For profit psych hospitals

[Merely]

What do you guys think of working at a place like this? Some of the stories I’ve read are very shady. What kind of doctors work at these places? Why would a doctor want to work here if they pressure you to act unethically?

UHS can't dodge claims it held patients illegally, investors say

Shareholders who have been in a legal fight with Universal Health Services since 2017 have argued the King of Prussia, Pa.-based hospital operator can't dismiss claims it fueled revenues by exaggerating patients' risk of suicide and involuntarily committing them to its psychiatric hospitals.

www.beckershospitalreview.com

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[Armadillos]

Personally I wouldn’t work at one, too much shady stuff.

For example, the DC summaries I get from one are obviously a template (one for SI another for psychosis/mania) and you can tell a lawyer wrote it, so the psychiatrists are essentially fraudulently signing off that every single patient has the exact same upward trajectory during hospital course with all risks optimally mitigated by DC. Then I see patients 8-12hrs after they walk out door and they are floridly psychotic or still manic. This isn’t unique to UHS, another for profit hospital I get summaries from does the exact same stuff.

 

[splik]

For example, the DC summaries I get from one are obviously a template (one for SI another for psychosis/mania) and you can tell a lawyer wrote it, so the psychiatrists are essentially fraudulently signing off that every single patient has the exact same upward trajectory during hospital course with all risks optimally mitigated by DC. Then I see patients 8-12hrs after they walk out door and they are floridly psychotic or still manic. This isn’t unique to UHS, another for profit hospital I get summaries from does the exact same stuff.

Interesting, because I moonlighted at a for profit hospital some years ago and they also had a DC summary template. There was only one template that was so vague/generic that it was useless. It wasn't written by a lawyer either. They pressured me to keep patients longer than necessary if insurance was still paying which is of course unethical especially if the patient no longer meets criteria for involuntary hospitalization. The medical director admonished me for discharging my patients. Staffing was poor. The patient to nurse ratio was high. The social workers weren't actually social workers. There were no real groups. Most of the psychiatrists spent a few mins with the patient and there were lots of patients. The note templates were all box ticking. The pay was very good though (but you worked for it). I only worked there because they did not require credentialing (!) and so I was able to start immediately and I needed the money. I would never work at a for profit hospital now.

 

[nexus73]

Doctors take these jobs basically for one of 4 reasons: they’re dumb, they’re desperate, they’re divorced (with alimony/child support to pay), or in debt.

 

[Armadillos]

Interesting, because I moonlighted at a for profit hospital some years ago and they also had a DC summary template. There was only one template that was so vague/generic that it was useless. It wasn't written by a lawyer either. They pressured me to keep patients longer than necessary if insurance was still paying which is of course unethical especially if the patient no longer meets criteria for involuntary hospitalization. The medical director admonished me for discharging my patients. Staffing was poor. The patient to nurse ratio was high. The social workers weren't actually social workers. There were no real groups. Most of the psychiatrists spent a few mins with the patient and there were lots of patients. The note templates were all box ticking. The pay was very good though (but you worked for it). I only worked there because they did not require credentialing (!) and so I was able to start immediately and I needed the money. I would never work at a for profit hospital now.

This sounds very similar to what I hear about UHS hospitals here. Although I can’t imagine the chaos in our state’s ERs if UHS facilities closed, so I guess they have built themselves to be “too big to fail”.

 

[Merely]

Interesting, because I moonlighted at a for profit hospital some years ago and they also had a DC summary template. There was only one template that was so vague/generic that it was useless. It wasn't written by a lawyer either. They pressured me to keep patients longer than necessary if insurance was still paying which is of course unethical especially if the patient no longer meets criteria for involuntary hospitalization. The medical director admonished me for discharging my patients. Staffing was poor. The patient to nurse ratio was high. The social workers weren't actually social workers. There were no real groups. Most of the psychiatrists spent a few mins with the patient and there were lots of patients. The note templates were all box ticking. The pay was very good though (but you worked for it). I only worked there because they did not require credentialing (!) and so I was able to start immediately and I needed the money. I would never work at a for profit hospital now.

How is it that they pay more is my question, like wouldn’t you make the same working at a nonprofit but seeing the same amount of pt but being more ethical and less pressured

 

[FlowRate]

This sounds very similar to what I hear about UHS hospitals here. Although I can’t imagine the chaos in our state’s ERs if UHS facilities closed, so I guess they have built themselves to be “too big to fail”.

