Author Topic: Hospital Layoffs pick up as ObamaCare Era Begins  (Read 9390 times)

spuwho

  • Hero Member
  • *****
  • Posts: 5104
Hospital Layoffs pick up as ObamaCare Era Begins
« on: July 20, 2013, 01:21:07 PM »
http://news.investors.com/071913-664373-hospitals-cut-jobs-on-obamacare-medicare-medicaid.htm

Per Investors Business Daily:

Hospitals pick up the pace to cut costs as new ObamaCare laws go into effect.

That busy health care industry to-do list ahead of ObamaCare includes an increasing number of hospital job cuts. Since the start of May, hospital groups have announced plans to lay off nearly 6,000 workers. Add in several thousand additional positions seeing fewer hours or cuts through attrition and buyouts, and the work reductions impact more than 9,000 jobs.

An IBD review found layoff and workforce reduction announcements covering 75 hospital groups in 33 states and the District of Columbia.



Prognosis Negative

While hospital layoffs are much more common in recent years, what is notable is how widespread they've become, impacting even firms that have never before resorted to job cuts. Even more striking is the sudden change in patient behavior and rapid deterioration in hospital finances.

Baystate Franklin Medical Center, in Massachusetts, which is cutting up to nine nurses on its surgical staff, noted that the average hospital stay for its patients has fallen from 3.4 days in 2012 to 2.4 days this year.

Jordan Hospital, also in Massachusetts, is cutting 43 positions partly as a response to a 9% decline in inpatient admissions.

Cone Health of North Carolina, which earned $100 million in 2010, was reportedly $11 million in the red through eight months of its fiscal year. As a result, the hospital group is laying off 150 employees.

Baptist Health of Arkansas, which this week said it will lay off 170, nearly 2.5% of its workforce, listed the array of challenges forcing hospitals to find efficiencies wherever they can: "substantially less government reimbursement, burdensome government regulations, rapidly rising costs of supplies, increasing charity care and bad debt, and the need for technology and medical innovations."

Nashville, Tenn.-based Community Health Systems (CYH), with 135 hospitals in 29 states, warned late Thursday that it experienced its "first significant earnings miss" in almost seven years in the June quarter. The hospital group gave no word of layoffs but said it is intensifying its focus on managing expenses.

After-tax profit in the quarter sank to $65 million vs. $151.7 million a year earlier as admissions fell 5.1% and uncompensated care costs topped expectations.

Community Health, whose shares fell 9% Friday, also cited "a deterioration in payor mix" — which is another way of saying it wished more patients had private insurance, not Medicare and Medicaid.

Pain Will Grow

Some deterioration in hospital finances is to be expected, given Medicaid cuts in some states and a 2% reduction in Medicare payments due to sequestration. But these financial challenges are being exacerbated by patient frugality — partly a function of high-deductible policies — and by new federal regulations to curb Medicare costs.

Some hospitals said they were making cuts to be proactive because they expected Medicare reimbursements to continue to lag due to ObamaCare reforms.

"Admissions are expected to continue at a reduced rate because of initiatives that are part of health care reform," Florida's Indian River Medical Center said in a memo explaining the reduction of 50 staffers, including 21 layoffs. "For example, admission criteria will deny payment for a number of conditions that now must be taken care of on an outpatient basis."

As economists and federal budget watchers herald evidence that health care cost growth has slowed and projections that the slowdown will be sustained, the apparent acceleration in hospital layoffs demonstrates that the path toward that end is far from pain-free .

Medicare's actuaries have warned in recent years that ObamaCare's prescribed payment reductions would be difficult to achieve and could, over time, leave a sizable percentage of providers operating at a loss.

Aware that the financial pressures will be longstanding, a number of operators said that further work reductions are on the way.

Lifespan of Rhode Island, which laid off 53, told workers to expect an additional reduction of 200 jobs. The Hospital of Central Connecticut said it has avoided layoffs by cutting 100 positions through attrition and voluntary retirement, while decreasing hours "to maintain jobs for people who wanted to keep working." But that approach, the hospital warned, is "going to become more difficult."

Those hospitals are in states that have signed onto ObamaCare's Medicaid expansion. In states such as Missouri that have not signed up, hospitals warned that their finances may deteriorate further. That's because ObamaCare will reduce Medicaid payments to hospitals that serve a disproportionate share of low-income patients. Those cuts were passed when the expansion was supposed to be mandated.



spuwho

  • Hero Member
  • *****
  • Posts: 5104
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #1 on: July 20, 2013, 01:37:46 PM »
Medicare payments were cut as a part of Obamacare.

