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Eighteen acute-care hospitals across the United States shut their doors in 2013.

At least 12 more hospitals have closed this year in rural areas alone. More are getting out the plywood to nail over windows and barricades for doors.

 

Don’t worry, it’s just the new normal under Obamacare, says Lee Hieb, M.D.

 

“Events happening now give us some idea of what medicine will be reduced to in the future,” Hieb writes in her forthcoming book, “Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare.”

 

“Today, all over America, small and midsize hospitals as well as hospitals in inner-city, poor areas are closing,” she said.

 

Hieb is an orthopedic surgeon and past president of the Association of American Physicians and Surgeons.

 

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She said the reasons for the closures aren’t complicated. Most of the victims are smaller hospitals or those in poor areas, which often serve the greatest number of Medicare and Medicaid patients.

 

A report at Modern Health Care just a few weeks ago confirmed that among just the critical-access hospitals, which have 25 beds or fewer, there were 14 closures in 10 states in 2013.

And the federal bureaucracies that set reimbursement rates for needy patients simply aren’t keeping up with the costs, she said.

 

Hieb writes that “whereas private insurance might pay the surgeon $4,500 for a spinal surgery (my specialty), Medicare paid less than $1,200.”

 

In addition, she says the federal government refuses to pay hospitals for certain services, deeming them “not medically necessary,”regardless of what doctors and patients say.

 

“The result is predictable: economic failure of hospitals and physician practices that have become dependent on government payment for large segments of their population,” Hieb writes. “The hospitals and offices that will close are those with the least private insurance.”

 

One case she cites: Temple Community Hospital of Los Angeles closed its doors Sept. 9. Among the reasons the hospital gave for its closure were “low reimbursement rates” and “regulatory requirements.”

 

And then there was Vidant Pungo Hospital of Belhaven, North Carolina, which shut its doors July 1. It was the only hospital in a small, economically destitute farming town.

 

There, Kaiser Health News reported, “The closing has left local doctors wondering how they will make sure patients get timely care, given the long distances to other hospitals, and residents worrying about what to do in an emergency and where to get lab tests and physical therapy.”

 

Said Dr. Charles Boyette, “Half of them aren’t going anywhere. They’re taking a chance on if they’ll be alive or dead after the emergency passes. The disaster has already started.”

 

In November, the company that owns Quincy Medical Center, near Boston, announced the hospital will close by the end of this year. QMC suffers from too much competition – there are more than a dozen hospitals within a 10-mile radius – but also from having too many patients with government insurance. Roughly 70 percent of the hospital’s patients are on Medicare or Medicaid.

 

Some hospitals, rather than closing completely, have dramatically reduced their workforces. In fact, 37 hospitals and health systems cut, or are preparing to cut, at least 100 employees from their payrolls this year.

 

Hospital closures and staff reductions have left fewer facilities and health-care workers to take care of more patients. Consequently, wait times have increased.

 

That was the case in West Memphis, Arkansas, after Crittenden Regional Hospital closed Sept. 7. Physicians at local urgent care clinics told the Memphis CBS TV affiliate they were overloaded and had to stay open an extra hour or two every day. Patients had to wait several hours to see a doctor.

Hieb warns of that very phenomenon in her book.

 

“The hospital in Arizona where I used to work is a 250-bed facility with the latest state-of-the-art cardiac care,” Hieb writes. “It is a referral center for about 400,000 people. Although you will get great care there, if you go by foot or car to the emergency room with chest pain, you may wait over six hours for an evaluation because the system is overloaded.”

 

She previously had warned of the increasing workload for doctors and the negative consequences that can result.

 

She told of her own experience with government-run health care, in the form of Medicare. As more and more elderly Medicare patients moved to her city and as the government dropped physician reimbursement levels, doctors began to leave town for cities with more private-pay patients. This put added stress on the doctors who remained, she said.

