Category: “Healthcare”

Don't let anyone tell you hospitals aren't spending money, even in CA

Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor's Rating Services. The rating agency warned the healthcare sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures."

Medicare treats physicians as criminals — guilty until proven innocent.

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare warns patients on their billing statements to turn their physicians in for suspected fraud.

Just yesterday it was reported how well Tenet was performing under ACA. I suppose when you lose less money that's an accurate assessment. Perhaps instead of cheerleadering ACA the news should be accurately reflecting what is going on. Tenet's miniscule growth (2.6%) is attributable to acquisitions and mergers - not ACA volume growth.

For-profit hospital operator Community Health Systems has agreed to pay more than $97 million plus interest to the federal government, settling allegations that it submitted false claims for short-stay admissions. “I think that there are a number of people in the healthcare industry who have a growing concern about corporate pressure influencing medical decision-making,” Organ said. The settlement does not end scrutiny on CHS. The government is still investigating billing practices at Health Management Associates hospitals, the former North Naples, Fla.-based hospital chain that CHS bought earlier this year.

Wal-Mart Stores Inc. wants to disrupt another mass market: health care. The company is piloting what it hopes will be a broad network of primary-care clinics. The company already has urgent-care clinics in about 100 stores, but the new facilities will provide much broader services such as chronic-disease management that are normally provided at a doctor’s office. And it is doing so at an admirably low cost: A doctor’s visit at one of its primary-care clinics costs just $40, in cash -- the only insurance they take is their corporate health plan and Medicare.

Kaiser Permanente, the 32-hospital California-based system that also operates its own health plan, reported a 25% increase in its net surplus during the second quarter of the year as it added new members and scaled back its capital spending. This certainly explains their politics and advocacy of the ACA law.

The six systems are Aspirus in Wausau; Aurora Health Care in Milwaukee; Bellin Health in Green Bay; Gundersen Health System in La Crosse; ThedaCare in Appleton; and UW Health in Madison. Together, they comprise 44 hospitals and more than 5,600 physicians, and they provide care to about 90% of the Badger State's population, according to a release announcing the partnership.

Matt Heywood, CEO of Aspirus, said in an interview that the ultimate goal of the non-equity partnership is to migrate toward an accountable care organization. The six health systems already have started offering a commercial health plan with Anthem Blue Cross, available through the federal and private-insurance exchanges. If and when the collaborative becomes an ACO, it will aim for inclusion in more health plans as a low-cost, high-quality provider network.

When you think our business can't get any crazier it does. Siemens IT sells out. The most expensive rooms in Radiology get KLAS rating (cause I suppose money doesn't matter). Now California wants to make it harder even harder for hospitals struggling under ACA revenue constriction. CA wants not-for-profit hospitals to give more money away. Perhaps it's like the Federal government - we're in debt and borrowing 50 cents of every dollar so lets give more away. CA - good luck with that.

The health system in 2013
• $53.1 billion: Operating revenue in 2013
• $1.8 billion: Operating income in 2013
• $2.7 billion: Net income in 2013
• 9.1 million members
• 174,415 employees
• 17,425 physicians
• 48,285 nurses
• 38 hospitals
• 608 medical offices, facilities