Hospitals that have a high intake of Medicare patients are cutting staff.

spuwho

  • Hero Member
  • *****
  • Posts: 5104
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #2 on: July 20, 2013, 01:48:34 PM »
even more weird.  the article says that the work is being transferred from hospitalizations to outpatient procedures (usually in clinic)

Quote
"Admissions are expected to continue at a reduced rate because of initiatives that are part of health care reform," Florida's Indian River Medical Center said in a memo explaining the reduction of 50 staffers, including 21 layoffs. "For example, admission criteria will deny payment for a number of conditions that now must be taken care of on an outpatient basis."

isnt that supposed to be a good thing?

It is as long as there is an outpatient provider that will provide the service at Medicare or ObamaCare payment levels.  If there isn't one locally, then the patient would have to drive or be transported to the one that does or purchase private insurance or pay cash for one closer.

While it is hard to translate, the article is saying that as private insurance carriers raises deductibles to begin to accommodate ObamaCare mandates, people are deferring or deciding to live without certain elective procedures.

In combination with reduced Medicare reimbursement rates (which initially funds ObamaCare), this is driving reduced hospital use.

It has been generally known that ObamaCare will drive huge mergers or force many rural, semi-rural hospitals into networks with their larger brethren so that they have access to certain types of care ObamaCare will mandate but they can't afford due to the reimbursement rates.

NotNow

  • Hero Member
  • *****
  • Posts: 3335
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #3 on: July 20, 2013, 01:52:54 PM »
spuwho, are you a medical professional with experience or training in the field?

If you don't mind me asking.   :)
Deo adjuvante non timendum

JeffreyS

  • Hero Member
  • *****
  • Posts: 5946
  • Demand Evidence and Think Critically.
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #4 on: July 20, 2013, 02:21:42 PM »
So this article is saying that the healthcare industry cutting costs as a result of legislation designed to cut the cost of healthcare. Hmmmm
Lenny Smash

If_I_Loved_you

  • Guest
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #5 on: July 20, 2013, 03:24:21 PM »
And to the brainless people who voted for Rick Scott lets not forget about "Florida elects Rick Scott who admitted to 14 counts of Medicare fraud"

Florida voters gave gubernatorial candidate Rick Scott the nod of approval in the November 2, 2010 elections. However, Scott who beat Alex Sink in the Florida Governor’s race, admitted to 14 counts of Medicare fraud and paid the federal government more than $600 million dollars in fines for his fraudulent billing practices.

    In settlements reached in 2000 and 2002, Columbia/HCA rose to public attention when it pleaded guilty to 14 felonies and agreed to a $600+ million fine in what the Justice department then called the largest fraud case settled in the history of the Justice department.

    A series of New York Times articles, beginning in 1996, began scrutinizing Columbia/HCA's business and Medicare billing practices. These culminated in the company being raided in July 1997 by Federal agents searching for documents. Among the crimes uncovered were doctors being offered financial incentives to bring in patients, falsifying diagnostic codes to increase reimbursements from Medicare and other government programs, and billing the government for unnecessary lab tests.Following the raids, the Columbia/HCA board of directors forced Scott to resign as Chairman and CEO. He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million, mostly from his initial investment In 1999, Columbia/HCA changed its name back to HCA, Inc.”

State wide, Florida voters gave the victory to Scott with only a 48% to 47% margin. However in Hernando County, the breakdown of voters who approved of the candidate who admited to Medicare fraud was 51%. for Scott and 43% for Sink. http://www.examiner.com/article/florida-elects-rick-scott-who-admitted-to-14-counts-of-medicare-fraud

JayBird

  • Hero Member
  • *****
  • Posts: 1045
  • Back in home state - After living in Jax 10 years
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #6 on: July 20, 2013, 03:42:41 PM »
I think this is all good news, costs have to be cut. People from other countries constantly tell of how America treats their docs like gods when in Europe and Asia its just another job. These cuts would be happening regardless of Obamacare IMO, the bubble has to eventually burst.
Proud supporter of the Jacksonville Jaguars.

"Whenever I’ve been at a decision point, and there was an easy way and a hard way, the hard way always turned out to be the right way." ~Shahid Khan

http://www.facebook.com/jerzbird http://www.twitter.com/JasonBird80

spuwho

  • Hero Member
  • *****
  • Posts: 5104
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #7 on: July 20, 2013, 04:12:30 PM »

You sound like you are just cold making up stuff that sounds scary btw, since it hasnt been implemented yet.

No Stephen, I am afraid this isn't a cold "make it up as I go" thing.  This is only perhaps 10% of all of the issues facing health care today. This article only highlighted one.

Since the laws are in the books and affirmed by the SCOTUS, firms who are adjusting to the laws have to plan like any other. So they look at what the revenue landscape will be under the new regulations and they have to make adjustments, like any other business.

spuwho, are you a medical professional with experience or training in the field?