Same, they take the majority of our chronic homeless/secondary gain patients (the ones we can't manage to discharge.) It's a huge problem in that it enables us to continue avoiding difficult discharges and makes those hospitals scary places for patients and staff.

 

[Mass Effect]

From the article posted:

"UHS psychiatric hospitals kept patients longer than necessary and against their will to maximize reimbursement from insurers. "

Isn't it just kidnapping at that point? Hoping for criminal prosecution for such cases.

 

[Mass Effect]

Same, they take the majority of our chronic homeless/secondary gain patients (the ones we can't manage to discharge.) It's a huge problem in that it enables us to continue avoiding difficult discharges and makes those hospitals scary places for patients and staff.

All the more reason they should be shut down.

 

[PikminOC]

Doctors take these jobs basically for one of 4 reasons: they’re dumb, they’re desperate, they’re divorced (with alimony/child support to pay), or in debt.

Almost every physician has phat med school loans. Still doesn't mean they should do shady things

 

[PikminOC]

From the article posted:

"UHS psychiatric hospitals kept patients longer than necessary and against their will to maximize reimbursement from insurers. "

Isn't it just kidnapping at that point? Hoping for criminal prosecution for such cases.

I have seen this. Five day involuntary holds

 

[PikminOC]

How is it that they pay more is my question, like wouldn’t you make the same working at a nonprofit but seeing the same amount of pt but being more ethical and less pressured

Look at any non-profit CEO pay. They are shady too

 

[Armadillos]

Look at any non-profit CEO pay. They are shady too

Although to be fair, one or two non profit execs bringing home a couple million is nothing to whatever UHS brings its shareholders, think it’s something like 250 million a quarter profit, and that’s after paying their execs millions as well.

 

[dl2dp2]

This is highly unusual and frankly a very unique situation.

1) most inpatient stays are paid by third party, and most third party now use Medicare style bundled payment.
2) the usual pressure is therefore discharging too early, not too late.
3) even then, very often payers don't pay enough for inpatient stays, which means a lot of them are not profitable, but are mandated to exist for regluatory reasons. When a hospital tries to shut down an inpatient psych unit, it often requires layers of review, and can be administratively rejected.
4) this is not a known profit center (legit or not) in mental health, and large provider organizations are in general shutting things down rather than growing things out.

Private subspecialty hospitals do exist, and many can be quite lucrative. However, even then they are typically structured as a non-profit for a variety of reasons, typically because the business models are very local and not scalable.

 

[PikminOC]

Although to be fair, one or two non profit execs bringing home a couple million is nothing to whatever UHS brings its shareholders, think it’s something like 250 million a quarter profit, and that’s after paying their execs millions as well.

Non profits pay multiple people alot more than a few mil

 

[Merely]

This is highly unusual and frankly a very unique situation.

1) most inpatient stays are paid by third party, and most third party now use Medicare style bundled payment.
2) the usual pressure is therefore discharging too early, not too late.
3) even then, very often payers don't pay enough for inpatient stays, which means a lot of them are not profitable, but are mandated to exist for regluatory reasons. When a hospital tries to shut down an inpatient psych unit, it often requires layers of review, and can be administratively rejected.
4) this is not a known profit center (legit or not) in mental health, and large provider organizations are in general shutting things down rather than growing things out.

Private subspecialty hospitals do exist, and many can be quite lucrative. However, even then they are typically structured as a non-profit for a variety of reasons, typically because the business models are very local and not scalable.

I’m very confused by what you’re saying

 

[Armadillos]

This is highly unusual and frankly a very unique situation.

1) most inpatient stays are paid by third party, and most third party now use Medicare style bundled payment.
2) the usual pressure is therefore discharging too early, not too late.
3) even then, very often payers don't pay enough for inpatient stays, which means a lot of them are not profitable, but are mandated to exist for regluatory reasons. When a hospital tries to shut down an inpatient psych unit, it often requires layers of review, and can be administratively rejected.
4) this is not a known profit center (legit or not) in mental health, and large provider organizations are in general shutting things down rather than growing things out.

Private subspecialty hospitals do exist, and many can be quite lucrative. However, even then they are typically structured as a non-profit for a variety of reasons, typically because the business models are very local and not scalable.

Look up UHS financial info, they are profiting hundreds of millions a quarter. Although I haven’t looked enough to be certain that is primarily from inpatient psychiatric care, but my understanding is it is.

