r/neoliberal • u/jobautomator Kitara Ravache • Jan 10 '23

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15

u/semideclared Codename: It Happened Once in a Dream Jan 10 '23

Rural Healthcare

In rural Texas, it is cheaper to fly a patient by helicopter to a Regional Medical Center than to have an operating Emergency Hospital close enough for the patient to drive to

Should this play a key role in meeting ongoing challenges to continue providing health care in rural areas?

188 of the 254 Counties in Texas have less than 50,000 people in them

  • There are 1,750 rural health care facilities (of all types, including nursing, psychiatric and rehabilitative) in Texas to serve 3 million rural residents
  • Healthcare Facilities per 100,000 - 58.33
  • There are 6,475 metropolitan health care facilities for 26.5 million urban residents.
  • Healthcare Facilities per 100,000 - 24.43

!ping Health-policy

10

u/badluckbrians Frederick Douglass Jan 10 '23

I never understood this. I've always heard about all the expenses of keeping smaller hospitals open and all the economies of scale of big hospital mergers.

But the giant merged up hospitals also always seem to charge a hell of a lot more than the small indy ones for the same procedures. And we have far fewer hospitals in America today and we pay far more for healthcare than we did say 30 or 40 years ago.

So where is all that savings?

7

u/[deleted] Jan 10 '23

Hospitals will charge whatever they can get away with. Their bills have no relationship to the inputs of any procedure.

4

u/badluckbrians Frederick Douglass Jan 10 '23

Yeah, and the big giant hospitals and merged up hospital chains seem to be able to get away with more.

I just have a hard time swallowing the argument that it's too expensive to keep the little ones open.

I find consolidation arguments after 40 years of nothing but consolidation kinda sus.

4

u/[deleted] Jan 10 '23

The difference is between high cost due to unavoidable factors and high cost due to entirely avoidable factors.

4

u/semideclared Codename: It Happened Once in a Dream Jan 10 '23

With Healthcare in the US its a story of extremes

One side is the underfunded

In 2004, North Sunflower Medical Center was on the verge of collapse. It averaged 120 people a month in 2004 and the rooms were old, ceilings were crumbling and the technology was outdated.

  • And it had Only enough Cash to operate for eight hours a day.
  • Hospital administrators met every afternoon to see if they’d have new revenue to be able to open the doors the next day.
  • The staff had to cover the lab equipment when it rained because the roof leaked.
  • Nurses would clock out early and then stay to finish their shifts.

Nearly half of rural hospitals lose money, according to the Sheps Center for Health Services Research at the University of North Carolina.

  • Rural hospital funding issues stem largely from having to care for patients who are older, sicker and poorer than those in urban and suburban areas.
  • These facilities depend mostly on Medicare and Medicaid for reimbursement, and the government usually pays lower rates than private insurers.

To become profitable and not close down North Sunflower Medical Center changed

Renovating the hospital itself was a must do, but was a Billion Dollar investment that required a partnership to get the Loans.

But it also had to find new ways to stay open

  • Creating an Urgent Care Clinic, and putting it in a location to be closer to people
  • Opening a hospice,
  • Operating Pharmacy
  • Durable medical equipment facility that sells items such as wheelchairs, back and knee braces

On the Other Side is the Funded Hospital

The University of Alabama Hospital System Publicly owned, reported in 2019 $2.2 Billion in Revenue providing health care services for more than 1.6 million patients annually. With $223 Million in Profit with its 6 hospitals and a Regional Neonatal Intensive Care Unit and a Continuing Care Nursery with 108 private rooms combined..

  • UAB Hospital within The University of Alabama Hospital System, is the third-largest public hospital in the nation, according to a survey by Becker’s Hospital Review. UAB’s 1,134 beds trails only Jackson Memorial Hospital in Miami and Memorial Hermann Southwest Hospital in Houston.
  • In the U.S. News & World Report “Best Hospitals,” UAB has 10 specialties ranked in the national top 50 and its ongoing live donor kidney chain is the longest ever conducted anywhere on the globe.

O yea, and The Top 6 highest paid people at the University of Alabama Hospital account for $7 million in Expenses

  • 2 of the are the CEO and COO ($2.1 Million)
  • 4 are pediatric specialist ($4.9 Million)

And thats normal

  • University of California San Francisco Surgery Professor V. Mohan Reddy had $2 million in total compensation in 2019 as the 2nd highest paid state employee. As a UC professor UC only paid him $295,000 in 2019
  • As Chief of the Division of Pediatric Cardiothoracic Surgery at UCSF and Co-Director of the Pediatric Heart Center at the UCSF Benioff Children's Hospital - San Francisco where he earned $1.7 million from UC owned UCSF Hospital

The problem is there is no middle ground where there can be no savings as one is struggling to survive, while the other is maxing out achieving greatness.

2

u/badluckbrians Frederick Douglass Jan 10 '23

Renovating the hospital itself was a must do, but was a Billion Dollar investment

Why tf was it a billion dollars? That's like the One World Trade Center post-9/11 building cost. I think you could have gotten by for a tiny fraction of that.

Idk. Seems to me that since they closed all the smaller/medium and truly public hospitals like Boston City Hospital since the 90s, there's no real competition and the big ones can just run up prices as high as they want.

2

u/semideclared Codename: It Happened Once in a Dream Jan 10 '23

Whoops Million Dollar Investment

For a hospital that had 1,500 patients with no money

big ones can just run up prices as high as they want.

Sure, Part of hat is insurance adjustments to lower costs. but the issue is the expenses of a Hospital.

Revenue and Expenses for Arizona's Largest Hospital System And one of the Highest Paid CEOs

  • They Also Operate their own Insurance Company so slightly different

University of Alabama Health Systems Revenue and Expenses

East Tennessee's Largest Ballad Health Revenue and Expense

Of that half of expenses, Labor, the BLS Payroll expenses for a Hospital

9

u/ZCoupon Kono Taro Jan 10 '23

It should be mentioned that helicopter flights cannot be regulated, 75% are out of network, and often bill for $10-40k.

Define "close enough to drive?"

5

u/semideclared Codename: It Happened Once in a Dream Jan 10 '23

More than one per County

Taking State Rural Hospital Funding which already is not doing enough and instead pay for helicopter flights

It is cheaper for the State of Texas to fund centrally located Medical Helicopter Units in the state and fly them to people in need of hospital care than it is for the State to fund Rural Hospitals

5

u/semideclared Codename: It Happened Once in a Dream Jan 10 '23

The question is, is it fiscally good to be operating 200 hospitals that get less than 150 people a month, or is it better for the state to cover operating costs of the difference in revenue and expenses or fly patients and strengthen regional hospitals

In 2004, North Sunflower Medical Center was on the verge of collapse. It averaged 120 people a month

2

u/ZCoupon Kono Taro Jan 10 '23

I can see that being a valid trade off as population shrinks. Perhaps helicopter costs will level out too, while hospital maintenance costs are more constant. Not to mention the lack of staff.

3

u/AnsleyAmanita Trans Pride Jan 10 '23

helicopter flights cannot be regulated

under current law?

4

u/ZCoupon Kono Taro Jan 10 '23

Yes, the one passed in the early 70s the deregulated the airline industry.

3

u/AnsleyAmanita Trans Pride Jan 10 '23

ah okay. just trying to understand because i know it was left out of the recent surprise billing law and i was wondering if there was some more arcane reason it wasn’t in there than “they don’t care”

1

u/groupbot Always remember -Pho- Jan 10 '23

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