Hospital's preemptive strike

[TrumpetDoc]

Well, just got an email from our hospital that essentially due to HCR and the "changes" we must adopt....etc.

They are letting go 100 employees for soft containment.
Just hope it's all non clinical stuff, but they would not give details.

Who's hospitals are taking similar measures??

Wonder how many of those let go voted/sided this HCR?

---

Members don't see this ad.

 

[GeneralVeers]

We got a letter like that with mostly excuses and lies.

They said the "volume is down". Wrong, it's up 10% this year. We have the numbers.

 

[docB]

Housekeeping, lab and secretarial were cut. Now we're worried that dirt, lab delays and no one answering the phones will hurt our HCAHPs.

 

[EctopicFetus]

We have cut staff with ever increasing volumes. I must be too stupid to understand. If Obamacare is gonna add 30 million new paying customers why are hospitals shrinking their staff?

At one of my last shifts we had the charge nurse in the count, she also was effectively my secretary.

Perhaps what we really need is to fire some of the bean counters.

 

[Birdstrike]

Perhaps what we really need is to fire some of the bean counters.

Yes!

 

[GeneralVeers]

We have cut staff with ever increasing volumes. I must be too stupid to understand. If Obamacare is gonna add 30 million new paying customers why are hospitals shrinking their staff?

At one of my last shifts we had the charge nurse in the count, she also was effectively my secretary.

Perhaps what we really need is to fire some of the bean counters.

Medicaid =/ paying customers

 

[glorfindel]

We have cut staff with ever increasing volumes. I must be too stupid to understand. If Obamacare is gonna add 30 million new paying customers why are hospitals shrinking their staff?

That's a seriously good question.

It's not like all these people are new; they're just newly insured, right?

Maybe what hospitals fear is that all these previously not-sick uninsured (in the EM sense of "not-sick") will now come to the ED for their primary care, and that the ED docs will order the standard cbc/bmp/ua/cxr/head CT standard ED patient stuff on all these people, running up big bills, that Medicaid won't cover?

That doesn't seem plausible.

It's not like I ever see a paucity of completely uninsured self-pay pts coming to my ED.

If I were a hospital administrator, looking solely at ED revenue streams, I think I'd welcome any expansion in the # of insured patients, and any decrease in the # of uninsured patients.

But perhaps the key is that the administrators aren't looking solely at ED revenue streams. Is Obamacare going to pinch these hospitals in their outpatient clinics?

I really don't know. Gotta do more reading up on this....

 

[Birdstrike]

Wait until 2014 when Obamacare fully kicks in and hospitals, like many other industries, start dropping their employees from their health insurance plans leaving them to be picked up by Medicaid as required by law or in an insurance exchange, because its way, way cheaper to pay the penalty than continue to pay for an employee's private plan.

Many of us PHYSICIANS may be dropped and forced to pay out of pocket for insurance or go on Medicaid. Now that there will be a law placing the ultimate responsibility to insure you on the government, a business (especially one struggling or with a thin profit margin) would be stupid not to look at this option. Physician groups and hospitals are no different. They have to pay to insure their employees just the same.

Don't think that because it would be very ironic, that it won't happen. If it saves a buck, it will. Mark this Birds words.

 

[glorfindel]

Wait until 2014 when Obamacare fully kicks in and hospitals, like many other industries, start dropping their employees from their health insurance plans leaving them to be picked up by Medicaid as required by law or in an insurance exchange, because its way, way cheaper to pay the penalty than continue to pay for an employee's private plan.

Many of us PHYSICIANS may be dropped and forced to pay out of pocket for insurance or go on Medicaid. Now that there will be a law placing the ultimate responsibility to insure you on the government, a business (especially one struggling or with a thin profit margin) would be stupid not to look at this option. Physician groups and hospitals are no different. They have to pay to insure their employees just the same.

Don't think that because it would be very ironic, that it won't happen. If it saves a buck, it will. Mark this Birds words.

