Kentucky Hospitals Say They Will Lose $1 Billion Due to State’s Obamacare Exchange

a reply to: Krazysh0t

I would...I just can't seem to prove its existence just yet

a reply to: SlapMonkey

Zing! Got me! Well played

AWWWWWWWWW

The greedy for profit hospitals are losing their profit margin

originally posted by: acackohfcc
AWWWWWWWWW

The greedy for profit hospitals are losing their profit margin

Seems somebody else is missing the big picture of it all...

(pssst...your ideological bias is showing.)

a reply to: NavyDoc

no, the fraud claims are accurate. i've seen it myself when my wife was a young medical assistant working for a Pakistani doctor that ended up wrapped up in 9/11 hysteria. His favorite skim procedure was the whole allergy testing farce.

there are other practices/doctors that i have seen. and this is a small town. i can only imagine the nonsense done in bigger towns with more procedural access.

doctors are smart people. don't underestimate how effective such a person could be at fraud within their profession.

a reply to: bigfatfurrytexan

I have to agree.

My first chiropractor insisted I get X-rays at least once a year to satisfy BCBS.
So I went along.
Turns out he was FOS....I left his practice and went to two other chiros since then....both shy away from X-rays as much as possible and have told me there is no such need by BCBS to have those pictures.

originally posted by: bigfatfurrytexan
a reply to: NavyDoc

no, the fraud claims are accurate. i've seen it myself when my wife was a young medical assistant working for a Pakistani doctor that ended up wrapped up in 9/11 hysteria. His favorite skim procedure was the whole allergy testing farce.

there are other practices/doctors that i have seen. and this is a small town. i can only imagine the nonsense done in bigger towns with more procedural access.

doctors are smart people. don't underestimate how effective such a person could be at fraud within their profession.

Doctors also know the microscope over them and the vast majority sincerely try to do the right thing. Don't confuse regulatory nitpicking with deliberate fraud.

a reply to: NavyDoc

They do what they can get away with. Its pork, afterall. Just falling from the sky

originally posted by: reldra
a reply to: SlapMonkey I am wondering if it is because hispitals must charge reasonable prices for things now. Like they can't charge $74 for a tiny plastic cup and 2 aspiran. Medicaid would already pay out on a set rate schedule..now all insurances do. Maybe the hospitals have to get better materials vendors and cut costs to operate. Not necessarlly lay off staff, but buy suplies at a reasonable rate rather from, say, a board member's brothers company that is turning massive profits.

I agree....Kentucky hospitals got caught with the hand in the cookie jar...charging enormous fees before someone(ACA) came in and did some auditing and refused to pay the racketeering costs that the hospitals charged before. there is more to this story, and it is going to smell like a big turd.
of course......blame the ACA.....and blame Obama......everybody else is pure as the driven snow.

originally posted by: SlapMonkey
I'm happy for you doing high-end hospital construction, and I really wish you the best in your business endeavors, but I think that this conversation has run its course, unless, like I asked prior, you can provide evidence of your conjecture about the KY hospitals and your claimed "real" reasons that they're in financial trouble. I'd be happy to read something like that if you care to provide it.

AGAIN, I SAID HEALTHCARE MASTER PLANNING, that entails more than just a simpletons view of "construction work", MUCH MORE.

Being an Architect, engineer or contractor for hospital design is HIGHLY SPECIALIZED and is not simply a "hammer and nail" deal. It requires full understanding of the operations of the hospital, INCLUDING the financials, because the cost of mistakes are too high ($200-$440 per square foot) AND the master plans used are long term, so it ALWAYS cost less to do the construction in the PRESENT, rather than in the future. Well run health systems anticipate these operation cost increases YEARS in advance and to do so requires the help of equipment planners, architects, engineers AND CONTRACTORS. Sometimes that team is just one firm (as it is, in my case) whom provides all the services under one roof. What I am talking about here is ABSOLUTELY relevant to the discussion, whether you understand why or not.

originally posted by: NavyDoc
But how does that make you an expert on the myriad tangle that is billing, reimbursement, RAC, record keeping mandates, EMTLA, etc?