So you may be correct that providing good psychiatric isn’t profitable, doing sketchy stuff apparently is quite profitable.

The accusations aren’t that UHS is turning 4 day voluntary stays into 10 day stays, it’s that they take folks who may not have even needed admission at all in first place, then end up involuntarily admitting them. And then on other side also inappropriately DCing other patients too soon for financial reasons.

 

[dl2dp2]

Look up UHS financial info, they are profiting hundreds of millions a quarter. Although I haven’t looked enough to be certain that is primarily from inpatient psychiatric care, but my understanding is it is.

So you may be correct that providing good psychiatric isn’t profitable, doing sketchy stuff apparently is quite profitable.

The accusations aren’t that UHS is turning 4 day voluntary stays into 10 day stays, it’s that they take folks who may not have even needed admission at all in first place, then end up involuntarily admitting them.

No, I understand that. I'm just saying this is really weird and unusual. Very commonly every admission you take you lose money, so hospitals are fighting to NOT take admissions. I'm actually not sure which part of the system set up got weird in this story that made this feasible to occur. Like why is their reimbursement model not bundled, and if it is, why is it so high such that it can spin a high profit? Typically to maximize profit you want relatively easy voluntary patients with good insurance who come in and out, in and out, etc. Not turn well patients into sick patients that occupy your beds and time from your mental health lawyers. Very strange.

 

[Merely]

No, I understand that. I'm just saying this is really weird and unusual. Very commonly every admission you take you lose money, so hospitals are fighting to NOT take admissions. I'm actually not sure which part of the system set up got weird in this story that made this feasible to occur. Like why is their reimbursement model not bundled, and if it is, why is it so high such that it can spin a high profit? Typically to maximize profit you want relatively easy voluntary patients with good insurance who come in and out, in and out, etc. Not turn well patients into sick patients that occupy your beds and time from your mental health lawyers. Very strange.

They have 100 beds and they need to fill those beds with people who have insurance so they can get paid. I don’t understand what is strange about that..otherwise their beds are empty and they make no money

 

[Armadillos]

No, I understand that. I'm just saying this is really weird and unusual. Very commonly every admission you take you lose money, so hospitals are fighting to NOT take admissions. I'm actually not sure which part of the system set up got weird in this story that made this feasible to occur. Like why is their reimbursement model not bundled, and if it is, why is it so high such that it can spin a high profit? Typically to maximize profit you want relatively easy voluntary patients with good insurance who come in and out, in and out, etc. Not turn well patients into sick patients that occupy your beds and time from your mental health lawyers. Very strange.

The accusation I believe is potential patient talks to the screening people on phone or in person for eval. If they have insurance and beds are open then screeners do everything possible to convert this to admission, including involuntary if patient hesitant. As patient is relatively well from the start, then it’s easy to hold them exactly long enough to maximize payment then immediately DC. (I’m sure mechanics of process is different state to state depending on commitment law, but would be trivial to do in my state).

This is based on article I read a year ago, haven’t looked into it much more recently.

 

[Mass Effect]

Look up UHS financial info, they are profiting hundreds of millions a quarter. Although I haven’t looked enough to be certain that is primarily from inpatient psychiatric care, but my understanding is it is.

So you may be correct that providing good psychiatric isn’t profitable, doing sketchy stuff apparently is quite profitable.

The accusations aren’t that UHS is turning 4 day voluntary stays into 10 day stays, it’s that they take folks who may not have even needed admission at all in first place, then end up involuntarily admitting them. And then on other side also inappropriately DCing other patients too soon for financial reasons.

This. Someone needs to sue for malpractice in every one of these cases. Just another example of people taking advantage of the mentally ill. The fact that it's those who are supposed to be treating and advocating for them is even more sickening.

 

[FlowRate]

No, I understand that. I'm just saying this is really weird and unusual. Very commonly every admission you take you lose money, so hospitals are fighting to NOT take admissions. I'm actually not sure which part of the system set up got weird in this story that made this feasible to occur. Like why is their reimbursement model not bundled, and if it is, why is it so high such that it can spin a high profit? Typically to maximize profit you want relatively easy voluntary patients with good insurance who come in and out, in and out, etc. Not turn well patients into sick patients that occupy your beds and time from your mental health lawyers. Very strange.