 

“In general medicine and other areas, hospital on-call nights were so brutal – keeping doctors up all night in spite of working all the next day – that all the doctors who could function outside the hospital chose to leave the hospital staff for purely outpatient practices,” Hieb wrote. “Those who could afford to retire did so. And in orthopedics, we were left with four surgeons doing the work that was being done elsewhere by 10 or more.”

 

She continued: “In areas where fewer and fewer physicians remain, it is very difficult to recruit new physicians to the job – since the new docs do not want to be forced to cover impossible patient loads. Around the country, there are already these medical ‘black holes’ – areas without coverage for certain specialties.”

 

Just a week ago, a report from Fierce Healthcare said one of the impacts of hospital closures is that mothers-to-be lack prenatal care.

 

And a report from Becker’s Hospital Review found a total of 20 “closures and bankruptcies” for 2014.

 

“Numerous acute-care hospitals and health systems have filed for bankruptcy protection, closed or announced upcoming shutdowns,” the report said, citing the loss of divisions of even major organizations like Indiana University Health and the University of Missouri Health.

 

Also, Specialty Hospitals of America sold off two of its facilities in Washington to an investment firm, the report said.

 

In another case, the Regional Medical Center in Natchez, Mississippi, filed for bankruptcy for the second time in five years.

 

Healthcare Dive reported there’s a domino effect following a closure.

 

“Times are tough for our nation’s hospitals, and not just the ones forced to close their doors. While employees from hospitals that stayed open believed that inter-hospital communication could mitigate the stress of closures on the healthcare system, when there is too much demand for hospital care, it takes a toll on patients and their families.”

 

Get “Surviving the Medical Meltdown: Your Guide to Living Throught the Disaster of Obamcare”

 

 

http://www.wnd.com/2014/12/oba...r-killing-hospitals/

 

 

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No Crash.  Third party payors (not Medicare and Medicaid), determine their own rates.  Sometimes these rates can be contracted as part of an area health management system. Hardly any I know of pay LESS than Medicare.  Medicaid is the worst by far, but they do insure children and the poor, so they are necessary.  Unfortunately the reason many doctors refuse to see Medicaid is because those patients with Medicaid were determined to be far more likely to sue for dissatisfaction in a study many years ago.  Why should they lose money seeing a patient and increase their liability at the same time?

Many rates are based on Medicare.  Sometimes BCBS will adjust their rates slightly above Medicare rates. This is a big help if you have a high volume of mixed traffic.  It manages to balance things out.

I know currently there is a plan to develop Medicaid Management groups, there will likely be two in north Alabama.  These groups will be charged with overseeing Medicaid and making sure that the patients are taken care of, and that the program is being used efficiently.  This to me makes much more sense than the older model. It is certainly a step in the right direction.

Don't blame the demise of small hospitals on the ACA/O'Bamacare.  They were dead ducks long ago.  There's a point where hospitals can be marginally profitable, and smaller hospitals simply cannot compete.

 

Look at Helen Keller.  Despite having a very active out patient services, they don't stand a chance to ever turn a profit.  So much of any business' expenses are employees salaries, and Keller's wages are not even that high--compared to a UAB or Vanderbilt.  I cannot believe that Huntsville Hospital's considered taking over this hospital with current staffing size. 

 

I just hope that fine Keller employees pushing retirement age can bail out and go work in home health care or hospice or other services if they cannot afford to go to the house.  The writing's on the wall.

 

In the meantime, Huntsville Hospital and Helen Keller continue to spend $ millions on fighting ECM.  It just doesn't make sense when they're so unprofitable.

 

 

I was not blaming it on Obamacare, so don't confuse what I said with the argument made by the editorial.  My problems with Obamacare are that it places too many demands on smaller doctor's offices by requiring EMR systems and things in order to comply.  These things costs money and are not cheap.  On top of this they are increasing our taxes in order to pay for someone else's insurance. And yes, CMS has cut reimbursement to specialities by as much as 5% in the past few years. More cuts this year for my speciality. As it is now, you have to work much harder, and be more productive, to make even close to what you made previously. Medicare rates are the foothold for rate determination, and you are correct, however, no insurance company pays less than Medicare ( or else no one would accept their fee schedule/ As it is, there is no mandatory requirement to accept a fee schedule, but with MC/MC you have no choice if you take their patients. The other third party payors allow balance billing, for the most part, so you can collect the difference in what is paid and the actual charge, unless the contract forbids it.

