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In my position on the front lines of health care (Paramedic), I'm seeing changes in the Hospitals, 911, and other medical providers that are going on.  Some are directly due to the ACA, others might be, and some are just changes.

The teaser title is about two systems and how they are responding to the ACA changes.  One system has four hospitals in the county and is part of a nation wide system.  They announced layoffs last week as a way to get ahead of an expected $218 million dollar loss next year due to cuts in Medicaid/Medicare payments. (yes, the Medi's are suppose to cut what they pay and go to a system of rating the care provided for further cuts or bonus payments)

The system also is currently losing about $75 million a year for non-payment of existing bills (among other things - liability, new equipment, training, etc)

The other system has five hospitals in the county and a few more over two states.  They also expect to see a cut in what the Medi's payout, but are working to qualify for the bonus payments, are helping enroll every person who shows up and says "I don't have insurance".  They set a goal of reducing the non-payment of bills from the current 40% to under 20% by 2015.  From what they have said, this will let them break even in 2015, an improvement from the losses they currently have.

So, there you have one persons view from the street: ACA is Saving/Killing our Hospitals. (really just how you react to it.)

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Comment Preferences

  •  Tip Jar (11+ / 0-)

    Stupid question hour starts now and ends in five minutes.

    by DrillSgtK on Mon Feb 24, 2014 at 06:25:58 PM PST

  •  Has your State approved Medicaid expansion? (1+ / 0-)
    Recommended by:
    worldlotus

    "Because I am a river to my people."

    by lordcopper on Mon Feb 24, 2014 at 06:39:13 PM PST

    •  Yes. (4+ / 0-)

      They approved it and gave us warning that we could expect a 10 to 15% increase in 911 calls.  This is based of the experience of the last expansion they did in the early 2000's.

      I see from the current report numbers, they were not wrong.  I know i've had more people tell me they have WellCare and Passport (Medicaid) than I use to.  Still get a lot of "I can't afford insurance" though.

      Stupid question hour starts now and ends in five minutes.

      by DrillSgtK on Mon Feb 24, 2014 at 06:53:19 PM PST

      [ Parent ]

      •  Are the increased 911 calls related to the (0+ / 0-)

        Medicaid expansion?

        "Because I am a river to my people."

        by lordcopper on Mon Feb 24, 2014 at 07:03:01 PM PST

        [ Parent ]

        •  The State said it would be. (3+ / 0-)
          Recommended by:
          lordcopper, Delevie, JamieG from Md

          We have seen a 15%+ increase in 911 calls starting on 1 Jan.  I have seen a decrees in non-insured personally but also more medicaid insured. (I work the low income area of at the city mostly)

          Is this 100% across the state? I have no idea, just what one guy is seeing in one district in one city.  

          When Medicaid expanded to include childless adults, a similar increase.  This is on top of the average growth in 911 calls, about 3% a year nation wide.

          Keep in mind, 80% of all 911 calls are for non-emergency medial care.  Some studies have shown that 40% of people who called knew it was not an emergency and that an urgent care center or making a doctors appointment would be more appropriate.  But they called 911 because it is more convenient.

          We did just over 100,000 calls in 2013.  If we stay at our current daily rate, we are looking at 120,000 for this year.  And December to March is our "slow" time.  (I picked 132,500 on the call pool)

          Stupid question hour starts now and ends in five minutes.

          by DrillSgtK on Mon Feb 24, 2014 at 09:09:16 PM PST

          [ Parent ]

          •  One would think expansion of Medicaid would (1+ / 0-)
            Recommended by:
            kurt

            bring reductions in 911 calls and emergency care as preventive care is rolled out.

            "Because I am a river to my people."

            by lordcopper on Mon Feb 24, 2014 at 09:29:21 PM PST

            [ Parent ]

            •  You would think that. (1+ / 0-)
              Recommended by:
              Sherri in TX

              The information we were given in training was that having insurance increases the likelihood a person will call 911 or go to the Emergency Department.  They also will be more likely to go to the doctor on top of that.

              Medicaid has no co-pay, so going to the urgent care or ED cost the same. Going by Ambulance cost the same as getting a friend to drive you and is cheeper than a cab. (to the patient.)

              Emergency Departments are more convenient to access also - open 24/7, no appointment needed, and transport can be called.  You feel bad, you call 911, they take you and you get seen.  The ED tries to get you in and out as fast as they can.  The average wait to be seen in the US is 40 minutes.  (I waited that long past my appointed time at the doctors last visit.)

              We are not as bad off as places like Canada, Australia, or the UK (who now have a goal to get the average wait to under 3 hours).  

              Stupid question hour starts now and ends in five minutes.

              by DrillSgtK on Tue Feb 25, 2014 at 03:55:30 AM PST

              [ Parent ]

              •  I think you fix that by not treating non-emergency (0+ / 0-)

                calls, but referring them to their primary care physician.  BTW,

                Medicaid has no co-pay, so going to the urgent care or ED cost the same. Going by Ambulance cost the same as getting a friend to drive you and is cheeper than a cab. (to the patient.)
                "Cost", particularly in a medical setting is a tricky thing.  The way the system should work is that people should seek preventive care, which can be delivered through a "lower cost channel", and reduce the need to use the "high cost channel" emergency room. I think rational people can be taught the benefits of preventive care over time, and would actually prefer the outcomes.

                "Because I am a river to my people."

                by lordcopper on Tue Feb 25, 2014 at 05:56:55 AM PST

                [ Parent ]

                •  You do, but the law won't allow it (1+ / 0-)
                  Recommended by:
                  lordcopper

                  By state law, 911 transport can only go to an Emergency Department.

                  Many and by many we are talking 80% or more, could go some place else but we can't take them there. We also can not refuse to treat a non violent person.  So the person who called 911 because a house cat scratched them (really) we had to transport them to the ED.

                  Stupid question hour starts now and ends in five minutes.

                  by DrillSgtK on Wed Feb 26, 2014 at 03:07:59 PM PST

                  [ Parent ]

              •  Not as bad as Canada?? (0+ / 0-)

                Gimme a break!

                Face it, you guys haven't figured out how to do this stuff efficiently yet -- though I must make allowances for your ongoing 'Knife and Gun Club' meetings.

                Can't run a medical system, can't run Olympic hockey teams, can't run Olympic speed skating teams. Sad.

                /snark, in part.

                ObamaCare! Sign-up by phone: 1-800-318-2596

                by mwm341 on Tue Feb 25, 2014 at 06:30:26 AM PST

                [ Parent ]

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