The units are usually understaffed in terms of qualifications and number of staff. Good luck getting through to an actual MD at any of the UHS hospitals around here. Endless stories of patients being assaulted/raped by other patients on those units given the checks aren't done as frequently as they should and little thought goes into rooming. (Almost led to them being shut down in this state not too long ago.)

It's basically just the idea of cutting costs even when it means sacrificing quality until you get to a point where admissions are profitable.

 

[Mass Effect]

The units are usually understaffed in terms of qualifications and number of staff. Good luck getting through to an actual MD at any of the UHS hospitals around here. Endless stories of patients being assaulted/raped by other patients on those units given the checks aren't done as frequently as they should and little thought goes into rooming. (Almost led to them being shut down in this state not too long ago.)

It's basically just the idea of cutting costs even when it means sacrificing quality until you get to a point where admissions are profitable.

So we're talking insurance fraud, keeping people against their will, interpersonal violence, poor care. Why aren't more psychiatrists, psych nurses, and mental health advocates exposing this on a daily basis? If we want to talk about cleaning up the stigma against mental illness, places like this should be shut down ASAP.

 

[MedMan80]

Doctors take these jobs basically for one of 4 reasons: they’re dumb, they’re desperate, they’re divorced (with alimony/child support to pay), or in debt.

I'll add visa obligations to that list...

 

[PikminOC]

This. Someone needs to sue for malpractice in every one of these cases. Just another example of people taking advantage of the mentally ill. The fact that it's those who are supposed to be treating and advocating for them is even more sickening.

No lawyer will take the case if not enough damages

 

[PikminOC]

So we're talking insurance fraud, keeping people against their will, interpersonal violence, poor care. Why aren't more psychiatrists, psych nurses, and mental health advocates exposing this on a daily basis? If we want to talk about cleaning up the stigma against mental illness, places like this should be shut down ASAP.

These places have alot more clout than doctors. They lobby the govt. No one wants to stick their neck out and get it chopped off

 

[Mass Effect]

These places have alot more clout than doctors. They lobby the govt. No one wants to stick their neck out and get it chopped off

Just one of the many issues with medicine...

 

[Merely]

Can anyone explain why doctor at these facilities can make more money than usual? I don’t see why that’s the case if they can see the same number of patients elsewhere

 

[Taddy Mason]

Can anyone explain why doctor at these facilities can make more money than usual? I don’t see why that’s the case if they can see the same number of patients elsewhere

They’re generally seeing many more patients, have outpatient responsibilities in addition to a heavy inpatient load, and/or are covering 3-4 different units or hospitals.

 

[Merely]

They’re generally seeing many more patients, have outpatient responsibilities in addition to a heavy inpatient load, and/or are covering 3-4 different units or hospitals.

But if you cover the same amount at a more ethical place you’d make the same?

 

[BiscoDisco]

Can anyone explain why doctor at these facilities can make more money than usual? I don’t see why that’s the case if they can see the same number of patients elsewhere

How much do they usually make?

 

[Merely]

Interesting, because I moonlighted at a for profit hospital some years ago and they also had a DC summary template. There was only one template that was so vague/generic that it was useless. It wasn't written by a lawyer either. They pressured me to keep patients longer than necessary if insurance was still paying which is of course unethical especially if the patient no longer meets criteria for involuntary hospitalization. The medical director admonished me for discharging my patients. Staffing was poor. The patient to nurse ratio was high. The social workers weren't actually social workers. There were no real groups. Most of the psychiatrists spent a few mins with the patient and there were lots of patients. The note templates were all box ticking. The pay was very good though (but you worked for it). I only worked there because they did not require credentialing (!) and so I was able to start immediately and I needed the money. I would never work at a for profit hospital now.

How much do they usually make?

He said he made really good money but I was wondering why that is the case

 

[finalpsychyear]

But if you cover the same amount at a more ethical place you’d make the same?

More ethical = less patients = less $.

Most of your posts are always asking about money are you a PGY 1 now? If so, there will be several attendings you come across who will give you more feedback on maxing your $ as they are probably doing side gigs. You already have that business type of mindset and so long as you want to work hard your sanity is all that will limit your income.

 

[Merely]

More ethical = less patients = less $.

Most of your posts are always asking about money are you a PGY 1 now? If so, there will be several attendings you come across who will give you more feedback on maxing your $ as they are probably doing side gigs. You already have that business type of mindset and so long as you want to work hard your sanity is all that will limit your income.

