The problem with Hospitals

[SeaCat]

There is a major crisis brewing in health care that is not talked about. This is the staffing levels at the hospitals.

Most hospitals in the United States are For Profit Hospitals. They are a business there to make money.

Where they get the money os from the Insurance Companies. (This does include Medicare and Medicade.) The Insurance Companies set the amount they will pay to the hospital based on the type of care required by the patient. This is all pretty basic.

The Insurance Companies in their drive for profits are constantly adjusting the amounts they pay. Rarely does this amount go up.

The Hospitals constantly review their costs. How the Insurance payouts are going down while the hospitals own insurance payments are going up. (Among other expenses.) The hospitals too have to make a profit so they are constantly looking for ways in which to cut costs. Again this is pretty basic.

Now the easiest place and way to trim costs is in the staffing. Nothing new there.

Now here is the problem, and I'll use my experiences in my hospital as an example.

Ten years ago Lisa, an R.N., had an average patient load of four patients. At the same time Aide Missy had a patient load of between eight to ten patients. Lisa and Missy were easily able to care for their patients. If a patient went bad they could deal with that without endangering the safety or decreasing the care of their other patients.

The hospital changed to a for profit hospital. Cost cutting began. Lisa found herself taking care of five patients while Missy found herself taking care of ten or eleven patients. Now because of advances in treatment as well as government oversight they both had a slight increase in paperwork. They could deal with this even though it made more work for them.

The hospital admin. pointed to the fact that Lisa and Missy were able to care for the patients with this slight increase and said that all was good. They needed more profits so they again added to the workload.

Every time they added to the work load they pointed at Lisa and Missy and said they were taking care of the patients. They didn't see how the time they had to care for their patients was going down. They didn't see how when an emergency came up there was a scramble to take care of the emergency as well as the other patients.

Now ten years later Lisa is working on a daily basis with eight plus patients and Missy is working with between fifteen and twenty patients. They have more paperwork and they have increased duties as well. Many of the patients they deal with on a daily basis on the floor would have been in the I.C.U. ten years ago. They can deal with this but just barely. If a patient goes bad on them their other patients have to wait until the problem is taken care of.

While this has been happening the pay for the Nursing Staff hs pretty much stagnated. IN the past ten years the pay raises for both Lisa and Missy has gone up a total of two dollars an hour.

Student Nurses see this and decide to work in other places like Doctors Offices or in Staffing Companies.

Soon there will be problems. There will be accidents, people will be injured and/or die. Lawsuits will ensue.

Now the worst part of this will be who is blamed. It won't be the hospitals or their owners. It will be The R.N.'s and Aides. It will be the people who are there to help other people. It will be the people who put themselves through hell on a daily basis with the sole aim of helping others. They will lose their jobs, they will lose their licenses and in some cases they will be fined or even incarcerated.

So how do we fix this?

In my mind there are a couple of ways to stop this from happening or getting worse.

1) Institute mandatory minimum staffing levels.

2) Reign in the Insurance Companies.

3) Reign in the hospitals. Make them non profit once again.

No one is going to like any of these cures. They go against the Free Market Ideal.

Cat

[DeeZire]

Originally Posted by SeaCat

....No one is going to like any of these cures. They go against the Free Market Ideal....

I like your proposals, if that makes you feel better.

[amicus]

Hello, SeaCat:

"...So how do we fix this?

In my mind there are a couple of ways to stop this from happening or getting worse.

1) Institute mandatory minimum staffing levels.

2) Reign in the Insurance Companies.

3) Reign in the hospitals. Make them non profit once again.

No one is going to like any of these cures. They go against the Free Market Ideal.

