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Thread: The Hard Decade Ahead for Hospitals

  1. #1
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    The Hard Decade Ahead for Hospitals

    Trigger Alert: This post could be depressing.

    Morgan Stanley recently commented that 18% of American hospitals are at risk of closure.

    Moody's recently predicted that 8% (about 480) of the 6,000 hospitals they reviewed are "apt to close". I understand that Moody's would only be reviewing those hospitals that pay Moody's the fee to form an opinion of their credit-worthiness.

    Any time I care to read about a hospital in dire straits, I will read Becker's Hospital Review on-line. It is usually a rural hospital with declining admissions, or a hospital that cannot cope with reductions in Medicare reimbursement.

    The coming 10 years will be hard on hospitals, because
    A. There currently are about 53,500,000 Americans over 65. Except for those who are incarcerated, virtually all are enrolled in some form of Medicare for their hospitalization insurance.
    B. According to the Census Bureau, over the coming 10 years, approximately 10,000 Americans will turn 65 every day, and I believe they will be eager to enroll in Medicare.
    C. Some Medicare beneficiaries certainly will die every day too. But the actuaries seem to all agree that the number of beneficiaries will go up continually, to approximately 83,000,000 by 2050.
    D. (This is the most depressing part.) Notwithstanding the promises he stated during the election campaign, President Trump's budget proposal for fiscal year 2020 is to CUT Medicare spending by $800 billion over the coming 10 years. Although some mystery surrounds the details, it seems obvious that the President is urging that Medicare reimbursements to hospitals be cut.

    As hospitals consolidate (the more solvent hospitals acquiring their weaker sisters) or escape their creditors by filing Chapter 11 bankruptcy, it seems inevitable there will be job loss, and facility closures... More Americans may have no alternative other than to travel further for hospital care. It could be good for hotels located adjacent to the campuses of the hospitals that survive, because families of patients (or their drivers) may need overnight accommodation until the patient is discharged.

    Also poised to benefit are CVS and WalMart. I believe CVS plans to scale up their walk-in/urgent care capacity. And WalMart's new "Town Center" concept includes healthcare services in WalMart parking lots.

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    Virtual doctor's visits should also increase.

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    Hopefully Trump will be stopped from making any cuts to Medicare, SS, etc.

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    Senior Member iris lilies's Avatar
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    Our little publicly funded hospital in Hermann is always front page news for their finances. The finances are not healthy. There is constant turnover of staff at all levels. Too bad, because it is a senior citizen Mecca and that hospital is a matter of blocks from my house.

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    Senior Member catherine's Avatar
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    I think the growth of IDNs (Integrated Delivery Networks) will help redefine the traditional hospital. There are so many changing dynamics in healthcare that it will be an adjustment period for sure. IDNs have more outpatient services; some healthcare systems are merging with specialty pharmacies--some of these types of new profit centers may help to support traditional inpatient care.

    But. you're right: cutting Medicare is not the answer.
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    Working on the inside and in leadership for 27y now and having been Director for a privately owned facility for 8y amidst my hospital career parts: YES! All you state is true and so much more.

    I'm VERY concerned for healthcare in our country. No facility can survive on Medicare reimbursement. Our costs are astronomical hence YOUR costs are ridiculous.

    Becker is a good barometer of our reality so good for you for going there Dado.

    Rural Nevada:
    https://www.reviewjournal.com/local/...00-miles-away/

    And then there is senseless shit like this: https://www.nytimes.com/2019/03/09/w...s-vaccine.html
    Unlikely insured. This causes outrage amongst us as we are trying hard to save $1 here and $5 there.

    Family demanding we rush 99yo Grandma to the OR to save her. She dies minutes after we get her to the ICU. Another $30k spent! Why?

    My sister and I cared for Mom at home the final 7w of life. Final bill? $2876 fully paid by Medicare. The cost of 24h in the hospital back in 2009. but no, people don't want to take care of Mom or Dad at home. So the hospital it is.

    I could go on and on and on......but I won't!

    IDN's are not nearly as helpful as you might think they are Catherine.

    Yes, the next 10y in healthcare are going to suck the life and the money out of all of us

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    I agree that cutting Medicare overall is not the answer; however, I do agree with a lifetime cap on benefits for those 65+. I know that makes me sound mean and uncaring, but the numbers aren't sustainable. I think people have to be educated on natural death and supported in that by doctors willing and able to provide pain management during end of life. I don't think that relatives or guardians can simply demand "do everything" and then leave the bill to the taxpayers.
    I'm thinking of extraordinary and expensive procedures like bone marrow transplants for 80 year olds. If you want one at that age and can afford it, then have it. Perhaps a review of how they do these things in Great Britain would be a start.

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    Gardnr, we cross-posted but are thinking along the same lines.

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    Senior Member catherine's Avatar
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    Quote Originally Posted by Gardnr View Post

    IDN's are not nearly as helpful as you might think they are Catherine.
    Do you think they have to potential to evolve into a profitable business model? It boggles my mind that we have the highest per capita medical costs in the world, but we don't have the healthiest people, and we don't have financially healthy medical institutions either?? What gives? I think it's more than more people on Medicare.
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    The profit model for hospitals is not going to be able to work for small cities and rural areas over much of our country. Hospitals are not distributed by actual need but by the ability to make a profit. Medicare is not enough.

    In our big city, we seem to be in a construction boom for hospitals. They have small urgent care stand alone clinics and now small stand alone mini hospitals. We have everything within a walk from me from the newly rebuilt VA hospital, a huge cancer hospital, Riley hospital for Kids, Eskinazl semi public hospital, and Methodist Hospital which is replacing buildings. They are all huge. This does not count Community South, East, and North, St. Francis with new buildings, Johnson County Hospital, various heart specialty Hospitals, Women's Hospital, etc.

    I dont know what the answer is. Single payer has its own unique issues and would have unintended consequences.

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