For-Profit Healthcare

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kbot
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For-Profit Healthcare

Post by kbot » 10-29-2010 11:46 AM

Well, the Massachusetts Supreme Court has just approved the sale of Caritas Healthcare to Cerberus, essentialy turning the second-largest non-profit health system in New England into a for-profit entity. This will be interesting as time passes since new Medicare reimbursements call for further cuts, which would make the very concept of accepting Medicare unacceptable.

http://http://www.boston.com/news/local ... hospitals/

And, apparently these deals are restricted to Massachusetts. In this WSJ article, Detroit is also feeling the impact of impending for-profit healthcare.


http://http://www.boston.com/news/local ... hospitals/ snippet:
The Boston decision comes as hospital mergers and acquisitions have heated up nationwide, driven by for-profit companies and private equity flush with cash in a market with few investment opportunities.

Deals are unfolding in Detroit and smaller cities where many of the nation's 3,000 nonprofit hospitals—of the 5,000 hospitals total—are in debt, unable to borrow, and anxious to reinvest in their buildings and technology

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Post by Bobbi Snow » 10-29-2010 04:50 PM

Greed... greed... greed. This is what Wellpoint did with Blue Cross, and I can tell you - that didn't work out well for our retirement income.
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Post by Psychicwolf » 10-29-2010 08:38 PM

I'm so sorry, kbot.:(
Erasures of moral hazards and unintended consequences hurtling towards each other for a head on collision. People's LIVES are at stake, damn it!:mad:
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Post by kbot » 10-30-2010 06:35 PM

Thanks. At this point, none of know for sure what will happen. The state put a number of conditions on the sale - no staff layoffs for three years, no facility closures unless losses can be documented (whihc wouldn't really be all that difficult) as well as a few otehrs dealing with state oversight. After three years, how knows. The hospital that I work at has been on a building binge ever since hearing that we were going to be bought out and that an immediate infusion of cask for building projects would be forthcoming. So, in a way, it's good news. But, as in many parts of the country, referrals to hospitals are down because so many people are out of work and don't have insurance, or, those who are working are afraid to overtax their health benefits because it may make them look bad (and expendable) to their employers. Currently, I am in a six-hospital group, soon to be come seve, and I heard a rumor of anotgher hospital fifteen miles north of here that is looking to join a group - maybe our's, since they are currently unaffiliated, and this puts them at a disadvantage when it comes to ordering supplies and bidding on contracts, etc.

As I've been telling my coworkers "It's a brave new world......."

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Post by Bobbi Snow » 10-30-2010 10:26 PM

What we have seen in CA is... FOR PROFIT institutions require payments up-front for anesthesia tests such as colonoscopies, esophagus scoping, out-patient surgeries (i.e., setting of arms & legs, damaged teeth from auto accidents, etc.). They will still do the procedures if you can't pay for anesthesia, BUT - without anesthesia. And this is just the start... Next there will be other "cut-backs" for which insured patients think they have coverage, but their insurance companies won't cover them UNLESS they're hospitalized for 24 hours in a REGULAR hospital.

And so it goes...
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Post by kbot » 11-01-2010 05:53 AM

Bobbi Snow wrote: What we have seen in CA is... FOR PROFIT institutions require payments up-front for anesthesia tests such as colonoscopies, esophagus scoping, out-patient surgeries (i.e., setting of arms & legs, damaged teeth from auto accidents, etc.). They will still do the procedures if you can't pay for anesthesia, BUT - without anesthesia. And this is just the start... Next there will be other "cut-backs" for which insured patients think they have coverage, but their insurance companies won't cover them UNLESS they're hospitalized for 24 hours in a REGULAR hospital.

And so it goes...


Nice......... I don't know the exact costs for anesthesia, but I know that it's up there.

Well, I guess we can always revert to handing out bullets and knife blades for people to clamp down on, and I think that we still have some four point restraints lying around here somewhere....

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Post by Bobbi Snow » 11-01-2010 04:59 PM

kbot, at an off-site surgical center, anesthesia for a colonoscopy or an esophageal scope runs between $375 and $700, depending upon which center your doctor uses. Then there are the separate bills for the anesthesiologist, the ass't anesthesiologist, the Propvol (or whatever else they use) to put you under, and the ass't doctors who check you before your physician comes in, and the ones who monitor you in the recovery room. I have a PPO with Blue Cross, and the insurer covered only 30% of the assistants' charges, because it wasn't in a hospital. BUT. Blue Cross won't COVER me checking into the hospital for 24 hours for these tests, because overnight hospital stays are NOT REQUIRED... They get me coming and going...

Even when I had my gall bladder removed IN the hospital, Blue Cross wouldn't sanction an overnight stay unless I had "severe complications" as a direct result of surgery. So I was in and out in 4.5 hours, and sent home.
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Post by kbot » 11-02-2010 02:48 PM

Bobbi Snow wrote: kbot, at an off-site surgical center, anesthesia for a colonoscopy or an esophageal scope runs between 5 and 0, depending upon which center your doctor uses. Then there are the separate bills for the anesthesiologist, the ass't anesthesiologist, the Propvol (or whatever else they use) to put you under, and the ass't doctors who check you before your physician comes in, and the ones who monitor you in the recovery room. I have a PPO with Blue Cross, and the insurer covered only 30% of the assistants' charges, because it wasn't in a hospital. BUT. Blue Cross won't COVER me checking into the hospital for 24 hours for these tests, because overnight hospital stays are NOT REQUIRED... They get me coming and going...

