The myth of the non profit hospital

[southernhybrid]

I've known for years that what is called a non profit hospital can be just as greedy, and poorly managed as any for profit hospital. I've always been skeptical of Emory U hospital system since it is a so called non profit and has offices and clinics scattered all over northern Georgia. Emory might be a good hospital, as I've known a few people who did receive outstanding care there, but the NYTimes did an investigation of a large chain that is a so called non profit but has reduced staff, while increasing CEO pay, resulting in problems with quality of care, overworked nurses etc. It's much worse than I had imagined.

https://www.nytimes.com/2022/12/15/...fsunPpbGflXUYNsm_yr3SjHROfeNvA&smid=share-url

At a hospital in a Chicago suburb last winter, there were so few nurses that psychiatric patients with Covid were left waiting a full day for beds, and a single aide was on hand to assist with 32 infected patients. Nurses were so distraught about the inadequate staffing that they banded together to file formal complaints every day for more than a month.
About 300 miles away, at a hospital outside Flint, Mich., similar scenes were unfolding. Chronic understaffing meant that patients languished in dried feces, while robots replaced nursing assistants who would normally sit with mentally impaired patients.
Both hospitals are owned by one of the country’s largest health systems, Ascension. It spent years reducing its staffing levels in an effort to improve profitability, even though the chain is a nonprofit organization with nearly $18 billion of cash reserves.
Since the start of the pandemic, nurses have been leaving hospitals in droves. The exodus stems from many factors, with the hospital industry blaming Covid, staff burnout and tight labor markets for acute shortages of staff.

But a New York Times investigation has found that hospitals helped lay the groundwork for the labor crisis long before the arrival of the coronavirus. Looking to bolster their bottom lines, hospitals sought to wring more work out of fewer employees. When the pandemic swamped hospitals with critically ill patients, their lean staffing went from a financial strength to a glaring weakness.
More than half of the roughly 5,000 hospitals in the United States are nonprofits. In exchange for avoiding taxes, the Internal Revenue Service requires them to offer services, such as free health care for low-income patients, that help their communities.
But The Times this year has documented how large chains of nonprofit hospitals have moved away from their charitable missions.
Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debts. Others have plowed resources into affluent suburbs while siphoning money from poorer areas.

​

There's a lot more in the linked article, which I've gifted so you all can read it and then express your thoughts. My thoughts are that our health care system in the US is primarily made up of greedy organizations that are far more interested in making money than in caring for patients. They don't care about nurses or aides or other healthcare workers, and this is causing huge numbers of healthcare workers to leave the field or try to find jobs where they can use their skills without the demanding nature that hospitals expect of them. I don't know if there is a solution. As long as greed rules the day, how do things change? I saw home health and hospice go from caring organizations that put patient care first, to profit making organizations that wold violate Medicare rules in order to make more money. But, I digress. I primarily wanted to discuss non profit hospitals and how they have taken advantage of the system.

 

[steve_bank]

Here in Washington hospitals are in trouble financially and have been fpr awwhile, as with other states. Part of it is Medicaid which often does not cover actual medical costs.


It is getting acute with the possibility of smaller hospitals closing. Services are being curtailed.

Part of it is the requiremnt to treat all comers regadless of ability to pay. ERs have become a substute for doctor office visits. Illgal immgrants can walk into an ER and get help. The homeless. Legal citizens who don't gave insurance.

Part of it is staffing. Nurses are leaving hospitals for better paying areas. They are overworked in hospitals and nursing homes and underpaid. I saw that first hand.

From reporting in Wa ERs are overwhelmed with COVID, flu, and RSV cases. Pediatric beds are reaching limits.

The free market system has created a disorganized mess in medical care.

The takeaway is today don't get sick.

 

[thebeave]

Its not just limited to hospital non-profits. There is no shortage of corrupt, unethical non-profit organizations who hide behind the cloak of non-profits being seen as "good and pure". Sad, but true.

 

[TV and credit cards]

The few times I've used civilian care, Tricare always states what the hospital charged and what Tricare actually paid. I don't know if this is standard throughout the industry. Not to justify hospital rates but what they ultimately accept is a small fraction of what the hospital wanted.

on the other hand

Nonprofit Cleveland Clinic started charging fifty dollars for emails from your doctor.