You build stuff. We get it--but that really has nothing to do with the day to day running of a hospital. You get to see some of the budget that pertains to your project, but that is just a slice of the pie.

Glad you asked, we did this for about a dozen hospitals, RIGHT AT THE START OF ACA, which included master planning, design and construction (only the construction portion resembles what laymen like yourself would consider installation). Since this takes many years to complete, these projects are still going on.

For example ACA record keeping mandates requires a new system be installed, that is tied into existing IT and low voltage systems, some health systems are calling this system EPIC (this includes RAC reporting processes). The equipment planners work with the engineers and the contractors to meet the requirements outlined by the master planning architect, whom has access to ALL of the hospitals projected financial income and demographic data (they work directly with the doctor nurses and administrators to model the needs of their departments). I'd argue that the master planning architect and equipment planners know more about these systems than the people that will eventually use and administrate them.

As for EMTLA, well, I addressed that very briefly when I said in my earlier post, that these Kentucky hospitals "chose to not move a majority of outpatient services to less expensive locations". That means the cost to treat a patient goes down when they move as many services, as possible, off-site away from the acute care hospital and simultaneously reduce the number of beds that the hospital has within it, bringing down overhead. By doing this, they stand a better chance of being able to adsorb the costs assorted with unreimbursed services because the long term cost to operate the outpatient center is significantly less than a full blown hospital. MANY states help these hospital get VERY low interest loans to do the needed studies, upgrades and building construction because the the last thing the state wants is to not have too few operating acute care hospitals. That doesn't mean they need to be good or award wining hospitals, just functioning acute care hospitals.

At this stage of the discussion, I have to assume that both of you missed the part where I said I work in the "Health Care Master Planning" sector? Do either of you know what that process entails? The design team is planning the usage of the hospital 5-7 years out, that means they get to see the hospital financials, demographics and upcoming required build outs due to code changes because they are projecting the needs of the hospital and the community it serves, 5-7 years out. That team includes equipment planners, architects, engineers AND CONTRACTORS!

So yes, that means I get to actually see the hospitals REAL usage numbers for reimbursements, insured patients, staff overhead etc, at a high level. I also get to hear the perceived "needs" and "wants" of the hospitals executive staff and you'd be surprised how little some of them know about the codes and changes in laws that will affect them. The best healthcare systems have leaders that listen to the consultants and use that information given to PLAN AHEAD, the worst ignore it and then get bought out by the properly managed healthcare system, when their unsustainable business model fails.

Here is are some overviews of how that process works in the REAL WORLD:
1) Principles of Hospital Planning
2) Understanding the Hospital Planning, Design, and Construction Process
3) Strategic Planning Processes and Hospital Financial Performance

The fact that some of you are dismissing this "peek behind the curtain" reeks of ignorance and obtuseness. Its in your best interests to take the time to understand what I have said so far and hopefully, IN TIME, you will see that ACA has had a very minor role in the demise of these hospitals. The real negative affect and burden that ACA has caused is mostly for private employers and small businesses offering group insurance plans to their employees. The reality is that hospitals make their money either way, assuming they know how to react to the ACTUAL market conditions and not what they WISH those conditions were.

In fact, I challenge ALL of you naysayers here to call up an architect that does healthcare planning in your state and ask them for an INFORMAL INTERVIEW, buy them lunch and then ask how all this stuff ACTUALLY WORKS. Your mind will be blown once you find out how off track your beliefs have been.

Here are some more items to think about, Kentucky has a population of roughly 4,500,000, ranked 26th by state population figures, BUT this state took $154,638,217 in Federal Medicaid Disproportionate Share Hospital (DSH) Allotments for 2014: FY 2014 In contrast, Oklahoma, took $38,619,866 in DSH Allotments for 2014, with a slightly smaller population of 3,878,051, ranked 28th by state population figures.

Also, if you had bothered to read and think about the information presented in the white paper, that I posted, you'd see that Medicaid Payments to Kentucky hospitals increased from $5,249,989,000 in 2010, to $6,172,806,000 in 2014. With that in mind it should be VERY clear that Kentucky Hospital administrators and Boards based their revenue projections on DSH allotments and are now paying the price.