expansion to states sharing Medicaid sharing costs.

People don’t realize how much Medicaid costs and hospital coverage for Medicaid patients

Take my old hospital with 90% Medicaid ob. But hospital requires 24/7 coverage. Ob wasn’t super busy. Around 2000 deliveries a year. But enough to need anesthesia staff in house the vast majority of the time.

Who’s gonna to pay for anesthesia coverage of Medicaid. It’s a losing money service? And now the competition hospital has shut down its ob service 5 miles down the road. So more ob patients coming. Their payor mix is slightly better. But the competition hospital is now sending their ob patients to their sister hospital 12 miles away to the East. And my old hospital gets the leftover Medicaid population which makes it even worse.

As for amc. Emory Grady will be absolutely destroyed. A very similar thing happened in wash dc when the city hospital dc general closed. It dumped all
The indigent population to the city major trauma 1 center
 
aneftp said:
It’s not just politics.

The feds start reducing the shared costs to 90%. It’s bait and switch.

So it’s barely been a year since it went from free expansion to states sharing Medicaid sharing costs.

People don’t realize how much Medicaid costs and hospital coverage for Medicaid patients

Take my old hospital with 90% Medicaid ob. But hospital requires 24/7 coverage. Ob wasn’t super busy. Around 2000 deliveries a year. But enough to need anesthesia staff in house the vast majority of the time.

Who’s gonna to pay for anesthesia coverage of Medicaid. It’s a losing money service? And now the competition hospital has shut down its ob service 5 miles down the road. So more ob patients coming. Their payor mix is slightly better. But the competition hospital is now sending their ob patients to their sister hospital 12 miles away to the East. And my old hospital gets the leftover Medicaid population which makes it even worse.

As for amc. Emory Grady will be absolutely destroyed. A very similar thing happened in wash dc when the city hospital dc general closed. It dumped all
The indigent population to the city major trauma 1 center
Click to expand...

I'm not sure I understand your argument.

The states have always been paying into medicaid. It's a federal-state partnership. The medicaid expansion reached a larger portion of individuals who both didn't have health insurance nor medicaid. The alternative to not taking the expansion is just the states/private companies paying for the loss. The expansion is free money... relative to that alternative, no?

So the OB job you had that was 90% medicaid, the remaining 10% was either uninsured entirely (a wash for the hospital) or privately insured. Reducing the amount of uninsured benefits the hospital and you either way. Unless your argument is that the people who would have taken the medicaid expansion would have instead gotten private insurance... which I doubt.

But I agree that things aren't looking good for Grady in the near term.
 
rowsdower88 said:
I'm not sure I understand your argument.

The states have always been paying into medicaid. It's a federal-state partnership. The medicaid expansion reached a larger portion of individuals who both didn't have health insurance nor medicaid. The alternative to not taking the expansion is just the states/private companies paying for the loss. The expansion is free money... relative to that alternative, no?

So the OB job you had that was 90% medicaid, the remaining 10% was either uninsured entirely (a wash for the hospital) or privately insured. Reducing the amount of uninsured benefits the hospital and you either way. Unless your argument is that the people who would have taken the medicaid expansion would have instead gotten private insurance... which I doubt.

But I agree that things aren't looking good for Grady in the near term.
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You cannot function as anesthesia practice having to cover ob with 90% Medicaid. The payments for Medicaid are around $100. 6-7 deliveries or c/s a day won’t even pay for 1/2 CRNA coverage for 24 hours. Anesthesia cannot take a loss with staffing.

Medicaid expansion doesn’t help with my old hospital. It’s 10% private pay. 90% Medicaid.

Federal/state is 55/45% joint funding for Medicaid.

The expansion (was) covered by the feds (the state’s share of the 45%). Up until 2020. Remember we don’t know what impact the coverage will do since so many hospitals got Covid money.

So really 2022 is the first year the states with Medicaid expansion are really having to fork over 10-% cost sharing. It’s no longer free expansion.

If u really think it’s sustainable for the states. Wait till it hits the local budgets. Some states especially down south spend 20% plus of their own annual budget on Medicaid.

Medicaid Expenditures as a Percent of Total State Expenditures by Fund | KFF

www.kff.org www.kff.org
 
aneftp said:
You cannot function as anesthesia practice having to cover ob with 90% Medicaid. The payments for Medicaid are around $100. 6-7 deliveries or c/s a day won’t even pay for 1/2 CRNA coverage for 24 hours. Anesthesia cannot take a loss with staffing.