I can't believe the billing from CC for my appendectomy a year ago went off without a hitch. Private room, pretty nurse. I thought I was screwed.

I'll stick with my VA socialized healthcare. Nonprofit healthcare care scares me.

 

[steve_bank]

Yea, that is another issue.

Insurance companies negotiate rates with hospitals. Medicare rates factor into it. Hospitals have to compensate for lower Medicare rates.

Some doctors will not accept Medicare patients.

 

[Toni]

Medicaid does NOT reimburse at rates that actually cover costs. Increasingly, this is also true of Medicare. As I've written many times before, this is the ONLY reason I am not all on board with single payer medical insurance.

 

[Toni]

In other words, the problem with (some) non-profit hospitals/medical providers is not their non-profit status but that increasingly, they are behaving as for profit institutions behave. The fact that too many have strayed from their non-profit mission is the problem, not the non-profit status.

I used to work for a well known non-profit medical system and currently receive my medical care from the same system. I also have some concerns: Increasingly, under the former CEO, the system began to operate more and more like a for profit system. It acquired many small practices throughout the region--which had its benefits for patients there: easy access to a premiere medical care system. The two downsides were that not all existing staff at the newly acquired practices were willing to make the necessary changes in how they provide care (generally a big improvement in my observation) and more importantly, many rural hospitals were no longer allowed to provide common and necessary services such as labor and delivery. I live in a very rural state surrounded by other states which are also very rural. It is not a joke to have to drive over 100 miles through a blizzard to give birth--something that now happens much more frequently.

Specialty care can and probably should be better handled at larger regional hospitals/providers. But common needs must continue to be handled as near the patients as possible.

Having said that, I will say that my husband and I have both received nothing but excellent care in that system. I trust the system because I know first hand just how dedicated they are to providing the very best care possible, and the very high standards they set and achieve. It means that I drive longer than I'd prefer for care. Unfortunately, I have had nothing but terrible experiences with the local medical providers, as much as I really, really, really wish that were not true. I should be able to expect to receive good care in my home town, which supports an independent hospital and practice and a subsidiary of another larger medical practice. But, unfortunately, I really don't trust them as I should be able to do.

 

[steve_bank]

I have a Medicare Advantage program through United Health Care. You have prbly seen all the TV ads as it is enrollment time.

My Medicare premium is about $160 a month. As it was explained to me Medcare hands over the premium along with a one time fee for a sign up per person to for profit insurance companies.

I have a $0 monthly ptepium above my Medicare premium.

They are required to provide as a minimum the Medicare benefits. They add on to that.

It works well. It looks like any other insurance. One benefit is if you have trouble with it you can call Medicare and they will ensure you get benefits owed. The basic Medicare benefits are clearly defined along with max out of pocket expenses.

My primary doctor visits are $0 copay ohters $45.

If I go back to the hospital or nursing home for an extend stay max out of pocket will not bankrupt me. There are supplwental Medicare based programs at a cost that have zero out of pocket expenses.

I think it is a good model for a national program. A single payer system to the government that in turn sends it to private for profit companies with minimum requirements.

Minum benefits are established and there is free maret completion. A workable compromise.

 

[ZiprHead]

They are required to provide as a minimum the Medicare benefits. They add on to that.

It works well. It looks like any other insurance. One benefit is if you have trouble with it you can call Medicare and they will ensure you get benefits owed. The basic Medicare benefits are clearly defined along with max out of pocket expenses.

You fell for that sales pitch?

There are literally dozens of web sites with horror stories of MA patients being denied care by their insurers.

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds (Published 2022)

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

www.nytimes.com

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.

The new report, from the inspector general’s office of the Health and Human Services Department, looked into whether some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare.

Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of “widespread and persistent problems related to inappropriate denials of services and payment,” the investigators found.

The report echoes similar findings by the office in 2018 showing that private plans were reversing about three-quarters of their denials on appeal. Hospitals and doctors have long complained about the insurance company tactics, and Congress is considering legislation aimed at addressing some of these concerns.

 

[Elixir]

I have Medicare and secondary insurance. There’s a few hundred deductible per year (varies based on 2 year trailing income) and a monthly 90- something dollar premium for the secondary. After the royal reaming I got for decades with private coverage, this is a negligible expense.