Even when I had my gall bladder removed IN the hospital, Blue Cross wouldn't sanction an overnight stay unless I had "severe complications" as a direct result of surgery. So I was in and out in 4.5 hours, and sent home.


That's insane. We perform a number of LCCs (laparoscopic cholecystectomies - gall bladder removals) each week, and we always keep people at least overnight on what is caled a 23-hour observation status. If you're in-house under 24hours, you're technically still an outpatient and not admitted to the hospital. You're status is an outpatient on observation status. Guess that this will be shades of things to come here........

I went to Boston today to have my annual stress test. Didn't know what was worse - fighting the notoriously world-class crazy Boston drivers, taking two hours to travel what take no more than an hour - trying not to get killed along the way (btw, if any of you ever come to Boston, here's a litle hint - they travel in the breakdown lanes. No foolin'!!!! It's "legal" to travel on the highway in the breakdown lanes around Boston during certain times) the stress test itself, the doctor patting my belly while saying "You really could stand to lose some more weight there Kev", or the "tech" digging around inside my arm with a needle, after once already, digging around inside my arm with a needle, collapsing veins along the way.........the whole time with my wife sitting there watching the whole thing unfold, pushing for another cardiac cath (which I don't need, thankfully.........). The upside is that, if I ever do need one the doc said he would play some Hendrix for me, while the meds kick-in (unless of course, they do away with meds under the new health rules....):rolleyes:

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Post by Psychicwolf » 11-02-2010 03:16 PM

Your post, kbot, reminded me of my friend Kathy, who is just a few months younger than I am. She is a geriatric nurse and when we're commiserating with each other over this or that foible or physical problem attributable to the aging process...she always says, "Golden years, my azz!:D
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Post by kbot » 11-02-2010 03:37 PM

Psychicwolf wrote: Your post, kbot, reminded me of my friend Kathy, who is just a few months younger than I am. She is a geriatric nurse and when we're commiserating with each other over this or that foible or physical problem attributable to the aging process...she always says, "Golden years, my azz!:D


As I'm getting older I have come to realize and appreciate the absurdity of phrases such as "the golden years.....". Unless you're fabulously wealthy, or blessed with great genes and good health, chances are your older years will be a little more problematic rather than the ideal.

Meanwhile, my boss (I love this woman!!!!) sent me this. And, having had a colonoscopy a few years ago, I could relate....... ;). Bear in mind, while prepping for my exam, my wife and son were at our nephew's wedding reception having one heck of a good time..........

Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.

Colonoscopy Journal:
I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.
A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis .

Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.

I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, 'HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!'

I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America 's enemies.

I spent the next several days productively sitting around being nervous.

Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.

Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-literplastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes - and here I am being kind - like a mixture of goat spit and urinal cleanser, with just a hint of lemon..

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, 'a loose, watery bowel movement may result.'

This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but, have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

After an action-packed evening, I finally got to sleep.

The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?' How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked..

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep.

At first I was ticked off that I hadn't thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house..

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point.

Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand.

There was music playing in the room, and I realized that the song was 'Dancing Queen' by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, 'Dancing Queen' had to be the least appropriate.
'You want me to turn it up?' said Andy, from somewhere behind me.

'Ha ha,' I said. And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.
I have no idea. Really. I slept through it. One moment, ABBA was yelling 'Dancing Queen, feel the beat of the tambourine,' and the next moment, I was back in the other room, waking up in a very mellow mood.
Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that It was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.

On the subject of Colonoscopies...

Colonoscopies are no joke, but these comments during the exam were quite humorous!!!!! A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:
1. 'Take it easy, Doc. You're boldly going where no man has gone before!'
2. 'Find Amelia Earhart yet?'
3. 'Can you hear me NOW?'
4. 'Are we there yet? Are we there yet? Are we there yet?'
5. 'You know, in Arkansas , we're now legally married.'
6. 'Any sign of the trapped miners, Chief?'
7. 'You put your left hand in, you take your left hand out...'
8. 'Hey! Now I know how a Muppet feels!'
9. 'If your hand doesn't fit, you must quit!'
10. 'Hey Doc, let me know if you find my dignity.'
11. 'You used to be an executive at Enron, didn't you?'
12. 'God, now I know why I am not gay.'
And the best one of all:

13. 'Could you write a note for my wife saying that my head is not up there?'


Having worked in the OR and Endoscopy are for over twenty years now, I can honestly tell you, the things people say really are hilarious. I can also say that, having been on the receiving end (so to speak) I'm glad that this is one procedure I don't have to have very often.........

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Post by Psychicwolf » 11-02-2010 03:52 PM

Bwahahahaha!:D :cool:
I love Dave Barry. I had not seen this one.:D
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Post by kbot » 11-03-2010 05:52 AM

Psychicwolf wrote: Bwahahahaha!:D :cool:
I love Dave Barry. I had not seen this one.:D


It sums-up the experience nicely.......

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