Hospital Layoffs pick up as ObamaCare Era Begins

[NotNow]

No I am just another A-h%$& with an opinion.

Ha! Welcome to the club!

[NotNow]

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. 

Thanks Glitter.  Are these new rules for admission federal?  Are ypu seeing/fearing cutbacks in employees?  What changes would you make?

[redglittercoffin]

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. 

Thanks Glitter.  Are these new rules for admission federal?  Are ypu seeing/fearing cutbacks in employees?  What changes would you make?

Yep.  CMS Guidelines.  As far as I am aware, these guidelines are not necessarily part of Affordable Care Act.  That said, those of us who have been around long enough understand that sometimes coincidences aren't as coincidental as we may think they are.  I wouldn't say we have seen cutbacks in employees on a wholesale level, but we are seeing a lot of cuts through attrition -- simply not refilling vacant/vacated positions. 

As far as what changes I would make?  I do know that we are looking at some relatively innovative ways to better manage our costs for observation level patients -- while working within the understanding that in the near future our quality metrics and overall patients satisfaction will also be key drivers in our reimbursement levels.  Can we cut costs the 300-400% for those patients and still maintain the level of care they have come to expect?  That's the multi-billion dollar question. 

[JayBird]

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.

I can't track with you on this one Ock, funny you chose mechanic because that is really all the doc is, a mechanic for humans. Like every change this is a good one, it is forcing an industry wrought with fraud and overcharging to remodel itself. There will be negative effects, there will be some whom fall through the cracks, but in the end I feel that it will be seen as an overall positive. And for any positive to come from government, that's an improvement as of late.

Of course, just my opinion. The only knowledge comes from others and basic common sense. And most in the medical field whom I associate with seem to agree, they say these changes are flushing out the "unprofessional" professionals. So I am inclined to agree with such logic.