 

[ZiprHead]

I have Medicare and secondary insurance. There’s a few hundred deductible per year (varies based on 2 year trailing income) and a monthly 90- something dollar premium for the secondary. After the royal reaming I got for decades with private coverage, this is a negligible expense.

This is a much better way to go than an Advantage plan.

 

[Elixir]

I have Medicare and secondary insurance. There’s a few hundred deductible per year (varies based on 2 year trailing income) and a monthly 90- something dollar premium for the secondary. After the royal reaming I got for decades with private coverage, this is a negligible expense.

This is a much better way to go than an Advantage plan.

I agree, having looked into it. Especially given the drug cost limits, there's no question. At the pool where I swim they tell me to get "silver sneakers" which gets members free access. But you need MA to get SS. And local unlimited passes are under $300/yr, so that doesn't mean much. I had a 10K deductible with crapola for actual coverage and almost 1k/mo premium before. So I basically got zero medical care for decades. Since medicare, I've gotten a lot of neglected stuff taken care of, like pre-cancerous skin lesions, biopsies on colon polyps, and a laparoscopic inguinal hernia repair - which alone would have run over 30k and only about half would have been covered. The good news is that I'm in good health, and even getting in good shape. I took 3 days off swimming a couple weeks ago, came back and swam a strong mile plus, then did some PT "aquacize", and didn't feel a thing afterwards. (When swimming every day, I'm usually a little wrung out after more than a mile.) All of the biopsies turned out to be benign, my skin is much better -

I LOVE MEDICARE!

 

[steve_bank]

They are required to provide as a minimum the Medicare benefits. They add on to that.

It works well. It looks like any other insurance. One benefit is if you have trouble with it you can call Medicare and they will ensure you get benefits owed. The basic Medicare benefits are clearly defined along with max out of pocket expenses.

You fell for that sales pitch?

There are literally dozens of web sites with horror stories of MA patients being denied care by their insurers.

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds (Published 2022)

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

www.nytimes.com

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.

The new report, from the inspector general’s office of the Health and Human Services Department, looked into whether some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare.

Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of “widespread and persistent problems related to inappropriate denials of services and payment,” the investigators found.

The report echoes similar findings by the office in 2018 showing that private plans were reversing about three-quarters of their denials on appeal. Hospitals and doctors have long complained about the insurance company tactics, and Congress is considering legislation aimed at addressing some of these concerns.

I'd have to invetuigate the partculars. That kind of stuff generally comes from conservatives. It is common to hear conservtves say Medicare patients get poorre quality care than others, but that is not true.

From my experience my Medicare Advantage is treated like any other insurance. All major hospitals around here take it.

There are doctors who will not accept Medicaid patients because they can't afford it. Humana and United have been around for a very long time and have good reputations.

Over a 5 year period I had one minor issue with United. I called Medicare, they called United, and the next day it was resolved.

There are a number of companies getting into te market and ther are problems I have heard about with them. No different than my expeince with private insurance.

Dealing with private HMOs cam be like pulling teeth. There are private companies who are known to intentional deny covered treatments making people jump trough hoops hoping they give up.

The major Advantage providers have good customer service.

United has private doctors in their system.

This goes back a ways. I stepped on a nail and did not do a good job of cleaning. I ended up with a flsh eating bacterial infection in my foot that speard aroud my body. I ended up at a docors office who had experience with it. He took an xray and said I had to go to the hospital immediately. Then he asked if I had an HMO. He said if I had an HMO he would get me admitted to the hospital but would not take me on as a patient. I had regular insurance through work.

Good thing for me. he had experience with my condition. He saved my foot, my leg, and possibly my life.

There have been plenty of horror stores on private insurance especially HMOs.

 

[T.G.G. Moogly]

I've had an Advantage plan that costs next to nothing. The customer service is excellent as is the care when I need it. No complaints. But I'm healthy and don't use any meds so maybe I'm just lucky. During Covid I had to get tested and got charged $50.00 for the test, came out of my credit card. I complained, the insurer called the provider and I received a check in the mail.

A friend has medicare and a supplemental plan because he has some major health issues. Get what works for you. I wish I had some secondary coverage from a former employer like other people I know but wasn't that lucky. Such is life.

So I agree with steve_bank, an Advantage plan works very well for me.