Thx for your insight

 

[Sushirolls]

I set foot in one of the for profit hospitals very briefly because I drank the koolaid of puppies, kittens and unicorns. They said the right things but after the first week open, so too was my resignation upon discovering the lies.

The for profit model can work, but unfortunately these companies are all doing the same thing, of replicating on scale to maximize profits at all hospitals and possible sell off to the big player in town, UHS.

Its not as simply or as shut down the for profits as some sabbar rattles are claiming on here.
I have worked at a not for profit that is just as bad in its way.
I've seen countless non-profit community mental health agencies that have their own crisis beds, or addiction centers, fail to serve their mission by also under staffing, and burning thru staff.

Quality and simply giving a hoot while also balancing the need to be finacially solvent with patient care is a fine dance - and no entity, be it HMO, for profit, or non-profit, or FQHC, or VA can claim the secret recipe.

 

[Candidate2017]

Can anyone explain why doctor at these facilities can make more money than usual? I don’t see why that’s the case if they can see the same number of patients elsewhere

Businesses can increase profits by downsizing (less RNs, techs, SWs, security), squeezing productivity from employees (you act as RN/SW/security, see more pts in less time), increasing margin between product cost and product revenue (decrease/increase length of stay depending on how well a 3rd party payor reimburses), transferring risk (pressure you into shady practices that increase their profits but increases your malpractice risk) etc.

That's where the extra pay come from, but if anything, you’re undercompensated for the terrible environment and risk. “Non”-profit hospitals already do all of the above. I can’t imagine how much worse it would be at for-profit places.

 

[Merely]

Businesses can increase profits by downsizing (less RNs, techs, SWs, security), squeezing productivity from employees (you act as RN/SW/security, see more pts in less time), increasing margin between product cost and product revenue (decrease/increase length of stay depending on how well a 3rd party payor reimburses), transferring risk (pressure you into shady practices that increase their profits but increases your malpractice risk) etc.

That's where the extra pay come from, but if anything, you’re undercompensated for the terrible environment and risk. “Non”-profit hospitals already do all of the above. I can’t imagine how much worse it would be at for-profit places.

Yeah agreed this sounds awful

 

[Merovinge]

No, I understand that. I'm just saying this is really weird and unusual. Very commonly every admission you take you lose money, so hospitals are fighting to NOT take admissions. I'm actually not sure which part of the system set up got weird in this story that made this feasible to occur. Like why is their reimbursement model not bundled, and if it is, why is it so high such that it can spin a high profit? Typically to maximize profit you want relatively easy voluntary patients with good insurance who come in and out, in and out, etc. Not turn well patients into sick patients that occupy your beds and time from your mental health lawyers. Very strange.

They are not being paid in a bundled model, they get paid per day and often negotiate with public aid to make that amount a feasible number such that if their beds are filled, they are profitable. As people mentioned above, these hospitals are actually the only reason there is bed availability for psychiatric patients, if they were gone the system would burst at the seams. That said, many of the the things people are mentioning are deplorable, but it would take a major healthcare overhaul to fix...

 

[Sushirolls]

One enemy to possible solutions is the 'welfare' 'monopoly' handout of state governments to hospital associations with Certificate of Need laws.

I believe without these laws its possible to see smaller niche units open with solo or even small group psychiatrists of unit sizes 5-12. Not a big dent in system but a dent none the less.

 

[dl2dp2]

They are not being paid in a bundled model, they get paid per day and often negotiate with public aid to make that amount a feasible number such that if their beds are filled, they are profitable. As people mentioned above, these hospitals are actually the only reason there is bed availability for psychiatric patients, if they were gone the system would burst at the seams. That said, many of the the things people are mentioning are deplorable, but it would take a major healthcare overhaul to fix...

I'm still confused. Public aid refuses bundled payment because why? Secondly, if it's pure Medicaid, my understanding is it's often funded directly from the state or in the forms of block grants. Why can't the state just directly fund bed using medicaid dollars?

 

[Sushirolls]

Bundled payments means less payments.
Bundled payments mean less independent arrangements for physicians with hospitals and only larger groups.
Larger group dynamics with hospitals continues to leave us right were we are with the current muck of the system.

 

[wannabie]

I moonlight at a UHS hospital and am considering working for this hospital when I finish training. While there are a few psychiatrists there who practice unethically, there are also a few who practice responsibly and provide excellent care. This is the same as private, VA, state, forensic, and military sites I've rotated through. I've actually found the nursing and tech staff to be better than those other settings.