In Lawrenceburg, Tn, a doctor bills BCBS $265 for a simple office visit.  BCBS sends it to an adjuster, it gets lowered to $96. The adjuster gets a percentage (20%?) The doctor is on the preferred provider list, so he has to accept it. Then, the insurance company caused him to lose $169? How much does crap like that cost the nations health care. $96 for an office visit is pretty high.

The other issue that hospitals have to deal with are the wage index made by the federal government. The reason HH is able to pay their nurses more than ECM or Keller is because of the wage index. In Lauderdale county, as well as Colbert county, the amount reimbursed for the same disease is less than what is reimbursed in Madison county because of the government approved wage index.  If the reimbursements were the same, the hospitals would do much better.

 

jt,

I won't argue with you, but look at it this way.  How much time did he spend with the patient in order to bill that amount? 15 or 20 mintues?  That means he can see three patients, 4 tops, in an hour. If he gets 80% of $96 for that visit, and sees four patients.  He took in $307 for the hour. Now take into account his building rent or payment, his overhead with paper sheets, receptionist, and nurse, utilites, cleaning crew, etc, and you start to get the picture.  Last week, I had the brakes redone on my truck.  It costs m,e $400, and it took them about 1.5 hours. The mechanic, I am sure, did not spend 8 to 10 years in post graduate school after college. He does not pay for a business / occupational license, malpractice insurance, and manage his own health insurance benefit plan. Now if he can do 6 trucks a day like mine, he comes out for ahead of the doctor who is seeing patients and having to give (20% - your figure not mine) to someone else to collect his money.  BTW the only reason he may charge $265 for that visit is because somewhere there is a company which pays that amount. If he does not charge the maximum allowable, then if he sees that patient with the good insurance he does not get that amount. Medical billing is a complicated state of affairs.  I certainly wish it was much simplier, but then again it would put accountants and billing people out of work. I am in full belief that lawyers and accountants make our lives a living hell.

Last edited by teyates

Crash,

I have to tell you I was wrong about something (I know that will not surprise you..). I posted previously  that BCBS and other payors do not base payments upon Medicaid, and I stand corrected.  I talked with the billing office today, and was told that it is rare, but some things, usually in regards to women's health issues, may be based upon Medicaid rates. Since Medicaid tends to vary from state to state, BCBS (and others) may pay much less in one state than in another (AL vs. GA). So I stand corrected.

According to my billing officer, this year we were paid about 49% of what we billed. Our biggest problem is those without insurance (uninsured, despite the fact that the ACA was going to fix this). Of the uninsured, we discount everything 50% of the billable rate (whatever BCBS pays). As of today, only 31% of the uninsured even bothered to pay their bill.  Of those who paid, the majority are those who are 50 years old or older, the population which tends to be a little more responsible.

 

Medicaid rolls expanded even in states that opted out on the medicaid expansion, so it probably didn't matter in the closings.

 

Alabama has so far rejected the federal government's proposal to expand Medicaid.

Regardless, the Affordable Care Act still had the effect of increasing the size of Alabama's Medicaid rolls.

 

Medicaid enrollment in Alabama jumped up noticeably in January 2014, from around 970,000 to just over 1 million.

http://www.al.com/news/index.s..._effect_alabama.html

 

Supporters and opponents of the federal health law still can’t decide whether to call it the “woodwork” or “welcome mat” effect — the millions of people currently eligible for Medicaid who are not enrolled and who are expected to sign up as a result of the Affordable Care Act.

 

The Obama administration’s first enrollment report released Wednesday shows the phenomenon is real. It is happening even in Republican-led states that have fought the health law and refused to take advantage of a provision that would expand their Medicaid programs.

 

http://kaiserhealthnews.org/ne...ey-can-get-coverage/

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