Another example of broken healthcare insurance system

[TexasHusker]

here is a photo of our hospital CEO’s house:

[disneysteve]

here is a photo of our hospital CEO’s house:

How many more beds does that have than the hospital?

[amarowsky]

The reason your hospital is buying practices and opening new outpatient centers is to control all referrals and route patients into their cash machine. The reason that they bought out a competitor was true - they did it to “eliminate duplication of services”, the old bait that the FTC has been taking for decades now. By doing so, they eliminated a direct competitor. By doing that, plus scooping up referral sources and opening more, they foreclosed the market where you live, and their prices shot out of sight.

Do me a favor, go to AHD.COM and tell what your hospital’s average charges per discharge are. I’m guessing $55-65K with a length of stay a little below 4. That’s about 7 times their cost.

This helps to validate Marty’s book when he referred to “revenue officers” being added to hospital staff. This is maddening.... Some sector areas we do not need “profit optimization and expansion” and I’d say health care for USA societies should probably be on that list. I want to say, “I can’t believe your hospital is owned by a hedge fund”, but it be disingenuous statement as NO high profit industry seems to be free of wall streets greedy paws...

I think the (3) areas I would not mind profits being heavily regulated and controlled would be: Health care, corrections/prisons, and education. If these were regulated to something more similar like our utilities are, I think we would be in better shape. Best to save the most aggressive and profitable industries to less harmful areas like consumer products (electronics, furniture, restaurants, automotive, entertainment, travel, and the dozens of other sectors...).

TH’s mention to profit from 5 —> 75 —> ~>100 million @ the hospital he mentioned.... This seems like such dangerous waters. When these hospitals are so intrepid to charge to patients, it does not seem like a far cry to breed desperation. Especially once the middle class can’t afford to subsidize the costs of the uninsured. I really hope this make it to the top of the economic policy issue pile to all Americans. If we could get this stuff figured out, I would love to see the following surge in entrepreneurship in USA. We could really use lower barriers to exit from w-2 corporate employment.

I’m not totally confident, but optimistic that there are some sharp and genuine people (of great capability & status) that are working on solving these problems. *(I don’t have specific examples, but these anecdotes are brought up in the book + alongside some actual progress that is being made).

[amarowsky]

*would like to add at least SOME “news reporting” to that list of “no/controlled profit level”. I think we also deserve to be informed w/ out a dump truck of bias stapled to each corporation. It’s like pulling teeth to find a good news source that (at least feels) honest.

[disneysteve]

Do me a favor, go to AHD.COM and tell what your hospital’s average charges per discharge are. I’m guessing $55-65K with a length of stay a little below 4.

I missed this post earlier because the thread moved to page 2.

The hospital system has 5 hospitals. The first one I checked, the one closest to us and where I send most patients from urgent care, has no financial data listed. I checked another one and there is a bunch of data. Do you mean the Inpatient Utilization Statistics? If so, it's $79,101 with average LOS of 4.78. I checked another, the main hospital that recently became part of the system, and they are at $117,790 with LOS of 5.26. They also do much of the cardiac work in the area as well as transplants, plus they are located in one of the poorest cities in America where overall health is poor and acuity of patients is higher than average.

[TexasHusker]

I missed this post earlier because the thread moved to page 2.

The hospital system has 5 hospitals. The first one I checked, the one closest to us and where I send most patients from urgent care, has no financial data listed. I checked another one and there is a bunch of data. Do you mean the Inpatient Utilization Statistics? If so, it's $79,101 with average LOS of 4.78. I checked another, the main hospital that recently became part of the system, and they are at $117,790 with LOS of 5.26. They also do much of the cardiac work in the area as well as transplants, plus they are located in one of the poorest cities in America where overall health is poor and acuity of patients is higher than average.

Yes the inpatient utilization financial data. Those numbers are even more absurd than here. The first hospital is charging roughly $16,500 PER DAY for a hospital stay, or almost $700 per hour. The second one, over $23,000 PER DAY, or $958 per hour. Multiply that X several hundred patients per day in a typical hospital, and you can see that these hospitals are giant wealth sucking machines.

Your hospitals likely only have one other legitimate competitor, and perhaps not even that. Since the early 1990s, hospitals have been on a massive cash grab that seemingly knows no limits. The FTC has stood idle through merger after merger, allowing large hospital systems to foreclose the market in even very large cities. There is no longer competition, and the industry is sucking a massive amount of wealth out of our GDP. Quality has not improved.

It should be a surprise to no one that our health care finance system is collapsing.

[disneysteve]

Quality has not improved.

While not a cost benefit, there is one huge advantage to the consolidation of the hospital networks both for the patients and the providers. All of the patients' records are now in one place and can be viewed across the system. It is incredibly helpful when I see a patient in urgent care and I can see what meds they're on, notes from their PCP and specialists, past labs and imaging studies, etc. And there actually is some cost benefit to this as it reduces some duplicate testing occurring since everyone has easy access to the records.

But that's all beside your point of the outrageous cost of hospital care.

[ua_guy]

The reason your hospital is buying practices and opening new outpatient centers is to control all referrals and route patients into their cash machine. The reason that they bought out a competitor was true - they did it to “eliminate duplication of services”, the old bait that the FTC has been taking for decades now. By doing so, they eliminated a direct competitor. By doing that, plus scooping up referral sources and opening more, they foreclosed the market where you live, and their prices shot out of sight.