Cat

~~~

It is not, 'Free Market Ideals', that need concern anyone, it is freedom itself. You have the right, at this moment, to quit and take a higher paying job.

When you begin to use words like, 'mandatory', and 'rein in', you are talking about forcing people and institutions to do something other than what they choose. Who should manage the Insurance companies and the hospital?

Where does profit an non profit enter the picture? The only people I know who work for free are slaves or prisoners.

When I am tasked with trying to understand a large subject, industry or institution, my usual method is to go back to when it was a small subject and begin from there. The petroleum industry dates back to Pennsylvania in the mid to late 1800's, the automobile industry to the turn of the century. If I want to learn mathematics, I do not begin with Linear Algebra, but with math, geometry and pre algebra.

Run your Hospital back in time to where it was a one doctor, one nurse operation, learn how the hospital functioned, how it purchased the equipment needed, the drugs needed; learn how the building was acquired, who bought it, was it bought outright, mortgaged or rented?

The complexities of modern society are so involved that when a problem arises, it seems everyone tends to look for 'mandated service', control, regulation, rules, and laws as an answer to everything.

That inevitably leads to more laws, lawsuit, litigation, all of which become part of the cost factor of doing business.

Over 80 pecent of the costs of a business are people, personnel, wages and now benefits. Even before a new business opens its doors, costs have accumulated as 'start up' expenses, there is the building, utilities, a sometimes staggering debt just to start up a new business.

Somehow, in spite of government, the free market manages to do business on a competitive level with other businesses of the same type. They do so by efficiency, a better product, better service, and the ability to hire and fire to meet their needs.

Employees are always the biggest expense and if more efficient methods, machinery, equipment to make them more efficient, or even replace them is the method by which the best product/service at the lowest possible price is arrived at among free institutions.

If you think a bureaucracy of non medical personnel could better manage your Hospital, then, go for it!

Amicus

[Stella_Omega]

it's simply incredible how many words Ami can use to say absolutely nothing.

In any case, he has certainly proven Cat right-- he doesn't like it. He might not know what it is; but he hates it on principle.

I agree with you, Seacat.

[cloudy]

Originally Posted by amicus

If you think a bureaucracy of non medical personnel could better manage your Hospital, then, go for it!

Who the hell do you think runs it now????

Since the sky in your world is obviously some other color besides blue, here's a big ol' clue brick upside the head for you: hospital administrators are "non-medical personnel."

Absolutely clueless.

[amicus]

I would assume that 'hospital administrators', have some experience in the field of medicine, not everything is doctors and nurses, and since it is a business, whether you like it or not, some business education, training or experience is most likely included.

SeaCat, notice that three closet Marxists are in agreement with you...that should tell you something.

Amicus

[JAMESBJOHNSON]

Every place I've worked conforms to my theory about organized effort:

10% of the people do 90% of the work.
10% of the people steal 90% of the resources.
10% of the people create 90% of the problems.
10% of the people get 90% of the payroll.

[Liar]

Originally Posted by amicus

If you think a bureaucracy of non medical personnel could better manage your Hospital, then, go for it!

Sounds good to me. That way the medical personnel can spend more time managing the patients.

I have worked as a 'hospital administrator'. I managed the IT purchases. Didn't need to know shit about medicine.

[JamesSD]

I heard a really compelling piece on NPR a while back about why hospitals, even those not for profit, have to advertise. Many hospitals that function well are based on a business model where wealthy foreigners come to the US for superior medical care paid out of pocket and essentially subsidize the operations of that hospital. Luring in those willing to pay out of pocket for services and procedures is a major part of how hospitals can stay in the black.

[Stella_Omega]

A lot of Americans who travel are scheduling hospital processes for while they are in China.

[GratefulFred]

I tend to disagre with your analogy on hospitals and have a few comments.

Hopsitals in the past were perhaps victim to insurance companies and PPOs getting the better of them but that changed as more and more hospitals consolidated under a common name (Tenant, UHC, etc..).

One of the reasons that rates are high in some geographic areas is that the hospitals have formed a geographic monopoly and tell insurance companies and PPOs that if you want us in network, we will only accept this rate.

Plenty of insurance companies and PPOs could ill afford to drop parts of counties and thus the solution is that everyone pays higher rates.

The deeper problem with healthcare reform is that for profit hospitals can work fairly well recieiving 83% of their profits from rates running from medicaid, military, insurance companies and medicare and they charge over 200% of the medicare fee schedule rates against the poor uninsured.

Could hospitals adjust their staffing and profitability to a fee schedule without ripping off 17% and just getting medicare rates from uninsured? Absolutely.

Will service improve from insurance companies if they know that people may opt to stay out of insurance and just pay medicare rates? I believe so.

Insurance companies should only be tamed to raise their rates equal to that of medical inflation. Create an even playing field with everyone paying according to medicare and not being allowed to take over that, and curb the drug abuse from the drug manufacturers and rates can be less for everyone.

Demonizing the insurance companies will just lead to them bailing the individual and small group marketplace.

The hospitals working for excessive profit and killing the uninsured are the guiltiest party.

[JamesSD]

Originally Posted by Stella_Omega

A lot of Americans who travel are scheduling hospital processes for while they are in China.