Medicaid expansion doesn’t help with my old hospital. It’s 10% private pay. 90% Medicaid.

Federal/state is 55/45% joint funding for Medicaid.

The expansion (was) covered by the feds (the state’s share of the 45%). Up until 2020. Remember we don’t know what impact the coverage will do since so many hospitals got Covid money.

So really 2022 is the first year the states with Medicaid expansion are really having to fork over 10-% cost sharing. It’s no longer free expansion.

If u really think it’s sustainable for the states. Wait till it hits the local budgets. Some states especially down south spend 20% plus of their own annual budget on Medicaid.

Medicaid Expenditures as a Percent of Total State Expenditures by Fund | KFF

www.kff.org www.kff.org
Click to expand...

So your argument isn't against medicaid expansion, so much as an argument that it is insufficient on its own to address the problem.

I don't have a problem with that.

At your old hospital with the 90:10 ratio, there was no one who fell through the cracks between medicaid and private insurance? Because that's precisely the hole the expansion was trying to fix.
 
PainInTheAnes said:
Well the research you cited shows that utilization increased in most places that looked at Medicaid expansion. Medicaid reimbursement does not cover the costs or even come close to it for the conditions that the uninsured now want treated. Additionally, hospitals can’t just turn away insured patients so they’re requiring subsidy from state government to make their hospitals financially viable.

The issue I think is that poverty leads to huge healthcare costs. It’s fine to expand Medicaid in states with great private insurance rates with hospitals that can absorb some Medicaid, but when that happens in a poor state you’ve just volunteered these hospitals to get huge subsidies to adequately staff.

Where are a bunch of anesthesiologists going to come from to take the patients that are in states with Medicaid expansion? The state government will subsidize them, and that state will hemorrhage money by taking on Medicaid patients with the inadequate reimbursement they get.
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But the study I cited suggests that state governments are benefited by Medicaid expansion in terms of the overall economy. The guy who is able to get his shoulder surgery can go back to work etc...

In addition, KFF report suggests that overall payor mix is improved following the expansion.

Subsidizing poor people's healthcare is usually fine. The outcomes of doing so with medicaid expansion seem overwhelmingly positive.
 
rowsdower88 said:
So your argument isn't against medicaid expansion, so much as an argument that it is insufficient on its own to address the problem.

I don't have a problem with that.

At your old hospital with the 90:10 ratio, there was no one who fell through the cracks between medicaid and private insurance? Because that's precisely the hole the expansion was trying to fix.
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No. A management company came in and said they could do the contract for 1/2 the subsidy with more “efficient “ billing.

Guess what happened? It cost the hospital 2x as much the next year and they had to put an even bigger subsidy for the AMC vs the private group.

That’s what happen. And than the hospital kicked the management company out after 4 years and took everything in house and still continues to bleed money on ob services.

That’s my argument. Ob Medicaid is a money loser when it’s 90% Medicaid.

These satellite hospitals will eventually shut down all ob services and force women to drive 25-30 miles to closest tertiary women’s hospital.

That’s what Medicaid does cause hospital likes Atlanta medical center can’t continue to operate at a loss due to Medicaid.
 
OptionOffense said:
What dictates cost/ prices and what you can or cannot do at the end of the day are CMS rules and the like. Every year they are dialing down reimbursements and increasing the reporting requirements.
Can you imagine telling a car manufacturer that the car that they sold for 25K last year must be sold for 10 percent less this year and the upcoming 4 years while having more standard features and an extended warranty. Can you see what that would look like?
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You are right. That is a large contributor in a complex system with many factors.
 
You never know. There may have been many players in the backround gambling and actively lobbying for the failure of this hospital to gain market share. Look at who is to benefit from the closure
 
aneftp said:
No. A management company came in and said they could do the contract for 1/2 the subsidy with more “efficient “ billing.

Guess what happened? It cost the hospital 2x as much the next year and they had to put an even bigger subsidy for the AMC vs the private group.

That’s what happen. And than the hospital kicked the management company out after 4 years and took everything in house and still continues to bleed money on ob services.

That’s my argument. Ob Medicaid is a money loser when it’s 90% Medicaid.

These satellite hospitals will eventually shut down all ob services and force women to drive 25-30 miles to closest tertiary women’s hospital.

That’s what Medicaid does cause hospital likes Atlanta medical center can’t continue to operate at a loss due to Medicaid.
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I think we're talking past each other.