On the flip side, the caseload is 16-18 inpatients for attendings, but there are fellows, residents, medical students, and other trainees to help provide better care. The EMR is custom designed to optimize billing and speedy documentation, and I spend less time in useless documentation than in other EMR's. There's some pressure to maximize length of stays, I haven't seen any stable patient being forced to stay or involuntarily hospitalized longer than necessary (but it could be happening). I've seen unethical attendings in other settings also maximize/enable stable patients' stays. At the VA, the attendings were okay allowing patients to stay until the first of the month because they were stable and easy and if the ward was full, it meant no new admissions. The same reasoning applied in the state/forensic setting.

I don't think it's fair to demonize one particular hospital group or setting. It's our responsibility as medical students, residents, fellows, and colleagues to promote and support one another in practicing well. It's also our responsibility to advocate for our patients to be taken care of ethically and morally. Hospitals and providers who act illegally should be prosecuted to the full extent of the law. I would not hesitate to report any colleague who acted illegally--and the hospital if it covered it up or enabled it. My idealistic take is that optimal, ethical, and disciplined practice (and especially optimal collaboration with social work) can lead to cost savings for public insurance and private hospitals and better outcomes for the populations we serve. We needn't only serve populations from our ivory towers.

 

[Merely]

I moonlight at a UHS hospital and am considering working for this hospital when I finish training. While there are a few psychiatrists there who practice unethically, there are also a few who practice responsibly and provide excellent care. This is the same as private, VA, state, forensic, and military sites I've rotated through. I've actually found the nursing and tech staff to be better than those other settings.

On the flip side, the caseload is 16-18 inpatients for attendings, but there are fellows, residents, medical students, and other trainees to help provide better care. The EMR is custom designed to optimize billing and speedy documentation, and I spend less time in useless documentation than in other EMR's. There's some pressure to maximize length of stays, I haven't seen any stable patient being forced to stay or involuntarily hospitalized longer than necessary (but it could be happening). I've seen unethical attendings in other settings also maximize/enable stable patients' stays. At the VA, the attendings were okay allowing patients to stay until the first of the month because they were stable and easy and if the ward was full, it meant no new admissions. The same reasoning applied in the state/forensic setting.

I don't think it's fair to demonize one particular hospital group or setting. It's our responsibility as medical students, residents, fellows, and colleagues to promote and support one another in practicing well. It's also our responsibility to advocate for our patients to be taken care of ethically and morally. Hospitals and providers who act illegally should be prosecuted to the full extent of the law. I would not hesitate to report any colleague who acted illegally--and the hospital if it covered it up or enabled it. My idealistic take is that optimal, ethical, and disciplined practice (and especially optimal collaboration with social work) can lead to cost savings for public insurance and private hospitals and better outcomes for the populations we serve. We needn't only serve populations from our ivory towers.

Thx for your first hand insight it is appreciated

 

[NickNaylor]

Just to provide a specific financial example, our university's private inpatient psychiatric unit - which has 18 beds that are almost always full - loses just over $1 million/year for the healthcare system. The upside of this financial black hole is that our unit is arguably "the place" to get inpatient care in our city: staffing ratios are reasonable (4 RNs, 3-4 MHTs, and 3 MDs for a maximum of 18 patients), the unit is fairly nice, and, being a teaching unit, patients probably get more attention on our unit than anywhere else. That's not to say that it's the only good unit in the area, but it is certainly one of the best.

Many of the sketchy free-standing, for-profit hospitals in our area don't offer anything close to those staffing ratios, and most of the time the MDs don't spend much time with the patients. Inpatient psychiatry is so financially non-viable that over the past couple of years we've lost several hundred beds in the community, completely clogging the ED system since we have nowhere to send people, and the facilities that closed were already themselves fairly sketchy. This results in redirection of patients to inappropriate levels of care, inappropriate treatment, and other issues that ultimately make the system completely dysfunctional. I work in our county hospital ED, and I literally cannot send patients that receive indigent mental health insurance to an inpatient facility on a voluntary basis. It simply won't happen. If someone voluntarily wants to go to the hospital, they clearly aren't "acute" enough to warrant inpatient admission, says the mental health authority. It's a complete farce, and it leaves psychiatrist in the crappy position of having to involuntarilyy admit patients - even if they are willing to be admitted - just so that they can actually get a bed... a bed that they will probably wait at least 2-3 days for.

