Safety Net Hospitals and the GOP Bill

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Dawkter

Dawkter

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With the current bill passing in senate, what do you expect will be the implication for safety net hospitals or hospitals serving primarily patients on Medicaid? Which hospitals are at risk of reducing clinical services or closing down entirely?
 
2 major hospital systems in our city announced 1.5% layoffs this week. One of the CEOs announced he would be taking a 20% pay cut.


These are/were strong hospital systems with large recent building projects that seemed flush with money. Both systems have safety net hospitals in their portfolio. The layoffs came out of nowhere and with no warning. I think they’re anticipating the effects of the BBB. Will be interesting to see if this was just a coincidence or if it will be a trend.
 
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There are 20+ rural critical-access hospitals in my smallish state heavily dependent on Medicaid. This will drown them in red ink to the point of closure, with the closest hospital becoming an hour or more away.
 
Things that will crash the anesthesia market are not usually predictable but this bill will probably have an impact. If the Medicaid cuts lead to many hospital closures less hospitals means less ORs means less surgery means less need for anesthesia care.

Even if surgical volume is static a consolidation of hospitals to a few networks is not good either as they can set the regional market salaries low if they are not competing for staff.

This bill overall is probably not good for us.
 
More specific to our profession. How does this affect crnas doing independent rural practice?

I haven’t heard any statement from the aana They pick and choose their battles.
 
aneftp said:
More specific to our profession. How does this affect crnas doing independent rural practice?

I haven’t heard any statement from the aana They pick and choose their battles.
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They’ll prob go ape****, and start buying even more billboards and magazine ads saying they are superior to us🤣 so they can get more OR time. Simultaneously they will start a war with AAs saying they aren’t good enough. Man, I wish I had become a crna since they are so amazing🤢🤮🤣😂
 
centdoc said:
They’ll prob go ape****, and start buying even more billboards and magazine ads saying they are superior to us🤣 so they can get more OR time. Simultaneously they will start a war with AAs saying they aren’t good enough. Man, I wish I had become a crna since they are so amazing🤢🤮🤣😂
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It’s easy to argue from a lower level that you are equal

It’s funny how they look down to AAs. I get some of them really pissed when I say AAs make up or $300/hr in the Midwest (I’m lived in Midwest for 12 years). Drives them crazy.
 
aneftp said:
It’s easy to argue from a lower level that you are equal

It’s funny how they look down to AAs. I get some of them really pissed when I say AAs make up or $300/hr in the Midwest (I’m lived in Midwest for 12 years). Drives them crazy.
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Just like the salaries, behavior and speech of some CRNAs and the AANA drives us crazy.
 
It will be interesting to follow hospital credit downgrades related to this. Mine was A- prior to this. I guess I should probably stop contibuting to my 457 plan.
 
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rick roller pump said:
It will be interesting to follow hospital credit downgrades related to this. Mine was A- prior to this. I guess I should probably stop contibuting to my 457 plan.
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Very basic question I should probably know the answer to but do 457B contributions dissolve if a hospital system closes?
 
pgg said:
View attachment 405953
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Only way to pay for massive cuts
1. Health spending
2. Defense spending

Like I stated on so many occasions the ACA’s primary gains in people newly insured has been via Medicaid expansion

The bill just makes it more of a nuisance to get on the free stuff.

I’d like them to cut defense spending as well. But as Obama found out the hard way. No one wants to cut the defense spending.

So they rather pick on poor people with Medicaid.

I’d prefer defense cuts.
 
Dawkter said:
Very basic question I should probably know the answer to but do 457B contributions dissolve if a hospital system closes?
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If it’s not a governmental 457B it is susceptible to your hospitals creditors. You may still get your 457B holdings in a bankruptcy. It doesn’t get dissolved but you’d have to fight to get your deferred payment in a bankruptcy.
 
dizzy21 said:
If it’s not a governmental 457B it is susceptible to your hospitals creditors. You may still get your 457B holdings in a bankruptcy. It doesn’t get dissolved but you’d have to fight to get your deferred payment in a bankruptcy.
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This is an interesting discussion post on this topic:


note that this was likely not a 457 plan but a similar plan (according to posters in the blog)
 
Dawkter said:
Very basic question I should probably know the answer to but do 457B contributions dissolve if a hospital system closes?
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For non governmental entities:
The 457b funds are at risk from creditors.

Per the IRS website:
"Employees are lower in priority than general creditors in the event of legal claims against the employer"

Non-governmental 457(b) deferred compensation plans | Internal Revenue Service

Non-Governmental 457(b) Deferred Compensation Plans
www.irs.gov www.irs.gov

My employer is a large FQHC (non governmental) and I skipped contributing to the 457b. Too many risks for me.
 
aneftp said:
Only way to pay for massive cuts
1. Health spending
2. Defense spending
Click to expand...
Agreed 100% -

And if this bill cut both and didn't cut taxes and it was all presented as an austerity approach to balancing the budget, we could have a conversation about the merits and risks of that approach.

They're not paying for anything.
 
Dawkter said:
Very basic question I should probably know the answer to but do 457B contributions dissolve if a hospital system closes?
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You're not first in line amongst all the entities that are owed money if the system goes bankrupt.

I've always figured that would mean the money is probably gone forever.

The question is if that risk of loss is worth the tax benefits of participating and deferring the income. I would have more faith in a Harvard 457 than a Podunk Community Health Inc 457.
 
pgg said:
Agreed 100% -

And if this bill cut both and didn't cut taxes and it was all presented as an austerity approach to balancing the budget, we could have a conversation about the merits and risks of that approach.