Eep. That's scary.

Given China's human rights record, there's a good chance your blood transfusion, etc would come from a "donor" who was an executed political prisoner. And China is a Republican's dream in terms of Torts... they botch your operation? Too bad, go home.

[Liar]

Originally Posted by JamesSD

Eep. That's scary.

Given China's human rights record, there's a good chance your blood transfusion, etc would come from a "donor" who was an executed political prisoner. And China is a Republican's dream in terms of Torts... they botch your operation? Too bad, go home.

On the other hand, I have a feeling they're not overly nice to doctors who botch operations.

[popcorn2721]

Originally Posted by JamesSD

Eep. That's scary.

Given China's human rights record, there's a good chance your blood transfusion, etc would come from a "donor" who was an executed political prisoner. And China is a Republican's dream in terms of Torts... they botch your operation? Too bad, go home.

Cheap parts, cheap labor... this is America, who cares where it comes from. The real fortunes will be made when they can train 10 year olds to do liver and kidney transplants.

[Epmd607]

Originally Posted by SeaCat

There is a major crisis brewing in health care that is not talked about. This is the staffing levels at the hospitals.

Most hospitals in the United States are For Profit Hospitals. They are a business there to make money.

Where they get the money os from the Insurance Companies. (This does include Medicare and Medicade.) The Insurance Companies set the amount they will pay to the hospital based on the type of care required by the patient. This is all pretty basic.

The Insurance Companies in their drive for profits are constantly adjusting the amounts they pay. Rarely does this amount go up.

The Hospitals constantly review their costs. How the Insurance payouts are going down while the hospitals own insurance payments are going up. (Among other expenses.) The hospitals too have to make a profit so they are constantly looking for ways in which to cut costs. Again this is pretty basic.

Now the easiest place and way to trim costs is in the staffing. Nothing new there.

Now here is the problem, and I'll use my experiences in my hospital as an example.

Ten years ago Lisa, an R.N., had an average patient load of four patients. At the same time Aide Missy had a patient load of between eight to ten patients. Lisa and Missy were easily able to care for their patients. If a patient went bad they could deal with that without endangering the safety or decreasing the care of their other patients.

The hospital changed to a for profit hospital. Cost cutting began. Lisa found herself taking care of five patients while Missy found herself taking care of ten or eleven patients. Now because of advances in treatment as well as government oversight they both had a slight increase in paperwork. They could deal with this even though it made more work for them.

The hospital admin. pointed to the fact that Lisa and Missy were able to care for the patients with this slight increase and said that all was good. They needed more profits so they again added to the workload.

Every time they added to the work load they pointed at Lisa and Missy and said they were taking care of the patients. They didn't see how the time they had to care for their patients was going down. They didn't see how when an emergency came up there was a scramble to take care of the emergency as well as the other patients.

Now ten years later Lisa is working on a daily basis with eight plus patients and Missy is working with between fifteen and twenty patients. They have more paperwork and they have increased duties as well. Many of the patients they deal with on a daily basis on the floor would have been in the I.C.U. ten years ago. They can deal with this but just barely. If a patient goes bad on them their other patients have to wait until the problem is taken care of.

While this has been happening the pay for the Nursing Staff hs pretty much stagnated. IN the past ten years the pay raises for both Lisa and Missy has gone up a total of two dollars an hour.

Student Nurses see this and decide to work in other places like Doctors Offices or in Staffing Companies.

Soon there will be problems. There will be accidents, people will be injured and/or die. Lawsuits will ensue.

Now the worst part of this will be who is blamed. It won't be the hospitals or their owners. It will be The R.N.'s and Aides. It will be the people who are there to help other people. It will be the people who put themselves through hell on a daily basis with the sole aim of helping others. They will lose their jobs, they will lose their licenses and in some cases they will be fined or even incarcerated.

So how do we fix this?

In my mind there are a couple of ways to stop this from happening or getting worse.

1) Institute mandatory minimum staffing levels.

2) Reign in the Insurance Companies.

3) Reign in the hospitals. Make them non profit once again.

No one is going to like any of these cures. They go against the Free Market Ideal.

Cat

There's nothing in American Healthcare that resembles free market competition. I hope they just socialize the whole deal, instead of having this hybrid of social medicine and for-profit medicine.

Actually there is something in American Healthcare that resembles a free market. If you're rich you can get the best care a whole lot quicker than me with my VA card.

[Handley_Page]

Originally Posted by SeaCat

There is a major crisis brewing in health care that is not talked about. This is the staffing levels at the hospitals.

Most hospitals in the United States are For Profit Hospitals. They are a business there to make money.

Where they get the money os from the Insurance Companies. (This does include Medicare and Medicade.) The Insurance Companies set the amount they will pay to the hospital based on the type of care required by the patient. This is all pretty basic.

The Insurance Companies in their drive for profits are constantly adjusting the amounts they pay. Rarely does this amount go up.

The Hospitals constantly review their costs. How the Insurance payouts are going down while the hospitals own insurance payments are going up. (Among other expenses.) The hospitals too have to make a profit so they are constantly looking for ways in which to cut costs. Again this is pretty basic.