But that's ok, this is the internet.

It doesn't sound like you fully understand what Medicaid expansion is or the problem it's trying to fix.

Arguing that an individual practice cannot sustain a high percentage of Medicaid patients doesn't mean Medicaid expansion is a bad idea.
 
rowsdower88 said:
I think we're talking past each other.

But that's ok, this is the internet.

It doesn't sound like you fully understand what Medicaid expansion is or the problem it's trying to fix.

Arguing that an individual practice cannot sustain a high percentage of Medicaid patients doesn't mean Medicaid expansion is a bad idea.
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I understand Medicaid expansion.

It’s for childless adults in poverty. I totally get Medicaid expansion

What you don’t understand is Roberts barely upheld half of Obamacare making up his own interpretation of the laws of this country.

But the vast majority of the Supreme Court understood state rights not being forced to accept Medicaid expansion.

It’s up to the individual states to decide. And some stated cannot afford even to contribute 10% more to Medicaid now that the govt doesn’t kickback 100% subsidy. Remember the Cornhusker kickback? Where in exchange for the Nebraska senator vote in 2009? The senator wanted his state to be guarantee 100% Medicaid federal subsidy for the expansion forever.

So yes. I understand the laws and Medicaid expansion
 
aneftp said:
I understand Medicaid expansion.

It’s for childless adults in poverty. I totally get Medicaid expansion

What you don’t understand is Roberts barely upheld half of Obamacare making up his own interpretation of the laws of this country.

But the vast majority of the Supreme Court understood state rights not being forced to accept Medicaid expansion.

It’s up to the individual states to decide. And some stated cannot afford even to contribute 10% more to Medicaid now that the govt doesn’t kickback 100% subsidy. Remember the Cornhusker kickback? Where in exchange for the Nebraska senator vote in 2009? The senator wanted his state to be guarantee 100% Medicaid federal subsidy for the expansion forever.

So yes. I understand the laws and Medicaid expansion
Click to expand...

download-1_5OzzwuAX.jpg


Edit: The discussion doesn't need to be brought back to a**hat constitutional law. No one is disputing that Georgia politicians have the authority at this point in time to meaninglessly disenfranchise their citizens of needed federal funds.

The evidence suggests that medicaid expansion has been beneficial for both state citizens and their government's financials in states that have accepted. If the states which refused are struggling to pay for their share of medicaid expansion, they should raise taxes and stop defrauding their citizens with Brett Favre schemes.
 
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rowsdower88 said:
I'm not sure I understand your argument.
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You do understand that you are arguing with a guy who bought a $10,000 TV to check his work email so that he could write it off on his taxes don't you?
 
rowsdower88 said:
View attachment 359928

Edit: The discussion doesn't need to be brought back to a**hat constitutional law. No one is disputing that Georgia politicians have the authority at this point in time to meaninglessly disenfranchise their citizens of needed federal funds.

The evidence suggests that medicaid expansion has been beneficial for both state citizens and their government's financials in states that have accepted. If the states which refused are struggling to pay for their share of medicaid expansion, they should raise taxes and stop defrauding their citizens with Brett Favre schemes.
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On the topic of raising taxes. Notice the New Yorkers who make their money or get their state pension and than escape down to Florida to avoid taxes.

Eventually the tax base (aka the working class even the upper working class like the docs/lawyers etc) leave. Lose the working tax base. You end up like Detroit. So only so much taxes you can can raise.
 
nycitygas said:
This is just the beginning. Hospital systems closed out 2021 with record profits because of all the Covid money. Now that is all gone, they are all stuck with much higher labor costs (>20% across the board) and flat reimbursement.

I’m expecting a large number of closures soon (hospitals & Ascs).
Click to expand...

How poor hospitals continue to operate despite their financial disadvantage is something I didn't understand even before COVID.

The details of the financial relationships of these hospitals and the state and federal funding are poorly understood by those outside the highest levels of the hospital. I believe that its way more complicated than just bad medicaid reimbursements and medicaid expansion. Different states have different incentives for different population metrics, different patterns of funding/corruption state to state and hospital to hospital.

There are hospitals near me that have been open for decades, surrounded by absolute poverty in an otherwise rural setting. Former factory towns now just havens for drug addicts. Yet they have a huge functioning (but not great) private hospital.. how? I don't get it.