Do me a favor, go to AHD.COM and tell what your hospital’s average charges per discharge are. I’m guessing $55-65K with a length of stay a little below 4. That’s about 7 times their cost.

I'm looking at a relatively well-known hospital in the Seattle area.

Average length of stay is 8.98 and average charges are $90,216

There's a smaller medical center to the south. Average los is 4.43 days and $51,377 average charges.

They're both part of county and regional health systems; non-profit, run by the state, and one of them is a teaching hospital. People seem to forget that "healthcare" is a mix of public and private, including private non-profit, and that a lot of reimbursement is set by the government.

[ua_guy]

While not a cost benefit, there is one huge advantage to the consolidation of the hospital networks both for the patients and the providers. All of the patients' records are now in one place and can be viewed across the system. It is incredibly helpful when I see a patient in urgent care and I can see what meds they're on, notes from their PCP and specialists, past labs and imaging studies, etc. And there actually is some cost benefit to this as it reduces some duplicate testing occurring since everyone has easy access to the records.

But that's all beside your point of the outrageous cost of hospital care.

A doctor I talked to recently about EMR's and he made an interesting point about nationalizing the health record. Where health systems with many hospitals and clinics can share records internally to the patient and provider's benefit, because they are consolidated, and because they generally operate on an enterprise-wide EMR, sharing with other hospitals and health systems is more challenging. If health systems are on a common platform like Epic, they can set up information sharing to outside organizations fairly easily, but not with other health systems on different EMR platforms. (There are some small-scale solutions and valiant attempts to create small private health information exchanges, but they are not scaleable).

In light of all the recent political discussions about what candidates want to attempt with the US healthcare system, nobody has specifically addressed the sharing of health information and it would be a relatively easy win, and pave the way for greater overhaul.

[TexasHusker]

Sharing records isn’t going to matter much if we are all broke from paying the hospitals - either from our checking account or insurance premiums.

I used to work as an executive for a large hospital system. Seven years later, it sure appears that I am very much still working for them.

[disneysteve]

A doctor I talked to recently about EMR's and he made an interesting point about nationalizing the health record. Where health systems with many hospitals and clinics can share records internally to the patient and provider's benefit, because they are consolidated, and because they generally operate on an enterprise-wide EMR, sharing with other hospitals and health systems is more challenging. If health systems are on a common platform like Epic, they can set up information sharing to outside organizations fairly easily, but not with other health systems on different EMR platforms. (There are some small-scale solutions and valiant attempts to create small private health information exchanges, but they are not scaleable).

I've said from day one that this is one area where the government really screwed up. When they came out years ago with the mandate for doctors to get onto EMR, they should have said, "Here! This is the EMR we want you to use." They were paying an incentive for doctors to go electronic. It would have made perfect sense for them to provide the platform, just as they provide the online claim submission platform for Medicare. Doctors could have been free to use any EMR they wanted, but if they wanted to get the incentive payment, they had to do the government EMR. Then nearly every doctor in the country would have been on the same system and everyone's data would have been in one place. Instead, they left it up to every doctor and facility to choose their own. There were literally hundreds of options and none of them could "talk" to each other. Over time, many of them have merged or shut down entirely so doctors have had to change systems 2 or 3 or 4 times. We're finally approaching a point where there are a handful of major players but there are still too many to be practical.

[amarowsky]

After re reading this whole thread, and considering the maelstrom that has broke land on the USA from corona since the last 3-5-2020 post. This is all the more reason we ALL need to support fixing out healthcare costs for ALL citizens. (not just those who are old, poor, or working under a W-2).

This is like a massive shackle around the leg of Entrepreneurial growth in USA. Making the personal risk WAYYY to high to go out on your own....

[amarowsky]

F.Y.I - I don't care what you call it. National Health care, socialized health care, single payer health care, medicare for all, or our "for profit" system. The Syntax does not matter at all, the semantics are the same. We HAVE to make this either affordable or free (of transaction, it will be paid by taxes) to everyone. IMO this is at the top of my "policy concern pile" in the USA (along w/ climate change/pollution, education, prison reform, and infrastructure need). Health care is technically the most important, if you consider maslows hierarchy of needs. Ability to survive is the very very bottom, and that is health.

Everytime I look at my amputation on my right hand, it makes me sick that it was more affordable that basic stuff here to the typical american. This needs to be changed.

[disneysteve]

After re reading this whole thread, and considering the maelstrom that has broke land on the USA from corona since the last 3-5-2020 post. This is all the more reason we ALL need to support fixing out healthcare costs for ALL citizens. (not just those who are old, poor, or working under a W-2).

This is like a massive shackle around the leg of Entrepreneurial growth in USA. Making the personal risk WAYYY to high to go out on your own....

Very true. The fact that we don't yet have universal healthcare in this country is a disgrace.

You're right that it ties many people's hands. I know many people who have been stuck in awful jobs because they couldn't afford to lose their coverage. A new job would have provided coverage but not for 90 days. And, as you point out, it also prevents people from striking out on their own and starting new businesses. It also keeps people from retiring when they'd like to. I'll be able to afford to retire before 65 but will need to buy my own insurance if I do, which may or may not be feasible. There's no way to know.

[jenn_jenn]

No doubt that our healthcare system is broken and needs to change but I am not onboard with universal government funded healthcare. Who is going to pay for that? And do you really trust our government to implement this efficiently? I don’t.