 

[southernhybrid]

Since we are speaking of Advantage Plans, I confess that I have one too. The only reason we have chosen that option is because if we had standard M'care, a supplement and a drug plan, it would cost the two of us about 7 to 800 per month, which would be more than we could comfortably afford. So far, we've had no problems with our AP and it does give us generous dental coverage, vision and hearing and a few other things.

I did learn something about these plans this week that was new to me. My plan is a PPO with Cigna, and at least until I told them off, they constantly sent me surveys asking for detailed information about my health, as well as pushing a home health nurse visit on me for an assessment. WTF. I never fill out the surveys and refused the home visit. I just found out why these plans do this.

The APs want to justify adding more diagnosis so they can get additional money from M'care. The way the government subsidizes these plans is partly due to how sick or dependent their clients are. The worse off they are or appear to be, the more money the AP receives. That doesn't mean that the Ads approve all of the needs of these clients, it just means they've found sneaky ways of bringing in more revenue. The home health nurse visit is part of the plan to justify more problems that may or may not exist. There was an article in one of the papers I read. If I find it, I may add it to this thread. They have scammed the government billions by doing this.

Let me add, that here in Georgia, M'caid hasn't been the problem when it comes to shutting down smaller, mostly rural hospitals. The problem is fact Georgia is one of about 12 states that hasn't expanded M'caid. These small hospitals serve too many people who lack any type of insurance and can't afford to pay out of pocket. If M'caid was expanded, the hospitals would likely be okay. Hospital care in small rural hospitals in the South tends to be much cheaper compared to urban areas, especially those in Northern states. Thanks to the Republicans who control the state, we don't have M'caid for that large number of people, including a friend of mine, who lack insurance.

I can't say that I love M'care, as. traditional M'care with all the extra parts is a bit expensive for a lot of middle class recipients. That is why the Advantage Plans have become so popular. Next year more than half of M'care recipients will be on APs. And, I will add that one of my former patients almost left his AP, but he received such excellent care from Kaiser, when he was treated for cancer, which provided his plan, that he decided to stay with it. APs aren't all bad, but again, these plans will do what they can to squeeze every buck they can from the government. They are already heavily subsidized. Of course, this is the problem when it comes to healthcare in the US. It becomes more bout making money than caring for patients.

 

[steve_bank]

I intentionally did not give the insurance company an email address. I do get voice mails. They kept trying to get me to use their home visit doctor service. I called them and asked to stop the calls and they did.

I get paper mail prooting their mail pharmacy. After all, it is for profit.

Yea the drug program is important. All my meds are tier 1, so I have no co-pays.

As I understand it if you have the Kaiser plan you can only go to Kaiser.

 

[ZiprHead]

I remember working in the finance department at the hospital system. Not only did the bigwigs get huge salaries, they got amazing benefits. The hospital actually paid to have their personal taxes done, over a thousand bucks for each of them.

They could have had their weekly meetings in any one of the very nice conference rooms off of the cafeterias. No, they had them at the local very swanky and expensive social club where their memberships and meal fees were paid for by the hospital. They also had hospital paid memberships to the country club. Lord knows what else they got that I wasn't privy to.

 

[steve_bank]

It all depends on what you think responsibility is worth. Lee Iaccoca made an obscene amount of money, but he turned Chrysler around. In the end the union owed him.

What struck me at the UW medical center was how smooth everything ran. The person or persons at the top of such an organization carry the load 24/7 while everybody else can clock out and forget about work.

 

[Loren Pechtel]

Here in Washington hospitals are in trouble financially and have been fpr awwhile, as with other states. Part of it is Medicaid which often does not cover actual medical costs.

It's the same problem everywhere. Everybody is about squeezing the price they pay down to as close to the marginal cost as possible. It's in their interest to take the patient so long as they make any profit--but that doesn't cover their base expenses. Then the government comes along and decrees they must take patients at below their marginal cost and even worse is all the cases where they don't get paid at all.

To be profitable a hospital must either not have an ER at all, or have an ER that pulls from an area where most people have insurance.

What we are seeing is the inevitable result of driving prices as low as possible.

 

[Loren Pechtel]

Medicaid does NOT reimburse at rates that actually cover costs. Increasingly, this is also true of Medicare. As I've written many times before, this is the ONLY reason I am not all on board with single payer medical insurance.

What the VA has done should also be a reason against single payer.

We have three single-payer systems in this country, all are bad to horrible. Fix them first, show us you can actually do it before you expect us to trust our health to it!