I'm not an Obamacare expert by any means, but I think one thing that'll stop the tidal wave of employees being dropped from their current plans and into the arms of Medicaid is -- competition for employees.

Low-value, low-skilled employees that can be found under any rock are a lot different from rare, high-value, highly-skilled employees that any employer has to actively compete to retain.

Where each employee fits into this picture depends on the local labor market, I think, so I make no broad predictions about how many folks are going to be dropped from their employer's plan under Obamacare.

Again, I'm not an Obamacare expert. Not disagreeing specifically with anything you say. I just don't know enough yet.

 

[docB]

We have cut staff with ever increasing volumes. I must be too stupid to understand. If Obamacare is gonna add 30 million new paying customers why are hospitals shrinking their staff?

This is a great question. I think it's because hospital admins really don't think in terms of where they'll be in 5 or 10 years, i.e. after the ACA changes mature. They are obligated to show profits (whether the facility is profit or non-profit) in 12 to 24 months.

Business executives don't stay in the same job for 20 years these days. It's slash, collect and move on up.

 

[Arcan57]

This is a great question. I think it's because hospital admins really don't think in terms of where they'll be in 5 or 10 years, i.e. after the ACA changes mature. They are obligated to show profits (whether the facility is profit or non-profit) in 12 to 24 months.

Business executives don't stay in the same job for 20 years these days. It's slash, collect and move on up.

The key is to make sure you've moved higher up on the mountain so the avalanche of consequences crashes down below you and not on you. Sometimes it's even better to just take helicopter evac to another mountain where you don't even have to deal with managing the system you've created at any level. For most hospitals, inpatient care is about to become a money loser. Why would you staff up adequately when it just means bigger losses. It's easier to create "zero tolerance" or "never" policies and fire the people for not following policy.

 

[beanbean]

In Connecticut the state has made significant cuts in reimbursement for uninsured and medicaid patients to help balance the state budget. My hospital now needs to find another 2.8 million in cuts. We are small and have a bit better payor mix compared to Yale, Hartford Hospital, and St Francis Hospital, etc.

Combine the state cuts and federal changes and it's going to be fun!

 

[EctopicFetus]

Some food for thought.. Obamacare will mandate that medicaid payment has to equal or be better than medicare payments to docs.

 

[EctopicFetus]

The key is to make sure you've moved higher up on the mountain so the avalanche of consequences crashes down below you and not on you. Sometimes it's even better to just take helicopter evac to another mountain where you don't even have to deal with managing the system you've created at any level. For most hospitals, inpatient care is about to become a money loser. Why would you staff up adequately when it just means bigger losses. It's easier to create "zero tolerance" or "never" policies and fire the people for not following policy.

Then why should hospitals exist at all?

 

[deleted109597]

Then why should hospitals exist at all?

I bet the model goes towards more home health and less inpatient. Soon, only ICU patients will be admitted. Look at the requirements for inpatient today, compared to 30 years ago. Hospitals used to function as nursing homes, and our floor patients were their ICU patients, and our ICU patients just died back then. In the future, everything short of intubation (and even that can be done at home, just look at the trolls) will be stabilized and sent back home likely.

Low-value, low-skilled employees that can be found under any rock are a lot different from rare, high-value, highly-skilled employees that any employer has to actively compete to retain.

Nurses are pretty highly skilled (no laughing), and most hospitals can't find enough of them as is. When nurses cost more, there will be fewer. That is, until the government steps in and mandates nursing ratios for hospital beds and suddenly we have a new group of government employees, the nursing corps.

 

[Arcan57]

Then why should hospitals exist at all?

Because hospitals were a more convenient unit of control over health care costs than individual doctors/small groups. RACK audits, core-measures, etc are all easier to enforce at a hospital level then at an individual practice level. I'm not sure that was directly behind the decision to reimburse inpatient procedures at a higher rate, but at least in terms of improving control it worked out for the feds. And I guess I'd be remiss in mentioning that there are a few hospitals that are profitable on Medicaid pts currently, but that's usually accomplished with staffing levels not usually seen outside of plague ships.