If you don't mind me asking.   :)

Not a problem. I personally do not work in the health care industry, however, my father was a 40 year CEO in health care, developed the first hospital based outpatient center, was nominated by the governor to the first state Health Facilities Planning Board, was President of the state hospital association and was way ahead of the curve when he started working on the first cooperative health care network.  I also have Uncles and Aunts who are doctors and nurses, so I hear what is happening on the both sides of the health care equation.

My father worked in rural, semi-rural and urban hospital settings. My uncle created from scratch and developed two hospitals in very rural South Africa that still stand today, though they have since been socialized tremendously by the new government. That is where my familiarity with health care comes from.

The health care landscape is changing big time in the US. It's not a scare thing, it is just what is happening now. What is cool about the United States, entrepreneurs are going to come up with alternatives when they see the opportunities the changes will bring. Actually they have already started, but many expect that to accelerate as ObamaCare becomes more the norm.








NotNow

  • Hero Member
  • *****
  • Posts: 3335
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #8 on: July 20, 2013, 04:32:45 PM »
Thanks spuwho.
Deo adjuvante non timendum

spuwho

  • Hero Member
  • *****
  • Posts: 5104
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #9 on: July 20, 2013, 05:00:43 PM »

So then, no.  you are not a health care professional, and your familiarity with the changes is simply second hand what you are reading in the media, same as the rest of us.

Thanks for making that clear.


My "second hand"  knowledge comes from listening to my well experienced family in the nuances of modern health care issues and then translate that against the many media reports, as I noted, only refer to perhaps 10% of the issues or impacts. 

Not a guru by any means, but I would like to think I am well informed on the issues of the day on the subject.

Ocklawaha

  • Phd. Ferroequinology
  • Global Moderator
  • Hero Member
  • *****
  • Posts: 10448
  • Monster of Mobility! Ocklawaha is Robert Mann
    • LIGHT RAIL JACKSONVILLE
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #10 on: July 20, 2013, 07:55:52 PM »
My daughter is a healthcare professional and she is telling us the same things. Doctors with seniority are simply saying 'screw it,' and retiring early, shuttering their practices. She calls it a 'free fall.'

Healthcare may be just another job in Europe, but here my Honda mechanic has, 'just another job,' and I sure as hell don't want him stitching me up. If we lower medical professionals to 'just another job' status, we are not going to like the results.

JeffreyS

  • Hero Member
  • *****
  • Posts: 5946
  • Demand Evidence and Think Critically.
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #11 on: July 20, 2013, 08:39:24 PM »
I have no doubt that no matter how good or bad the change people will be scared just before it happens.  I imagine the long time healthcare workers will judge whether or not they want to learn a new system before they retire.  I am sure there will be bumps in the road but so far the changes have been good.

We had to get away from the just die or just go broke healthcare system.
Lenny Smash

NotNow

  • Hero Member
  • *****
  • Posts: 3335
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #12 on: July 20, 2013, 09:06:13 PM »
Jeffrey, if you don't mind me asking as well, are you a health care professional or have experience of some kind in the industry?
Deo adjuvante non timendum

JeffreyS

  • Hero Member
  • *****
  • Posts: 5946
  • Demand Evidence and Think Critically.
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #13 on: July 20, 2013, 09:08:11 PM »
No I am just another A-h%$& with an opinion.
Lenny Smash

redglittercoffin

  • Jr. Member
  • **
  • Posts: 75
Re: Hospital Layoffs pick up as ObamaCare Era Begins
« Reply #14 on: July 20, 2013, 09:42:25 PM »
I am a healthcare professional.  What I can tell you is that there are nuances in reimbursement that haven't been discussed here. 

To make a long story short, just because  patient spends three or four days in a hospital after a major surgery does not necessarily make them an "inpatient".  The "inpatient" reimbursement rates are much higher than "outpatient" or "observation" patients -- while at the same time, the hospital is still using the same resources on those "observation" patients that they did a year ago when they were "inpatients".

For instance, a total abdominal hysterectomy two years ago was an open and shut inpatient stay that usually lasted at least two, and most likely three days -- including the surgery and any follow-up. The hospital was reimbursed at the inpatient rate.

Today, most hysterectomies are reimbursed at the "observation" rate -- typically about 3-4 times less than that of the "inpatient" rate -- all despite the fact that the same resources are being used -- same medications -- same bed space -- etc.  The costs are the same -- the reimbursement is not.  The standards for classifying an patient as "inpatient" are much higher than they were only 18 months ago. 

Just because a patient is not "inpatient" does not mean that the patient is "outpatient" and is done in the clinic setting for much less -- it is likely still being done in the hospital, for the same cost, but not the same reimbursement.

Combine that with Florida's unwillingness to expand Medicaid -- and you have the perfect storm for Florida hospitals. 
...I just need one last nail