Now the easiest place and way to trim costs is in the staffing. Nothing new there.

Now here is the problem, and I'll use my experiences in my hospital as an example.

Ten years ago Lisa, an R.N., had an average patient load of four patients. At the same time Aide Missy had a patient load of between eight to ten patients. Lisa and Missy were easily able to care for their patients. If a patient went bad they could deal with that without endangering the safety or decreasing the care of their other patients.

The hospital changed to a for profit hospital. Cost cutting began. Lisa found herself taking care of five patients while Missy found herself taking care of ten or eleven patients. Now because of advances in treatment as well as government oversight they both had a slight increase in paperwork. They could deal with this even though it made more work for them.

The hospital admin. pointed to the fact that Lisa and Missy were able to care for the patients with this slight increase and said that all was good. They needed more profits so they again added to the workload.

Every time they added to the work load they pointed at Lisa and Missy and said they were taking care of the patients. They didn't see how the time they had to care for their patients was going down. They didn't see how when an emergency came up there was a scramble to take care of the emergency as well as the other patients.

Now ten years later Lisa is working on a daily basis with eight plus patients and Missy is working with between fifteen and twenty patients. They have more paperwork and they have increased duties as well. Many of the patients they deal with on a daily basis on the floor would have been in the I.C.U. ten years ago. They can deal with this but just barely. If a patient goes bad on them their other patients have to wait until the problem is taken care of.

While this has been happening the pay for the Nursing Staff hs pretty much stagnated. IN the past ten years the pay raises for both Lisa and Missy has gone up a total of two dollars an hour.

Student Nurses see this and decide to work in other places like Doctors Offices or in Staffing Companies.

Soon there will be problems. There will be accidents, people will be injured and/or die. Lawsuits will ensue.

Now the worst part of this will be who is blamed. It won't be the hospitals or their owners. It will be The R.N.'s and Aides. It will be the people who are there to help other people. It will be the people who put themselves through hell on a daily basis with the sole aim of helping others. They will lose their jobs, they will lose their licenses and in some cases they will be fined or even incarcerated.

So how do we fix this?

In my mind there are a couple of ways to stop this from happening or getting worse.

1) Institute mandatory minimum staffing levels.

2) Reign in the Insurance Companies.

3) Reign in the hospitals. Make them non profit once again.

No one is going to like any of these cures. They go against the Free Market Ideal.

Cat

We have similar problems in the UK- added paperwork, patients and ill-qualified staff (they are cheaper).

Good Luck!

[SixtyMinuteMan]

Originally Posted by Stella_Omega

A lot of Americans who travel are scheduling hospital processes for while they are in China.

I worked in Taiwan for a while a few years back. While we were there we had three major injuries (it's just that kind of job): one guy had a cable hit his face so hard it broke his safety glasses and drove a piece right back into his eye. He needed a bunch of stitches, minor surgery to fix the eye, and a lot of aftercare. Had several wand MRIs done to make sure they hadn't missed anything and it was healing right, daily bandage changes and wound care, lots of meds, all that. Total cost to us? $1000NT, at the time the equivalent of $30.

I broke my hand, needed minor surgery and all the care that goes with broken delicate bones. Total cost? $1000NT. My best friend also broke a hand, worse than mine, needed pins and what have you. Total cost? You guessed it. $1000NT.

We saw numerous Americans on their way to hospitals in the local countries all over Asia, not just in Taiwan and mainland China. The care is quite good, many of the doctors are trained right here in the US, and the system isn't held hostage to the insurance industry and the drug companies.

So, yeah. You're right.

[JAMESBJOHNSON]

Originally Posted by GratefulFred

I tend to disagre with your analogy on hospitals and have a few comments.

Hopsitals in the past were perhaps victim to insurance companies and PPOs getting the better of them but that changed as more and more hospitals consolidated under a common name (Tenant, UHC, etc..).

One of the reasons that rates are high in some geographic areas is that the hospitals have formed a geographic monopoly and tell insurance companies and PPOs that if you want us in network, we will only accept this rate.

Plenty of insurance companies and PPOs could ill afford to drop parts of counties and thus the solution is that everyone pays higher rates.

The deeper problem with healthcare reform is that for profit hospitals can work fairly well recieiving 83% of their profits from rates running from medicaid, military, insurance companies and medicare and they charge over 200% of the medicare fee schedule rates against the poor uninsured.

Could hospitals adjust their staffing and profitability to a fee schedule without ripping off 17% and just getting medicare rates from uninsured? Absolutely.

Will service improve from insurance companies if they know that people may opt to stay out of insurance and just pay medicare rates? I believe so.

Insurance companies should only be tamed to raise their rates equal to that of medical inflation. Create an even playing field with everyone paying according to medicare and not being allowed to take over that, and curb the drug abuse from the drug manufacturers and rates can be less for everyone.

Demonizing the insurance companies will just lead to them bailing the individual and small group marketplace.

The hospitals working for excessive profit and killing the uninsured are the guiltiest party.

Youre correct.

In the 90s the insurance HMOs put several local hospitals out of business by refusing to authorize treatment, and the hospitals treated the patients for free until they closed the doors. Then the mega-hospital corporations bought up the hospitals and tossed out the HMOs. The HMOs were forced to pay for services or go out of business.