They're not paying for anything.
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I do not like this current bill. It’s a bad bill it’s fiscally irresponsible
 
dizzy21 said:
Things that will crash the anesthesia market are not usually predictable but this bill will probably have an impact. If the Medicaid cuts lead to many hospital closures less hospitals means less ORs means less surgery means less need for anesthesia care.

Even if surgical volume is static a consolidation of hospitals to a few networks is not good either as they can set the regional market salaries low if they are not competing for staff.

This bill overall is probably not good for us.
Click to expand...
Seems like the medicaid provisions will not take effect until late 2026, so I think it will be awhile before any effect is felt. Labor market will continue losing providers until then.

There are big predictions about how many people will lose coverage because of this but those things may not even materialize depending on how difficult the work requirement is to satisfy.
 
chessknt said:
Depending on your situation if you quit you immediately get full possession of it. Need to do that now if you are worried about the health of the system.
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In theory, you can quit, get the money, and then get rehired.
 
chessknt said:
Depending on your situation if you quit you immediately get full possession of it. Need to do that now if you are worried about the health of the system.
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At minimum, find out where those 457 funds can be transferred (ie, a traditional IRA, Roth IRA, SEP IRA, etc) without penalty and open one of those accounts ASAP at a brokerage. At least then you have a ready account in case you need to move quickly. Better yet, just open the account and get your money out of the 457; then you’ll worry a lot less.
 
centdoc said:
At minimum, find out where those 457 funds can be transferred (ie, a traditional IRA, Roth IRA, SEP IRA, etc) without penalty and open one of those accounts ASAP at a brokerage. At least then you have a ready account in case you need to move quickly. Better yet, just open the account and get your money out of the 457; then you’ll worry a lot less.
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It's non governmental so it can't be transferred anywhere. Whole sum will be hit at marginal tax rate. But it's better than 0.
 
centdoc said:
At minimum, find out where those 457 funds can be transferred (ie, a traditional IRA, Roth IRA, SEP IRA, etc) without penalty and open one of those accounts ASAP at a brokerage. At least then you have a ready account in case you need to move quickly. Better yet, just open the account and get your money out of the 457; then you’ll worry a lot less.
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Non-qualified retirement accounts can’t be rolled into an IRA. I stopped contributing to mine years ago. Just put my extra contributions into a brokerage account.
 
Lab Lover said:
In theory, you can quit, get the money, and then get rehired.
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My plan documents state that I cannot get my 457 money until like June the year after I quit. If I were to quit in May for instance, I would need to wait for the following year June.

I am not particularly worried about the 100k or so I have in there, if I lose that I'm still totally fine (although unhappy). But have stopped my contributions.
 
nimbus said:
nashvillebanner.com

VUMC announces staff reduction due to budget cuts - Nashville Banner

Vanderbilt University Medical Center will lay off up to 650 employees due to federal budget cuts, and the impact will be felt in research and patient care.
nashvillebanner.com nashvillebanner.com
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They can cut the admin positions first folks.

Thats where the real bloat is in healthcare.

Even on Lower scale level. I’ve seen chairs of anesthesia dept have 2 executives secretaries. Like wtf. And this is low level

Imagine the higher up admin. Vandy can cut cost elsewhere to keep the research going. But they won’t.
 
aneftp said:
They can cut the admin positions first folks.

Thats where the real bloat is in healthcare.

Even on Lower scale level. I’ve seen chairs of anesthesia dept have 2 executives secretaries. Like wtf. And this is low level

Imagine the higher up admin. Vandy can cut cost elsewhere to keep the research going. But they won’t.
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Cutting the bloat at Academic Medical Centers is long overdue.

How many of us know of Anesthesia Chairs who haven’t anesthetized a patient in the past decade?
 
aneftp said:
They can cut the admin positions first folks.

Thats where the real bloat is in healthcare.

Even on Lower scale level. I’ve seen chairs of anesthesia dept have 2 executives secretaries. Like wtf. And this is low level

Imagine the higher up admin. Vandy can cut cost elsewhere to keep the research going. But they won’t.
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I know of an academic hospital system that was desperate to cut costs, so they got rid of the refrigerator sandwiches from the doctors lounge (the ones that allowed staff to quickly eat and return to work without having to wait in line at the cafeteria).

A short time later, a new CEO was brought in, and within a few months he had fired 11 unnecessary vice presidents.

Hospitals can absolutely save money by gutting their bloated administration, but only after trying to squeeze blood from the stone. It’s also easier for new leadership to cut someone else’s hires.
 
DesiredMemberName? said:
I know of an academic hospital system that was desperate to cut costs, so they got rid of the refrigerator sandwiches from the doctors lounge (the ones that allowed staff to quickly eat and return to work without having to wait in line at the cafeteria).

A short time later, a new CEO was brought in, and within a few months he had fired 11 unnecessary vice presidents.

Hospitals can absolutely save money by gutting their bloated administration, but only after trying to squeeze blood from the stone. It’s also easier for new leadership to cut someone else’s hires.
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Have a friend who just joins zoom meetings and says "Nothing on my end" and gets paid 6 figures
 
My hospital system has huge middle management bloat. Like VP roles that didn’t even exist when I was hired that now have 2 people below them doing the job that the original guy was promoted to do. So now it’s gone from a zero to a 3 person job? Sure. Zoom meetings make it worse. People don’t even come in.
 
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IlDestriero said:
My hospital system has huge mid level management bloat. Like VP roles that didn’t even exist when I was hired that now have 2 people below them doing the job that the original guy was promoted to do. So now it’s gone from a zero to a 3 person job? Sure. Zoom meetings make it worse. People don’t even come in.
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Time for the bloat to be trimmed…long overdue
 
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