So while it makes sense that many hospitals can't sustain - I believe somehow they will, like they always have.... due to some (probably corrupt) financial relationship with the government that I dont understand..

Why this particular poor hospital closed I suspect had something to do with politics or corporate interests on a high level that made the decision to let it fail.
 
Hoya11 said:
How poor hospitals continue to operate despite their financial disadvantage is something I didn't understand even before COVID.

The details of the financial relationships of these hospitals and the state and federal funding are poorly understood by those outside the highest levels of the hospital. I believe that its way more complicated than just bad medicaid reimbursements and medicaid expansion. Different states have different incentives for different population metrics, different patterns of funding/corruption state to state and hospital to hospital.

There are hospitals near me that have been open for decades, surrounded by absolute poverty in an otherwise rural setting. Former factory towns now just havens for drug addicts. Yet they have a huge functioning (but not great) private hospital.. how? I don't get it.

So while it makes sense that many hospitals can't sustain - I believe somehow they will, like they always have.... due to some (probably corrupt) financial relationship with the government that I dont understand..

Why this particular poor hospital closed I suspect had something to do with politics or corporate interests on a high level that made the decision to let it fail.
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Do you have any evidence that poor hospitals are engaging in these financially corrupt practices routinely? It sounds like you're just making this up.

If you just think poor people/hospitals must be corrupt in order to survive in the American Healthcare system then there should be some evidence you can point to. Whistle-blower testimony, lawsuits, records...

Maybe the private hospitals you're talking about renovate less frequently or don't pay their CEO's as much and are able to get by with legal state subsidies.
 
Hoya11 said:
How poor hospitals continue to operate despite their financial disadvantage is something I didn't understand even before COVID.

The details of the financial relationships of these hospitals and the state and federal funding are poorly understood by those outside the highest levels of the hospital. I believe that its way more complicated than just bad medicaid reimbursements and medicaid expansion. Different states have different incentives for different population metrics, different patterns of funding/corruption state to state and hospital to hospital.

There are hospitals near me that have been open for decades, surrounded by absolute poverty in an otherwise rural setting. Former factory towns now just havens for drug addicts. Yet they have a huge functioning (but not great) private hospital.. how? I don't get it.

So while it makes sense that many hospitals can't sustain - I believe somehow they will, like they always have.... due to some (probably corrupt) financial relationship with the government that I dont understand..

Why this particular poor hospital closed I suspect had something to do with politics or corporate interests on a high level that made the decision to let it fail.
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The constituency that use that hospital need to organize and make their voices heard to keep it open in the form of mass protests, calling out their local politicians ( phone calls, media blitz)etc etc and more importantly vote all the jack arses out of office and have them NEVER to return.
 
rowsdower88 said:
Do you have any evidence that poor hospitals are engaging in these financially corrupt practices routinely? It sounds like you're just making this up.

If you just think poor people/hospitals must be corrupt in order to survive in the American Healthcare system then there should be some evidence you can point to. Whistle-blower testimony, lawsuits, records...

Maybe the private hospitals you're talking about renovate less frequently or don't pay their CEO's as much and are able to get by with legal state subsidies.
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didnt mean to sound like a conspiracy theory.

just meant that we as physicians dont understand how the finances work of a major hospital

its not like our practices where it survives on insurance reimbursements vs staffing costs.. other factors at play that we dont understand..
 
Hoya11 said:
didnt mean to sound like a conspiracy theory.

just meant that we as physicians dont understand how the finances work of a major hospital

its not like our practices where it survives on insurance reimbursements vs staffing costs.. other factors at play that we dont understand..
Click to expand...
Not corruption, but an example of what I think you are referring to:

I work for a well-respected, well-connected hospital in a large city. The hospital does well but has a lot of Medicaid. It routinely receives multimillion dollar grants from the state government as earmarks/pork in legislation, despite having some of the highest paid c-suite types in the city. We do have several lobbyists.

No physician group or politically unconnected hospital would have a prayer of getting these earmarks, and it’s why the hospital continues to dominate the area and now employs many formerly independent physicians groups that work there.
 
Predictable. Diminishing revenues from homeless patients having multidrug resistant infections ensuring that the hospital cannot discharge them, revenue from high reimbursing elective spine and other complex surgeries that are cancelled because the hospital cannot guarantee post operative room availability, rising utility and supply costs, and a growing percentage of patients without US citizenship making them ineligible for medicaid and medicare. This coupled with the rising employment costs for nursing and every other staff position (except physicians).
 
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