The surviving hospitals that haven't closed or been shut down have a monopoly on receiving patients that receive the county indigent mental health insurance, so I suspect that they survive solely on volume alone. A couple of these facilities have been on the local news for various scandals - patient abuse, inappropriate administration of emergent medications, assaults between patients, bad conditions, etc. It's a tragedy. But, barring more funding - both from insurance companies and from government authorities - for more beds, nothing is going to change. Unfortunately, the "system" has become so dependent on these sketchy facilities that it would immediately collapse if those beds disappeared.

 

[zolof]

These hospital systems, UHS, HCA, etc, have their problems and they are serious, but at the same time in many geographical areas these will be the only hospitals you can work at to do inpatient psychiatry. There really arent any other options.

 

[clausewitz2]

Just to provide a specific financial example, our university's private inpatient psychiatric unit - which has 18 beds that are almost always full - loses just over $1 million/year for the healthcare system. The upside of this financial black hole is that our unit is arguably "the place" to get inpatient care in our city: staffing ratios are reasonable (4 RNs, 3-4 MHTs, and 3 MDs for a maximum of 18 patients), the unit is fairly nice, and, being a teaching unit, patients probably get more attention on our unit than anywhere else. That's not to say that it's the only good unit in the area, but it is certainly one of the best.

Many of the sketchy free-standing, for-profit hospitals in our area don't offer anything close to those staffing ratios, and most of the time the MDs don't spend much time with the patients. Inpatient psychiatry is so financially non-viable that over the past couple of years we've lost several hundred beds in the community, completely clogging the ED system since we have nowhere to send people, and the facilities that closed were already themselves fairly sketchy. This results in redirection of patients to inappropriate levels of care, inappropriate treatment, and other issues that ultimately make the system completely dysfunctional. I work in our county hospital ED, and I literally cannot send patients that receive indigent mental health insurance to an inpatient facility on a voluntary basis. It simply won't happen. If someone voluntarily wants to go to the hospital, they clearly aren't "acute" enough to warrant inpatient admission, says the mental health authority. It's a complete farce, and it leaves psychiatrist in the crappy position of having to involuntarilyy admit patients - even if they are willing to be admitted - just so that they can actually get a bed... a bed that they will probably wait at least 2-3 days for.

The surviving hospitals that haven't closed or been shut down have a monopoly on receiving patients that receive the county indigent mental health insurance, so I suspect that they survive solely on volume alone. A couple of these facilities have been on the local news for various scandals - patient abuse, inappropriate administration of emergent medications, assaults between patients, bad conditions, etc. It's a tragedy. But, barring more funding - both from insurance companies and from government authorities - for more beds, nothing is going to change. Unfortunately, the "system" has become so dependent on these sketchy facilities that it would immediately collapse if those beds disappeared.

Man, and at our institutions we grumble when someone who really ought to be on our autism floor is temporarily admitted to one of the non-autism floors used to a more volatile population (dual diagnosis floor or psychosis floor) pending a bed, or when someone who really ought to be on our eating disorder unit is temporarily admitted to the Geri floor because the PA team and nurses up there aren't scared of medical problems.

I am not sure how but I do know our inpatient side heavily subsidizes our outpatient side. Economies of scale and 14 residents per class, maybe?

 

[Mass Effect]

But if you cover the same amount at a more ethical place you’d make the same?

This came up before. No, you won't make the same, even covering the same amount of people. Also, no ethical place will allow you cover the same number of patients. The reason for the high pay is so people check their ethics at the door.

 

[BiscoDisco]

How short are these visits typically at the private inpatient hospitals?

 

[Mass Effect]

How short are these visits typically at the private inpatient hospitals?

An attending told me all he has to do is pass the person in the hall, ask how they're feeling today, and the note's done. So less than 5 minutes in some patient's cases? He said that med switches, etc. rarely happen except on admission and he hears from nursing/social work if the patient isn't tolerating the med. Alarming.

 

[BiscoDisco]

An attending told me all he has to do is pass the person in the hall, ask how they're feeling today, and the note's done. So less than 5 minutes in some patient's cases? He said that med switches, etc. rarely happen except on admission and he hears from nursing/social work if the patient isn't tolerating the med. Alarming.

Yah that's pretty crazy. I sometimes feel bad if I'm hurried and I do a 8-10 minute interview.