Eventually the unit of control will pass to multi-specialty groups/out-patient based networks (some/many of which will be run by existing hospital systems) who suck up the in-patient losses to get the payments for their outpatient population. Taking care of in-patient sick patients is going to become a necessary evil to get the insurance companies' capitated payments for the large percentage of patients that will pay more into the system then they get out.

 

[EctopicFetus]

I read the EP monthly deal wth the guy from team health.

They also think it will go to more of a home health model. I think outcomes will be worse. We will see how it turns out. I think hospitals going out of business isnt good for people. We will see, that home hospital deal is good for the chronic problems but less so for anything acute. Perhaps we could cut admits by 25%.. thats fine.. There is so much guessing its kind of funny. 1/7th of our economy is in total limbo..

 

[Arcan57]

I read the EP monthly deal wth the guy from team health.

They also think it will go to more of a home health model. I think outcomes will be worse. We will see how it turns out. I think hospitals going out of business isnt good for people. We will see, that home hospital deal is good for the chronic problems but less so for anything acute. Perhaps we could cut admits by 25%.. thats fine.. There is so much guessing its kind of funny. 1/7th of our economy is in total limbo..

It would be tough for outcomes to be worse. So much of in-patient care is putting a bandage on a wound that gets ripped off within days of being back home where the patient reverts to the behaviors that got them into the hospital. The list of things we deal with that are not answered by a brief (or even extended) in patient stay is quite long:
1) In-patient admits for COPDers who are still smoking and don't have the money/resources for long acting controller meds
2)Chest pain admits for patients who have CAD but are vaguely compliant with their medical management (listen to any recent EMRAP for a damning critique of invasive therapy for anything other then STEMI)
3)almost anything to do with dialysis

If you're pointing out that there will be a bump in mortality because in-patient care availability is going to decline much faster than outpatient care will ramp up, I think you are probably right. I think it will be transient, and only hope that the bump doesn't derail us from aggressively pursuing rational outpatient care. Better systems and preventative care is the only humane way of containing costs.

 

[GalenAgas]

We have cut staff with ever increasing volumes. I must be too stupid to understand. If Obamacare is gonna add 30 million new paying customers why are hospitals shrinking their staff?

At one of my last shifts we had the charge nurse in the count, she also was effectively my secretary.

Perhaps what we really need is to fire some of the bean counters.

But what about the beans? Think about the beans people! Who will count them? Will you?

 

[EctopicFetus]

It would be tough for outcomes to be worse. So much of in-patient care is putting a bandage on a wound that gets ripped off within days of being back home where the patient reverts to the behaviors that got them into the hospital. The list of things we deal with that are not answered by a brief (or even extended) in patient stay is quite long:
1) In-patient admits for COPDers who are still smoking and don't have the money/resources for long acting controller meds
2)Chest pain admits for patients who have CAD but are vaguely compliant with their medical management (listen to any recent EMRAP for a damning critique of invasive therapy for anything other then STEMI)
3)almost anything to do with dialysis

If you're pointing out that there will be a bump in mortality because in-patient care availability is going to decline much faster than outpatient care will ramp up, I think you are probably right. I think it will be transient, and only hope that the bump doesn't derail us from aggressively pursuing rational outpatient care. Better systems and preventative care is the only humane way of containing costs.

I would argue that rationing is the only humane way of containing costs.

Those chest painers arent just gonna be discharged. Cycle the trops and dc them. from recent personal history those obs stays are cheap.. inpatient stays expensive.

 

[EctopicFetus]

But what about the beans? Think about the beans people! Who will count them? Will you?

Computers dude.. its the 21st century.. If they are good enough for patient chart they are good enough to take the job of some bean counters.